Dental work with low platelets?

Good afternoon all.

I searched the forums a bit, but wasn't able to really find much of a discussion on dental work with low platelets. My last two platelet counts (done a month ago) showed my platelets to be around 50,000 - to which the Doctor thought was fine until my next checkup in February.

However, I have a dentist appointment next week for a cleaning/check up and everything I've read about low platelets says to check with your Doctor beforehand. Being that it is Tuesday, my Doc is closed until tomorrow - to which I plan on calling then, but I wanted to collect some information from the community.

What procedures are the most risky for people with low platelets? Cavity fillings? Oral surgery? Teeth cleanings? I know my gums are going to bleed in a teeth cleaning, but they have in my past experiences before I was diagnosed with low platelets and I've always been fine.

What can a dentist do to control bleeding in these situations? I know I may need a tooth extraction sometime in the near future, is there something the dentist can do on their end to help the bleeding? Or would it be a Doctor driven treatment, if anything were needed at all?

Is the inherent risk involved just bleeding out? Are there any other factors or results to consider? My biggest anxiety is that I probably need a tooth extraction to continue having a healthy mouth, but if my low platelets get in the way, I don't want to be at an impasse.

I appreciate all the first hand accounts, advice, or stories anyone could give.

Thanks!

The procedures would all depend on your counts and what your dentist is comfortable with.

I was told by my hemo no cleanings or fillings under 50k. If I needed work done, I'd treat to get the counts there. I don't even think I mentioned my counts to the dentist at that point. I know some people here have had those things done with lower counts. I wouldn't expect much bleeding from a filling. A cleaning, yes, more likely.

I had four wisdom teeth removed with counts of 100k. No problems, I was fine. I had it done in the office of an oral surgeon.

I've heard that wet tea bags can help control bleeding from teeth. It would be worth a shot if need be.

Yes wet tea bags they have tartaric acid in them.

Thanks for the tips. I'll have to wait and see what the Doc says tomorrow. The cleaning should be no problem, it's just the tooth extraction I'm worried about, especially if they decide they need to put me under.

I've had plenty of dental work done before my diagnosis - a time before I ever knew what platelet counts and CBCs were, but possibly a sufferer of low platelets. It's funny how paranoid I am now to do the same things I did before knowing.

If anyone else has any stories to share, I'd love to hear them.

I think oral surgery/tooth extraction would be the biggest risk if counts were low, (50k range or lower). A cleaning would be a slightly lower risk, depending on how gentle the person doing the cleaning is. If they are scraping at the gum line, there will very likely be bleeding with low counts. I doubt a filling would be much of an issue with low counts, but would be best to check with your hemo. The day before I found out my count was 5k 4 weeks ago, we went out to cut firewood. DANG lucky I did not get injured!!! I do not even recall getting bumped where the worst bruise ever was. ITP definatly makes us think about things that we never used to be concerned about.

"The procedures would all depend on your counts and what your dentist is comfortable with."

Yep.....what Sandi said. We are all different. One size of ITP does not fit all.
I had oral surgery in July with a count around 17k. I had an upper canine removed in pieces and a couple of stitches came with it. My hematologist was consulted and I got a count a couple days before, no biggie. This was a complete non-event for me. Bleeding was basically normal and the extraction site healed quickly.
Yes, I could have taken a Dex pulse to raise counts some. But, neither my hematologist nor my oral surgeon thought that was a good idea, due to interference with the healing process.
Since I have had ITP, I've experienced 2 oral surgeries, 2 root canals, 21 cleanings, replaced 4 crowns, and I'm sure some other stuff that I don't recall over the past 11 years. Never had a problem. But everyone is different.

NOTE: I put this surgery off and was in pain for a year because I thought it would be an ITP hassle. But as I said, it was a total non-event. Everyone is different.

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Agree. ITP does not roll the same for everyone.

Spoke with my hemo today and they suggested if I need any sort of tooth extraction/root canal to come up with a plan to boost my platelets, since they wouldn't be comfortable with me undergoing oral surgery at 50. Cleanings and general fillings should be fine though. Part of me feels like it wouldn't be an issue since I've never really had any clotting issues before, but I'll have to wait and see what my options are when the time comes.

Good communication between your hemo and your dentist is important. My dentist makes me take pre meds (amoxcillin - sp) before every appointment (my counts are usually in mid 30s and I'm on N Plate) I have recently had quite a bit of dental work done - the details are on Social Chat titled "My Saga" If you have any questions - don't hesitate to ask. BTW I still look like a Jack O'Lantern/Scary Granma. Things have been delayed because of our Thanksgiving.
High Platelets, Christine

Just remember if the treatment is an imunosuppressant it will interfere with the healing process! So say you took dex or pred even for a short time would probably double the healing time.

I have had dental work done with ITP. I usually bleed a bit but nothing dramatic. My counts are usually 20 to 30. I don't check my doc before. He would order a cbc and if low would want to do IVIG or something else. I just am not going to do that for a cavity or cleaning. I will run my chances, but you should do what you are comfortable with doing. Best of luck!

Jeffrey