Any advice on my dental issue will be appreciated

Hi to all, i am a 36 year old female who has had itp for around 12 years now and my count sits between 30,000 and 40,000 usually, however i now have a huge issue i really would like some advice or info from anyone who has been through something similar or who has advice for me. I have to have all of my teeth out as i keep getting dental abscess's and not only are they very painful but i cant take anti inflammatory's like most people (we all know why) so now im told i need all of my teeth out so has anyone been through similar or have advice as im really worried about the bleeding, my count is currently 32,000 and i just dont know how to bring it up. My dentist has not delt with an itp patient and my oncologist says it cant be done with such a low count but it needs to be as ive had 14 abscess's in 12 months and i cant handle this. My teeth issue has been an accumulation of issues to get this bad and i havent helped it because i did reduce my brushing because of the amount of bleeding when i brushed but that was not the main issue for it. I appreciate any help as this is the first group ive found and i really am excited as i dont know anyone else with itp as its not common and here in Australia i havent been able to find any help/talk groups. Thanks guys

Are you having them all pulled at one time? I guess if counts are low and this needs to be done asap, maybe an oral surgeon rather than a Dentist would be better, in case there is a bleeding issue. It can be better handled in an operating room. Platelets could be given in a surgical setting if there is an issue.

What have you tried to higher your count? Steroids, IVIG or one of the new TPOs, Nplate or Promacta are good for getting the count up high enough for surgery. Failing that, platelet transfusions just prior and during the procedure would be appropriate. As Dean says, having this done in hospital would be, I'd think, essential.

In 2007, my daughter was having counts in the teens to thirties when she needed all remaining (stubborn) baby teeth extracted for braces at age 13. She had seven teeth removed by a specialist as an outpatient procedure in the OR of the teaching hospital where her hem/onc group practiced. That way, hemorrhage control measures were at hand, and the hem/oncs were right down the hallway. The hem/oncs and dentist together formed a plan. (This is what I treasured about our teaching hospital docs when we were enduring ITP.) She took pred for several days before and after, with the count reaching the nineties. (It fell later, of course.) She was also prescribed amicar (expensive, around $200US), but it was later realized she probably could not take it because she'd recently started on the bc pills to stop terrible periods. (Some can take amicar when bleeding is a problem, but there are some contraindications in folks at risk for clots, women on the pill, etc.) The pediatric dentist (you would likely have an oral surgeon) used dressings developed for the military (the substance is chitosan), and inserted them as packing in the sites. He'd never used them before, but was using this as a teaching opportunity in grand rounds, and was planning a journal article on the subject. I'm not sure that was ever published. (Goal for ITP patients: try not to be so interesting you become a journal piece. In medicine, "interesting" is to be avoided.) Our dentist was Rockman of the Medical College of Georgia, now known as Georgia Health Sciences University, if your guy wants to call him. Our regular dentist would not have done the extractions in his small rural clinic. It can be done, and sounds like your health would be better with dentures. Good luck. Let us know how you do.
Norma

The dental dressing was called HemCon.
Norma