I have got abscessed fractured root canal tooth which needs removal,have been to 4 different dentists,and everyone is reluctant to remove it because of CML and blood coagulation?I have shown them by blood tests,and all they do is give me antibiotics and painkillers!Am very concerned and feel that they are worried that if something happens to me,they are liable!Please can anyone offer me any help and of a good dentist in Melbourne or Sydney that will remove my tooth.
Thank you
Tanya,
See the article regarding dental treatment in patients with leukemia (all leukemias) linked bellow:
https://www.hindawi.com/journals/jo/2015/571739/
Key statement from the article which relates to CML:
"Considering the risk of bleeding and serious infections associated with invasive procedures in the oral cavity, there are already some protocols that emphasize the importance of evaluating certain hematological indices, mainly neutrophils and platelets."
All that is important for you to explain to your dentist is that as long as your blood counts show normal neutrophils and normal platelets, you are good to go. Assuming your CML level as measured by PCR is also low (< 0.1%), then your remission status would indicate a healthy blood system (immune).
It is likely more important for you to make sure you are taking plenty of vitamin C, D3 and K2 (and Lysine) so that you have plenty of collagen on hand for any soft tissue mending following invasive dental work.
Show your dentist the article with the neutrophils/platelets statement highlighted. Teach your dentist that having normal neutrophils and platelets is all he/she needs to care about when doing dental work on a patient.
I just went through the exact dental issue. Check my posts on both this site and the American L L site. Short version.i am in USA
An upper back tooth went bad. Saw excellent endodontist. Had root canal. Told there was no fracture. 8 days of amoxicillin. 2 weeks later my regular dentist was preparing tooth for a crown when she looked closely and saw a hairline fracture. Told me it had to be removed because it would become infected. My platelets were at 113. My BCR ABL at 14% I am a slow responder. All other blood work normal. Normal hemoglobin. I am well over 70.
spoke with my hematologist Oncologist. Posted on both CML web sites. Read these as several people had experienced this. Tooth was removed by dental,surgeon. Pressure gauze applied.
I did not clot and seeped blood, mostly thick gelatinous, sometime just bleeding for 8 hours. Was told to apply tea bags. After 8 hours went to a University Hospital ER. Physician applied something on gauze pressure pack to affect clotting. It worked. Week of antibiotics. Scared, exhausted, lots of pain. It did clot and 10 days later I am finally Ok.
Good thing I rejected a bone graft for a possible implant. I cannot have implants.
spoke with a physician to ask why, when I was told by everyone, that if platelets were above 50, it was Safe. Mine were 113. Physician told me that it is the speed with which the platelets work that make the difference. In the future, for any surgical procedure, they need to test my clotting time.
i think a Dental school with a clinic, if you have them, is the way to go. You need expertise for this. They may just need to test your clotting time. No one who posted to my question, a few weeks ago, had my experience. It is not just the platelets, but the clotting time.
i am OK now. The infection you have needs to be dealt with. It will keep getting infected. You need dental expertise, try a a University linked place. Keep us posted.
my thoughts are with you. gitel
I can ask my sister - a dental surgeon - but I’m fairly sure she’ll say as long as your platelets are in good shape then there is no real concern. That said, you ought to listen to Gitel’s experierence. It would be nice to say “you can’t be too careful” but that not really practical all the time.
Would that help? It would obviously only be a general opinion, and nothing specific to your individual circumstances.
David.
Thank you so much for your detailed reply and experience!It has given me more clarity on the matter.I think I will get blood clotting test first then show it to dentist who hopefully will remove toothJ am glad that it worked out ok for you but sounds like a very scary experience!Will be in Melbourne next week,may try search out a dentist there.
Thank you again ,friends!
Gitel - I should have been more clear.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5020258/
Coagulation rate as you correctly point out is very important and and CML (especially advanced phases) can certainly affect it.
But keep in mind your bcr-abl was 14%. We don't know Tanya's PCR level. Studies show that when PCR falls below 0.1% blood parameters including coagulation factors return to normal. But to be safe, she could easily do what you suggest.
Tanya, you need a dental surgeon, not just a dentist. The dentists who refused to pull your tooth were wise. Did they refer you elsewhere? You have CML and an infection, in addition to the clotting question. Everything may go easily and then again may not. Is there a University Dental school where you can get a consult? A practice with experienced dental surgeons?
All the CML people who responded to my post did not encounter the problem I did. They did not have problems. However, you never know. Can your Oncologist or regular dentist provide any referrals? You seem to be searching on your own. Concerned , Gitel.
I think that's wise advice Gitel.
A maxillofacial surgeon would be one to check out too. One of those took out my wisdom teeth (pre CML).
David.
