Q. I have periodontitis. Kindly advise the management without surgery.

Answered by
Dr. Tooba Qazi
and medically reviewed by iCliniq medical review team.
Published on Jan 16, 2019

Hi doctor,

About three months ago, I was diagnosed with periodontitis. I am facing swelling of gums, gum bleeding and pus from gums. I would like to know available treatment options and can it be treated without any surgery. I am 26 years old. I am taking Vitamin C tablets.

Dr. Tooba Qazi

Dentistry
#

Hi,

Welcome to icliniq.com.

There are two treatment options for periodontitis. First includes deep scaling and medications. Periodically scaling will be done of each quadrant of the jaw in two weeks and meanwhile, you should take following medications, capsule Doxycycline 100 mg one time a day for seven days (take two capsules together at first day then take one capsule from the second day). Tablet Metronidazole 400 mg, twice a day for five days, tablet Flurbiprofen 100 mg twice a day for three days. Meanwhile, keep doing saline water mouth rinses. Take a cup of water and add 1/4th teaspoon of salt in it and do its rinses five times a day at least. For one week, it is the best therapy for healing of gums.

The second treatment option is for severe cases in which gum grafting surgery is done. If the first line of treatment does not affect you then go for the second option. Please provide your clinical pictures of teeth so I may suggest what should you opt for. Stay happy and blessed.

Hi doctor,

Please find the attached dental scans. Lately, I am also seeing some pus coming out from gums. Kindly advise. I have consulted a periodontist who has prescribed laser assisted gum cleaning which is quite expensive. Please let me know if I need this. He also suggested wisdom tooth extraction.

Dr. Tooba Qazi

Dentistry
#

Hi,

Welcome back to icliniq.com.

Just examined your x-ray (attachment removed to protect patient identity). It says that your lower left side of gums and bone are severely affected. My treatment plan for you is as follows:

Wisdom tooth should be extracted first following the antibiotic regime of medicines. Then after a week get started with deep scaling of whole mouth or all teeth. Each quadrant, i.e., one right or left side of teeth a week the other side second week. It will gradually improve your oral hygiene and gums healthy. New gums grow in every 14 days. After two weeks if you start feeling better then get your treatment concluded at this standard deep scaling treatment. If gum health does not get affected then go for laser treatment of cleaning after a month.

Pus is coming due to infection of wisdom tooth and in the tooth next to wisdom. After extraction of wisdom and the antibiotic regime of five days, this pus will go away and infection will be healed.

If possible provide me with a clinical picture of your teeth, the only x-ray was attached, and some irrelevant image was attached.

Keep doing saline water mouth rinses. It is the best therapy for healing of gums. Keep me updated with your treatment regime. Take care, stay happy and blessed. Thanks.

Hi doctor,

Thanks for responding. Pus is coming from the lower canine. I attached the clinical picture as you requested.

Dr. Tooba Qazi

Dentistry
#

Hi,

Welcome back to icliniq.com.

Yes, bone loss is seen at anterior teeth as well. This will be treated with the antibiotic regime. Start taking the following after a discussion with your treating doctor.

1. Capsule Nordox (Doxycycline) 100 mg. Take two capsules together on the first day and then take one capsule daily for the next six days.2. Gramex 400 mg (Metronidazole) two times a day for five days.3. Brufen 400 mg (Ibuprofen) two times a day for three days.

It will cover your infection inside the jaws and scaling will cover cleaning of tartar at your teeth and gums.

Hi doctor,

Do I need to get my wisdom teeth removed soon? Can I wait for 6 months as I have my wedding planned in upcoming months? Will the antibiotic treatment get rid of the pus?

Dr. Tooba Qazi

Dentistry
#

Hi,

Welcome back to icliniq.com.

After removing your wisdom tooth you can enjoy your wedding to the fullest! The wound will heal up in 10 to 14 days then get easy with teeth. Keeping wisdom for long now is not a good option for you as keeping it may get infection extended to the underline bone that may be dangerous to treat.

Antibiotics will stop the pus and infection for like a month i.e temporary treatment, it will recur as the root cause of pus, the infected tooth, is still there. Get rid of the culprit tooth as soon as possible.

Try to get your canine saved through scaling procedure. But wisdom tooth is the posterior tooth so it can be extracted for good.

Hi doctor,

I was concerned because none of my wisdom teeth are shaky or giving pain. Will it lead to the weakening of adjoining premolar teeth?

Dr. Tooba Qazi

Dentistry
#

Hi,

Welcome back to icliniq.com.

If any tooth extracted from the middle of the arch may cause weakening of adjacent teeth, but wisdom tooth is the last tooth of the arch. It does not cause weakening of teeth. It is not the major molar tooth that helps in biting and moreover it is not of the cosmetic importance. So, if the wisdom tooth is such grossly infected as clearly seen in x-ray, it must be extracted out. The infection is silent right now, it can cause trouble any time and can give you severe pain at any moment. Rest of the teeth and arch will not be affected.

Hi doctor,

Thanks a lot for your detailed suggestions. I have donated blood a week ago. Should this be a problem for tooth extraction surgery as it incurs blood loss? I am apprehensive whether RBCs have fully recovered in my body post blood donation.

Dr. Tooba Qazi

Dentistry
#

Hi,

Welcome back to icliniq.com.

For safe side, I would suggest you wait for wisdom tooth extraction for three weeks. Meanwhile keep taking any multivitamin tablets.

Around 2 million RBCs (red blood cells) are made in your body every second, and only 1 pint of blood is used in donation out of 8 pints of your body. Usually, a male donor is ready to donate his next 1 pint after around 12 weeks, and a female donor is prepared for the next donation in 16 weeks.

Your wisdom surgery would be a minor extraction, with a minimal amount of bleeding that will stop in a day hopefully. So to keep you safe it is okay to give your body a month to recover from any weaknesses and rest multivitamins will cover. All will be smooth then.

Start with your scaling treatment meanwhile during these three weeks. Start with antibiotics as well, one course of antibiotic of five to seven days cover infections for a month. So you will not need any medicines at the end for wisdom surgery except painkillers ideally.

Stay blessed dear. I am here for your guidance anytime. Take care.

Hi doctor,

I have my dental scans from a year ago. Can you have a look and maybe enlighten me about the progression of my condition?

Dr. Tooba Qazi

Dentistry
#

Hi,

Welcome back to icliniq.com.

Results are not good in comparison. Your case got severe, and bone loss has increased in one year. You have generalized horizontal alveolar bone loss. This may improve with the first line of treatment, i.e., deep scaling and root planning that I have suggested you. It stops further degeneration of bone around the tooth. Then, make a comparison in 6 months. If the tooth gets better or the bone loss stays at the same position where we tried to arrest it, then that is good. But if symptoms of further bone loss are seen after 6 months or in next few months then gum and bone grafting is done by periodontal surgeon. This is the last line of treatment. It will prevent all your teeth from mobility and falling off. Good luck for treatment.

Hi doctor,

Thanks for your priceless opinion.

Dr. Tooba Qazi

Dentistry
#

Hi,

Welcome back to icliniq.com.

My pleasure. Good luck for your treatment and wedding in the next six months. Stay blessed.

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