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Fractured tooth, pulling a tooth

My dentist suspects a fractured tooth which either needs a root canal to save it, or if the fracture is too deep, might need to be pulled.

any advice?  I will of course consult Onco.

i was dx December 2017.  Slow responder, resistant to Gleevac.  I am on 80 mg Sprycel. BCR originally 54%, then 36% then 24% and 3 weeks ago, 14%.  Platelets were 104 10 days ago. other CBC normal.  Am at Mayo Clinic for Onc.

any advice, info appreciated.  Oh yes, had a hip replacement so I take Amoxicillan before dental work.  Tooth very painful they thought it was TMD.  facial nerve pain at first.   I am over 70.   Gitel

 

 

Hi Gitel,

I have in the last 3 months gone through a similar situation.I was dx with CML over 12 years ago and have been on imatinib/Glivec and am currently on a high dose of 600mg.The normal platelet range is 150-450 so if you are at 104 it seems that you are below the lower threshold and suffering from thrombocytopenia which might be a result of the medication.If this the case then you might be advised to seek expert advice from your oncologist before considering any form of tooth extraction as the clotting function is lesser and there could be excessive and /or uncontrolled bleeding.

I had root canal treatment on two front teeth that had an abcess or a severe infection in the gum;it failed on one of them as it was like yours fractured or split so an extraction was advised.I think as a CML patient you should be OK with the root canal procedure as basically they drill out the roots and then pack the space .Xrays will show if the process has been successful or not.Take lots of pain killers before and after the procedure-however I would prefer root canal to the very invasive bone marrow biopsy!

If you have the root canal you may then have to have the tooth capped with a crown very soon after as infection may eventually develop.Fortunately my platelets were within range so there was not too much bleeding after extraction-however I took precautions by keeping in place under pressure and replacing often a gauze dressing on the cavity.Currently I am trying to get used to an acrylic denture/plate which is difficult.

I am sure that you dentist will not take any risks and if you really need an extraction then you may be offered a procedure to normalise your platelets via a transfusion on a prior basis or have the extraction undertaken in a surgical or hospital  environment where bleeding would be monitored and controlled.Amoxycillin is the best form of treatment to counter any potential or existing infection of the roots/gum but medium term it would not get to the base of the abcess or rotten roots-only extraction clears it up.As a postscript Amoxycillin does not conflict with or compromise your existing CML medication.

Finally I did ask my oncologist  if as a CML patient I would be more likely to suffer dental issues and we agreed that like you in my 70 s some things start falling apart anyway and teeth are included!

On that note I wish you well with your CML treatment and with any future dental issues.

I trust that my response has helped a little.

Regards

John

Thank you for the excellent and complete reply. I have checked with the oncologist and he said platelets over 100 were ok.

 I will know more tomorrow.  I am hoping for a root canal rather than extraction. All the root canals I have had, about 3 or 4 in a long life have been easy...very skilled endodontist. No problems. I would rather have the BMB, since it is 5 minutes and not that painful. I have been fortunate.

thanks again. I will refer to your post.  Gitel

Prepared for the worst and I got the best...I am fortunate. Tooth was dying, not fractured. Excellent endodontist.  He cleaned it out, did a root canal and put me on a week of  Amoxicillan.  I’ll need a cap. Expensive, but so is living. All OK now.

With lowered platelets and cML an extraction terrified me.  Thank you all for letting me vent my fears. Gitel