Dentist

Hello All,

I'm still pretty new here and I didn't find much on a quick forum search, but Have many of you run into the issue that when applying for a new dentist they won't approve you because of your ITP or, as I just got from the last phone call, I have to have a CBC done before I can have a teeth cleaning performed?

I suppose I'm mildly annoyed to have a receptionist explain to me what ITP is and that I have to prove I have a count higher than 50,000. My last CBC was 3 months ago and I was over 100,000 but now they are calling my hematologist, all before they can approve me as a patient. Is this standard or am I just over reacting?

Thanks,

Austin

I think most dentists would prefer a count prior to a cleaning. Calling your Hemo is really not a big deal...maybe he will reassure them.

They sound like extremely cautious dentists! I've always managed the count side of things myself (making sure I didn't have signs of a low count before going in for a cleaning, making sure to get a CBC before having more significant work done, etc.). I have yet to find a dentist who even commented on the ITP when seeing it on the form. Maybe they weren't reading the forms, lol!

It usually works out that the dentist will maybe comment, "you seem to be bleeding a lot" and then I mention the ITP to explain why I bleed more than the average patient. That's usually the end of the discussion and they continue on.

Maybe try to find a less cautious dentist and manage the count side of things yourself. Good luck!

I would call him an "excessively" cautious dentist.
I've been to two different ones since my diagnosis, and they both figuratively yawned at it. It has never been an issue to them.

Both my husband, who is on warfarin therapy, and I see the same dentist. They discussed his needed extraction. The cardiologist said not to stop warfarin for the procedure and said no one has ever died from bleeding after an extraction. The dentist said he has options he can use and would be able to handle it in any event.
I was actually in the waiting room one day when a patient on warfarin was having an emergency extraction. I had to wait about 20 minutes longer until his bleeding stopped, but it certainly didn't take hours.

I don't think a low count from ITP would be very much different from warfarin in terms of lethal dental bleeding.

My Hemo wouldn't even allow me to have a cleaning when I was below 50k. I even begged and asked for Amicar. Nope. I guess they are all different.

Well that is what makes me chuckle too is my Hemo just told me to go live life, come back when I show signs of a low count otherwise see him in 6 months. Now this woman at the dentist keeps implying that they might not be able to help me. Heck, I wasn't going to worry about anything until my gums oozed and I had purpura. I guess they don't get many patients with ITP.

I cannot seem to hyper link this.


Dental prophylaxis (descaling, deep cleaning) ≥20–30
Simple extractions ≥30
Complex extractions ≥50
Regional dental block ≥30

Is recommended by

International consensus report on the investigation and management of primary immune thrombocytopenia

Blood 2010 115:168-186; doi:10.1182/blood-2009-06-225565

MrsB, It's no wonder you could not manage to hyperlink it.

The current article is at www.bloodjournal.org/content/115/2/168.long?sso-checked=true .

There is a footnote that says there was a supplement linked from the original online version, which can be found here:
www.bloodjournal.org/content/early/2009/10/21/blood-2009-06-225565/tab-figures-only
(there is also this link: www.bloodjournal.org/content/suppl/2009/09/24/blood-2009-06-225565.DC1/ )
Files in this Data Supplement:

Document 1. Classification of evidence and recommendation table (PDF, 15 KB)
Document 2. Diagnosis of adults (PDF, 118 KB)
Document 3. Management of adult ITP (PDF, 258 KB)
Document 4. Managing ITP in pregnancy (PDF, 23.8 KB)
Document 5. Obstetric anaesthetics (PDF, 14.1 KB)
Document 6. Diagnosis of children (PDF, 34.5 KB)
Document 7. Management of ITP in children (PDF, 115 KB)
Document 8. Supplemental recommendation boxes (PDF, 80.6 KB)
Document 9. Peripheral blood film analysis for ITP diagnosis (PDF, 18.8 KB) -

Document 8 contains the relevant data: www.bloodjournal.org/content/bloodjournal/suppl/2009/09/24/blood-2009-06-225565.DC1/Document8.pdf
Consensus-based recommendation for target platelet counts during surgery in adults:*,^
(Evidence level IV)
Dental prophylaxis (descaling, deep cleaning) ≥20–30 × 10⁹

Simple extractions ≥30 × 10⁹

Complex extractions ≥50 × 10⁹

Regional dental block ≥30 × 10⁹

Minor surgery ≥50 × 10⁹

Major surgery ≥80 × 10⁹

Major neurosurgery ≥100 × 10⁹

Splenectomy see Splenectomy section
Obstetrics see Thrombocytopenia in pregnancy
*Adult patients considered to be at ‘typical’ bleeding risk from surgery.23 Target platelet count
depends on the clinical situation and urgency and need for procedure
^Concomitant use of antifibrinolytics immediately prior to the procedure may be helpful (see
Emergency treatment section)

Thanks Rob..
Every time I copied the link it wouldn't paste for some reason
Anne