If dental work is needed, extractions, implants ?

I've had ITP for 2 years, am 70 yrs. old. What should be done to get safely thru dental work such as multiple extractions at (1) time, or multiple dental implants done at (1) time ? I normally have platelet counts in the 45K-60K range. I've also had endocarditus, which I think brought about the ITP.

This would be something for you and your dentist & hematologist to discuss. First I'd talk with my hematologist and then have him/her get together with the dentist. I needed to have surgery going through gum & bone to get to a tooth root - my specialist wouldn't touch me without a current count done and my platelets being a certain number.

Scooter:

I agree with Melinda. Your hemo and dentist should let you know what an acceptable count would be, and then you'd probably need to treat to get to that number. Most procedures can be done with counts of at least 100k, some lower. Depends on the comfort zone of your doctors.

It is worrisome, but can be managed. My ITP teen daughter (now an adult in remission) needed several stubborn baby teeth extracted at age 13 to make room for braces. Our dentist, a wonderful friend, didn't feel comfortable doing it, and we knew that any dentist performing the procedure should be in communication with the hematologist. Our hematologist (at a teaching hospital) recommended a dentist associated with the hospital. The procedure was done in the OR in case of bleeding, with hemorrhage control measures in place if needed. The hematologist's office was just down the crosswalk if needed. She took prednisone for a few days before and after to get her to the magic 100k count. It went smoothly. The dentist used HemCon dental dressings to pack the sockets, which was a first in the area. (These are based on hemorrhage control bandages developed for the military.) We applied tea bags (brewed, then chilled in the freezer) as a compress to control oozing bleeds. (The caffeine constricts the vessels.) There is also a prescription drug (I am drawing a blank on the name, but Sandi and others will know) that can encourage clotting and control bleeding, but it has risks if you are prone to clotting or on birth control pills. It was prescribed for my kid, but I realized after buying it ($200) and before administering that, since she was on birth control pills to control bad (20 days+) periods, I should call the doc before giving it. He said she shouldn't take it. Others here have used it, but, if you discuss it with your doc, be sure to ask about the risks and your own health situation. Communication and coordination can manage most anything an ITP patient faces.
Norma

The drug is called Amicar. It can help prevent bleeding. Some doctors are not comfortable using it though, but it's worth asking about.

My hema is ok with me having necessary dental work at around 50k. My dentist needs a letter from my hema before he feel comfortable with any procedure. My hema will only ok if I'm in pain...like a cavity or a cracked crown. He refused to have my wisdom tooth extracted. He told me it's not worth the risk.

Scooter,

I had a root canal done that was a very complicated one. My counts were about 40. I just did not say anything. I did bleed quite a bit, but I was will to risk the possibilities to get rid of the pain. And I bled for about 6 or 7 hours. Reflecting back it was worth it. That one really hurt.
Just go by you hema and dentist wishes and you will be fine! Good luck! Don't do what I did.

You will be having apples soon!

Jeff

My daughter (age 3--who's had ITP for 6 mos) had to have several baby teeth extracted recently, and her hematologist recommended her to a local dentist who specializes in hematoloy/encology. Her labs were checked before surgery, then 3 days later the morning of surgery, she was admitted to hospital for outpt surgery (in case of complications) (her platelets were 121k) and her surgery was successful with no problems. Best wishes.

I would contact your hemo and the doctor that treats your endocarditus. Each may have a set of things they want you to do before getting dental work.