Dental work - advice appreciated !!

I have been going to a hema for 1.5 years, attempting to hammer out a course of treatment to get me to the dentist. In the beginning, it seemed as if it would be far more complicated (mainly because I thought my wisdom teeth needed to be extracted - which, thankfully, is not the case). As it turns out, I only need a couple root canals and several fillings. No biggie, right? Well...
My first treatment with WinRHo (I wrote a rant about it on the old forum) was horrible. But my platelets went from 58000 - 172000. The hema just wanted to be certain it would raise my counts (I had never before been treated with anything, just keeping an eye on bruising for the last 17 years). So, I booked an appointment with the dentist - he had a look, cleaned my bottom teeth (it had been 5 years since going to the dentist - lots of cleaning required!!), and scheduled me for root canal appointments.
So, last week, I saw the hema again, he announced he was going on holidays, we agreed I would have another winRHo treatment and then 2 days before my dentist appointment, I would have a platelet count done, and as long as I was over 50000, I could go ahead. Because he was going away, however, he left an order that I should be treated if my platelets were low. Today was the day to check my platelets. 45000. Are you kidding me? 45000?? So, they treated me with winRHo, and because the hema is gone & I can't see another one, I can't get blood results to the dentist, the dentist won't do any work without the go-ahead from the Dr. and I continue to endure the toothache that I have had for almost 6 full months (and in the end, the treatment today was unnecessary, because even if my counts are good, I already had to cancel my dentist appt. and probably can't schedule another one for 3-4 weeks...). Sigh. I'm frustrated trying to orchestrate this all myself without enough information, or help from anyone. All anyone seems to be able to do is tell me what cannot happen.
Can anyone speak to dental work + ITP - ? I asked the hema for a recommendation for a dentist, but all he did was throw up his hands and feign idiocy. (I'm also beginning to wonder about this hema anyways - he will not discuss treatment options with me, or ever really fill me in on what the drugs are/what they do/what they are made of/side effects/possible outcomes/etc. etc. - he seems like more of a blood guy than an "I'm-employed-in-a-helping-profession-helping-people" kinda dude. ).
I'm wondering about other people's experiences - does your hema speak to your dentist? How does WinRHO work for other people?

The last time I had such a nightmare treatment, the kind people here really helped me out. Thank you all so much for reading this. Sometimes it just helps to tell your story, right?!

I have never had a problem with dental procedures, and my platelets are rarely over 40K. I've never had a root canal though--but last year I did have to have new crown and a filling. Maybe both my dentist and hematologist are more relaxed than yours! They've never spoken to each other. Once an oral surgeon removed a cyst in my mouth, and though my platelets were at their regularly low level (probably in the 20K range), he reported very little bleeding. If you don't bleed a lot, I suspect you shouldn't have a problem either.

(I can't take WinRho since I have no spleen. I control my ITP with relatively low doses of prednisone--9 mg/day right now, for example.) Karen R

Chaos
I went to the dentist 6 months ago had 6 teeth removed & some additional work done to shave down my jaw so that a partial would fit correctly. Lots of blood lots of work.
My count was about 35k. Tea Bags helped with any bleeding i thought lasted to long.
Which only happened once and i had panicked after about 10 mins. Bit down on a black tea bag and it clotted in about 3 min.

I didnt even run it past my hemo. Once your body gets used to having a lowered count the platelets seem to work pretty well.

I've had a root canal and I didn't see how it could cause bleeding. It seemed less invasive than a filling.

I guess, according to the hemo, the problem is the anesthetic, not the bleeding itself. I'm not sure (we don't communicate well, I feel..) but I think the fear is that the freezing injections will perhaps drop my platelets further? Or that I will bleed from the injection site (which is ridiculous considering I was poked 3X yesterday to get blood from me and 3X to get the frigging IV line in....have 2 inch x 4 inch bruise on forearm from that!)?? I'm going to start looking for a new Dr. tomorrow....I think it's necessary to get a second opinion...I just really need to get this dental work done. It's so stupid because I don't want to take any pain killers for fear of dropping my counts, in case I manage to find a hema on my own who will tell the dentist to go ahead, but my toothache is getting worse and worse...I feel like I'm trying to herd caffinated kittens. Thanks for the dental info, friends. It's helpful to talk to people who know what you're going through...I appreciate it.

I have never heard about anesthetics affecting the number of platelets. There is certainly no evidence that dental anesthetics have had any effects on MY platelets.

Also, I've never seen any connection between pain killers and platelet numbers, but I admit I am very limited in what pain killers I can tolerate--Tylenol and Ultram (Tramadol).

Sorry you're having to undergo all this stress. If everyone--your hema, your dentist, and you--could only relax a little. Most of us think 45K would be a lovely number of platelets!

Karen R

You're telling me! I'm so happy to have 45K!! I even offered to sign a waiver at the dentist because I've never had any sort of bleeding problems - and usually only have 30K - I bruise easily, but not even THAT badly. He didn't feel comfortable doing work, I guess he's never had a patient with ITP before. I am so frustrated with the whole situation. I have a letter from my Dr. stating that they are not to do ANY dental work if my counts are under 50K. Also, about painkillers, I've always been told to avoid them, if possible because most of them thin blood, so they can cause bleeding - I've always operated on that premise.... I thought that was pretty normal, until reading here....Is it that hemos in Canada have different protocols, perhaps? ARRRRGhhhh! (extreme exasperation!). Again, thank you for feedback.

Many, many years ago before I was diagnosed as ITP, I had the dentist hit a small vien when he injected the novicain. Since my mouth was numbing, I didn't notice the problem until the next day when I had a lump in my cheek that was 2-3 inches around, hot and painful. I ended up on antibiotics to clear it up. He apologized profusely, saying he'd only ever had it happen to 2 patients in his whole career. (One of them was his wife :dry:). Hadn't thought about it in forever, until you mentioned the concern. Guess it wouldn't be good at a lower count