Oral surgery and wisdom teeth removal

I have idiopathic thrombocytopenia. I've been to 2 different hemolotogists and tested for everything I can think of. It was discovered in 1993 when I got pregnant with my daughter. Last hemo said either I can do entire testing again (lab, bone marrow etc) but she felt it's something I can live with. Since they can't figure out why I have it they really can't do much. I've had surgery since on my eye and now am getting oral work done. Cleanings are no issue. I seem to heal fine. My bleeding time is actually average too.

Fast forward to today. My wisdom teeth need to be extracted. Oral surgeon ordered a platlet count and it's 58k. He wants it at least 50k.
I'm wondering if this will cause an issue? I'm scared I guess cause if they determine its safe for me they are putting me completely out.
Since I was discharged from past hemo I'm not sure if maybe I should go back there too. They didn't seem concerned cause I haven't had any bleeding issues concerning it.

Guess I just need advice from people that have been there with no known cause.
Will steroids help me or hurt? I know I took some before delivering my daughter due to the low platlett and gamma globulin (sp?) in my IV
Thanks a lot!!

It's really up to you and your doctor as to whether or not you should treat. Prednisone would help the counts (if you respond to it), but you'd then have to deal with the side effects.

Most people with ITP do not have a 'cause'. Certain things can trigger ITP, but it is believed that they had a predisposition towards autoimmune disorders in the first place.

I had four wisdom teeth removed, but my counts were about 100k at the time. Counts dropped a few weeks later and I'm not sure if it was due to the anesthesia or the trauma to the body.

Ok thank you
Oral surgeon says he doesn't feel comfortable doing surgery. They called me today

So I am setup to go to the hematology dept at Mayo Clinic here to get more tests done. Luckily it's not an emergency to get the teeth out right now.

This study of 68 patients receiving extraction, with platelets <100k, and with average platelets of 45k, concludes that extractions are safe. Only 5 patients had excessive bleeding, which was then controlled with routine intervention.

Dental extraction in the thrombocytopenic patient is safe and complications are easily managed.
www.ncbi.nlm.nih.gov/pubmed/23932116

I wish my oral surgeon felt that way. Either way I probably should go see a doctor again. Last time I had work up was 22 years ago so maybe something has changed

Thanks!!

I have had at least 2 extractions - dentist and hema consulted each other. One making sure my pts were at least 50 before surgery. With the dentist/oral surgeon aware of bleeding they should be prepared for any excessive bleeding.

Christine wrote: I have had at least 2 extractions - dentist and hema consulted each other. One making sure my pts were at least 50 before surgery. With the dentist/oral surgeon aware of bleeding they should be prepared for any excessive bleeding.

Thank you. Yes that's what I need. Once I get to the hemo I can hopefully get them to coordinate my extractions!
Not that I want it done lol

Perhaps your hemo can recommend an oral surgeon who is more experienced and more comfortable with ITP.

Rob16 wrote: Perhaps your hemo can recommend an oral surgeon who is more experienced and more comfortable with ITP.

good idea! Didn't think of that. It's Mayo clinic so I've heard they are great doctors. We will see

Usually, people with ITP don't need a full work-up if there are no physical symptoms or other odd findings on the CBC. Seems you've been doing pretty good all these years! That's great!

I would have my oral surgeon get together with my hematologist - they can talk it over. Get those 2 doctors of yours talking together!

Years ago, my ITP teen needed some stubborn baby teeth extracted to get braces on. Our dear dentist, in private practice in a small town, did not think he should do the job. Our med professor hematologist knew a great dentist at the same med school, and they had previously collaborated on care of a patient. They developed a plan to raise the platelets with prednisone, and to have the extractions done in the OR, where hemorrhage control would be easier than in a private dental office setting. They had hemcon dental patches on hand, just in case. The hematologist, if needed, was just over the crosswalk in an adjoining building. Everything went well, and I felt more comfortable knowing she was in the good hands of folks who knew how to work together. Hope it all goes well.

Norma

I was supposed to have a tooth pulled with a normal platelet count. The dental surgeon said he was familiar with ITP. He was more concerned with getting a letter to say it was safe than getting a recent platelet count.

I still have that tooth. My new hematologist is willing to write me a letter the moment I decide to have the tooth pulled. I have decided I will keep the tooth till I absolutely have to have it pulled.


You need to have a doctor/ dentist you trust that will listen and be willing to talk to one another. Most important information needed is your platelet count and the knowledge if you are a bleeder or not.

The timely platelet count is good point. (Scary to think a letter would have sufficed for any dentist.) My daughter's extraction proceeded only after a CBC that morning to be sure the prednisone had brought the platelet count up.

I had my upper wisdom teeth out last year with count of around 50K. I am 55+ years old, older age can be a problem. teeth were not impacted- that makes a difference too. My teeth had some decay and I thought it better to get them pulled than crowned. My oral surgeon wanted my platelets to be 80K.

My hemotologist is very relaxed about platelet counts, he knows I'm not a bleeder even with counts under 10K, he never worries about me. But he was willing to get them up from 20K to please the oral surgeon. Hemo did not want me to get them up with prednisone because of the way it can suppress the immune system and there is a lot of bacteria in the mouth. Tooth socket infection can be really bad, so we used Nplate and about 5mg pred.

I chose to have a local anesthetic to save money, plus I wanted to drive myself home. Glad I did because it was really quite easy and fast! My clotting time and recovery was within normal- a minute to get an initial clot, an hour to get a strong clot and 12-24hrs for no pink saliva. My oral surgeon didn't use stitches, just pressure to create a clot. When my hemo heard there were no stitches he laughed and said about the dentist, "hes a brave man." I was super super careful for the next week- only liquids so not to loosen the clot. Generally its liquids for 3 days but in my case the nurse advised a week. good luck!

I would second the n-plate/romniplostim approach to getting counts up temporarily for surgery. My son needed a mole removed last year and he had two injections the previous two weeks which brought his count up to the 70s. No side effects, no hassle apart from a weekly visit to the hospital. It worked perfectly.

Hi, My son had a tooth extraction with a platelet count of 2k. They gave him tranexamic acid and something to gargle (I really can't remember the name - apologies) but this helps clot the blood as well. The doctor was on the safer side and did platelet transfusion at the same time but I think that was unnecessary. In any case, he was bleeding when the tooth was moving but when the tooth was pulled out, it all stopped. Maybe you can ask for this 'safer' treatments (tranexamic acid + mouth gargle) during the oral surgery?

Updated on my surgery!

I decided to go to a Hematologist at Mayo Clinic on April 4th. They did alot of bloodwork and an ECG. Everything was normal including iron, B12 and white cells and red cells, etc...they took 12 tubes and did a bunch of coagulation testing and PTT's etc...My platelets at that time were 112k which is much better than the previous 58k. Since my counts are so great there is no need to remove spleen. I also didn't need prednison nor IVIG before surgery.

I had my 4 teeth extracted yesterday morning. Minimal bleeding. I think it bled maybe an hour or 2 but it clotted now. I have zero pain too from the surgery. I'm eating nice soft stuff like jello and pudding and doing oral hygeine too today (salt water rinse). So far so good.

Thanks for all the advice! That one upper left tooth was decayed and very painful and now I have no pain. Doc put me on antibiotics and gave me percecet (which I don't need). Lady in the office tried to say here's an RX for motrin and I gave it back!! LOL...no no no. I'll stick with tylenol if it hurts later. I think because I used alot of ice first day that helped. I have no swelling either.

Oh and my clotting time is normal range. I have large platelets (body makes excess new ones to compensate) and they think that's why. I also show no platelet antibodies in my system.

Glad it all went well.