Bad teeth and CLL

[oldguy68]

to have a tooth extracted is it necessary to stop Ibrutinib 3 days before and after the procedure.? And stop low dose aspirin for 7 days.

[cajunjeff]

I think most Cll doctors suspend ibrutinib therapy for dental procedures that may involve bleeding risks. The number of days they suggest to suspend ibrutinib could vary from doctor to doctor and from patient to patient.

While three days before and after seems reasonable to me and in line with other recommendations I have seen, this is surely the type of question you should present to your Cll doctor. It might not be a one size fits all recommendation for any number of reasons. Good luck with your procedure.

[oldguy68 in reply to cajunjeff]

Thanks for the info, the amount of days are from the doctor. Dentist wanted to know what the recommendation was. I was more concerned about stopping Ibrutinib and then starting it again because when I first start taking it, (white count was 132k) in the first week I was so sick I was in the hospital as white count went up to 302k. Have been on it for 1 year and they don't think that will be a problem to stop it for a week.

My concern is being in the Houston area, and the virus, all of these overloaded hospitals I shudder to think of having to be hospitalized anytime soon.

[cajunjeff in reply to oldguy68]

I went off ibrutinib for about that long for a different reason and there was no issue for me stopping and starting.

While its common for wbc to spike after starting ibrutinib, I have actually not heard of that causing anyone to be sick and hospitalized before now. I wonder what caused you to be so sick.

I understand your concern about being in a Houston hospital. I would be more concerned about exposure at the dentist office to covid or some other infection than any issue with suspending ibrutinib for so short a time.

That said, dentists in my experience are very germ conscious and a bad tooth can be very painful, so I personally for me would choose to take the slight risk associated with going to the dentist and getting off ibrutinib for the benefit of getting relief from a bad tooth. Since a sore tooth is usually accompanied by a gum infection, there is a risk of the infection getting worse by not pulling it.

[oldguy68 in reply to cajunjeff]

Thanks for your input Cajun Jeff. I am going ahead with it. And by your name I'm guessing you live in Louisiana. I got transferred there many years ago to baton rouge with Kmart. That's where I got introduced to reel Cajun food!! Good stuff!!👍🍽️🍹🍻

[sllincolorado in reply to oldguy68]

I do not think you will have any issues but I do want to offer a cautionary tale. I do not know if you have any nodes that are palpable/visible. Especially, if you are unmutated, 17p TP53 I would carefully monitor your nodes for the first 48 hours. If you notice anything I would contact your doc asap. Stopping btk inhibitor (acala) unleashed a torrent for me within the first 48 hours. I needed to stop acala to participate in a clinical trial. Not pretty. No indication based on blood work that this would happen. My body was overrun with nodes. Had stay in the ICU. Was on oxygen. Complete shock to me since CLL has never interfered with my life before (other than side effects of ibrutinib). My reaction was outside the norm and should not happen to you just want you to be aware.

[oldguy68 in reply to sllincolorado]

I don't know what that 17 p531 means. I've never had any conversations with four different oncologist about those kind of numbers or what they mean or there's many other things on there that I guess has never been discussed they primarily like to hang around what is my white cell count. So anyway thank you for your response and I will try to look into that further. By the way if you're in Colorado what a beautiful state I lived in Littleton many many years ago. I now am in a suburb of Houston. Give me Colorado any day!!😁

[AussieNeil Partner Administrator in reply to oldguy68]

As Cajunjeff notes, your experience of your white blood cell count going way up soon after starting Ibrutinib is quite typical. About two thirds of those starting Ibrutinib see this happen and it's caused by the CLL cells relocating from the nodes and spleen into the blood, where they eventually die.

Now that you have been on Ibrutinib for a year, you are less likely to see nodes swell while you are temporarily off Ibrutinib for your dental procedure, but be aware that it could happen, but if so, resolves when you restart Ibrutinib.

The 17p del information may have been determined in a FISH test before you started treatment and the TP53 information may have been checked in a separate test. These tests may not have been done on your blood if your oncologist decided to treat you with Ibrutinib, because the primary need for testing for these markers is to work out if you would do better on FCR than Ibrutinib.

Neil

[oldguy68 in reply to AussieNeil]

Thanks for the information Aussie. As I read your profile I would say wow have you been through the wringer!! Sometimes I just read articles on this site because it is so interesting and helpful especially to hear from people from other countries. So thanks again for your information and God bless you and I hope you continue you're road forward 🙏

[rcusher]

I just had 3 teeth extracted 2 weeks ago which took 1 1/2 hours to complete due to one tooth's long root. My Onco/Haem. had me go off my Ibrutinib 5 days before but because of very little bleeding I started Ibrutinib the very next day. Had no other problems whatsoever.

[oldguy68 in reply to rcusher]

Well that was very good news and kind of a relief to hear could I ask you what is your age? And thank you for your response with that information.

[rcusher in reply to oldguy68]

I am 73. I was also given by my dental surgeon an antibiotic to take for 7 days for possible infections but I didn't get any and things are healing really well. Just make sure that the antibiotic is not one of the one's listed on the Ibrutinibs no go list.

[oldguy68 in reply to rcusher]

What antibiotic did you take I was given amox clav. I am 71. 👍 So we're practically the same age.

[oldguy68 in reply to oldguy68]

Also I can't seem to find a list of drugs to not take with Ibrutinib.

[rcusher in reply to oldguy68]

I had the same antibiotic, seemed to work with the Ibrutinib.

[rcusher in reply to rcusher]

The pamphlet inside the box gives you a list but if not sure ask your pharmacist they usually check for me before giving me any Rx.

[oldguy68 in reply to rcusher]

Well isn't that interesting one of the things that took me years to really learn when all else fails read the directions 😳 mine is delivered by a courier and yes there's a big long page in there that I've never read!!😜thank you!!!

[country76]

My dentist also gave me an antibiotic before any procedure. Even a cleaning.

[morepork]

Like country76 my dentist gave me antibiotics beforehand, as well as the 7 days Ibrutinib stoppage before extraction. I did bleed a bit for 24 hrs afterwards but not drastically.

I'm one of those 17p- people, plus have very low Ig's. Started back on Ibrutinib 2 days after extraction, no problem.

[oldguy68 in reply to morepork]

Thanks for the information. It's so good to get comments from people on this site. I'm sure a lot of people would agree the input you get here is much more than you get from your doctor at any one time. Eat more pork!!🐖

[oldguy68 in reply to morepork]

Could I ask what antibiotic did you take? 🤔

[morepork]

Amoxicillin 500 mg tds in my case. 7 days worth. Starting 5 days before extraction and two after.

[oldguy68 in reply to morepork]

Thanks for the response I have amox clav.

[oldguy68 in reply to morepork]

I stopped Ibrutinib 4 days before had tooth pulled and I've had no bleeding issue at all here on the next day should I start my Ibrutinib now?

[morepork]

Sounds like you have got it sorted !

(Morepork is one name for the NZ native owl because of its nighttime call!) 😊

[oldguy68 in reply to morepork]

Well I just learned something I had no idea. 🐦