Wisdom teeth removal with ITP in bay area

I need to get my wisdom teeth removed since it starts to cause issues. However, I have no clue on how to get it done. I tried to see an oral surgeon two years ago and he just told me to boost my platelet count to a normal range and come back....

Some background: I have lived with an ITP for more than 30 years. The count is in the 30k range in recent years. The low count never bother me much and haven't had any bleeding problem. Prednisone couldn't boost my count while IVIG works. I am not too concern about bleeding problem during wisdom teeth removal, but try to figure out how to find a oral surgeon who is willing to do it and what is the most cost-effective method. I recently moved to the bay area and don't even have a hematologist. Any recommendation is really appreciated.

Loya:

The only way to do it is to do what the oral surgeon said...get counts up and go back. That's what I did. The problem isn't only during the surgery, it's the possibility of bleeding afterwards if a clot doesn't form. You might be okay with the 30k counts, but why take the risk? The surgeon doesn't want risk either.

Thanks for the reply. I just tried to figure out the logistics. I guess I need to first find a hematologist, figure out a plan to boost the platelet count, ask him to work with the dental surgeon. Another big question I have is about the medical coverage. Will the "boosting platelet count" procedure cover by my medical insurance or my dental insurance? The medical system is a myth to me and I really hope I can figure out the cost before moving forward...

Loya, I would guess it would be covered by your medical insurance. Dental insurance usually will only cover teeth, not medical issues.

Hi Loya, welcome. I live in the San Francisco bay area- is that where you are? Yes, as Sandi said you'll have to get your counts up to have teeth out.

I had my two upper wisdom teeth out in 2015. I'm over 55 years old and heard it was difficult for older people- it was fine. My oral surgeon wanted my platelets to be 80K. My hematologist thought 50K was fine but we had to go along with the oral surgeon. My hematologist did not want to use prednisone to get my counts up as it suppresses the immune system and might increase the risk of infection. He said iVig would be okay. I was already on Nplate so I upped my dose to get counts to 80K- or at least on paper they were 80K. I believe they dropped into the 70s before the actual surgery. But it was all totally fine, my bleeding time was within normal, my blood clotted right away and the clots held. Something I think is very important- follow the instructions regarding eating and drinking very carefully. You don't want to start bleeding again or lose the clots! A dental nurse advised me to not eat solid food for a week (most teens go only a couple days) and I followed that advice.

Boosting your platelets will be done by a hematologist so that would be a medical insurance expense. You can ask the doctor's billing office to see if they take your insurance and get an estimate for copay or whatever. I don't have dental insurance so I opted to have my wisdom teeth out with just a local anesthetic- an injection. And not go under general anesthesia which costs a lot more. I'm glad I did the local because it was not that big a deal- very fast. It took about 5 min on each tooth, about 10 more mins to make sure I had clots- then out the door and could drive myself home. My teeth were fully grown in, not impacted so that makes it much easier. My dental bill was about $350. per tooth- no insurance, got a bit of a discount by paying up front. good luck!

Thank you so much for the detailed reply!!! The information is very useful! Now it feels less like "mission impossible". Yes, I live in SF bay area.
So glad that boosting platelet count could be covered by medical insurance rather than the dental. Prednisone doesn't work for me and IVIG probably is what I will go for. From my past experience, that would bring a big bill ......

Do you mind sharing more information about the local anesthetic service and the dental office?

The dental office was in Petaluma-north of San Francisco. Petaluma Oral Surgery, my guy was Chavez. He was a fun guy and very fast, seemed competent. BUT he didn't use stitches!? I don't know why, he didn't mention it in advance and I was in no position to discuss it with my mouth full of cotton. The clots were all that was keeping me from bleeding. It was Friday afternoon, maybe he was just cutting corners wanting to get out of there?! haha I don't know. There is some thought that no stitches helps prevent infection in that its good to have a slight flow of blood and fluid coming from the hole preventing germs from getting in. I told my hemo that the guy didn't use stitches (with my low platelets counts) and my hematologist just rolled his eyes saying "hes a brave man".

My suggestion is to just look on Yelp. Google "best oral surgeons" in your area. I don't believe everything on Yelp, but I think its a good place to start.
The local anesthetic was just the old "novacaine" injection. Several injections all around the tooth and jaw on both sides- all very standard. For me being put to sleep with general anesthesia would have been totally unnecessary. Plus I live nearly 20 miles away and would have had to get someone to drive me home. However, it would have been nice to have a driver since I was bleeding somewhat so having to deal with that while driving. Bleeding stopped after about an hour, just pink saliva for 24-48 hours.
ps. If you are in the North San Francisco area- I love the hematologists at the St Joseph Cancer Center in Santa Rosa. They take people without insurance and are great at helping with costs, a wonderful charitable organization. Sutter Health dumped me when I had no insurance, so I have nothing good to say about that group- except that it forced me over to St Joseph where they have the most awesome doctors. good luck! the first step is the hardest! hah

Thank you very, very much! This thing is on my to-do list for a few years but I feel like I will never cross it off. I keep procrastinating on it because I have no clue where to start and what to do. The information you shared is really really helpful! Hopefully I can get it done soon.

Thanks again!!!