Dr. Keith Roach
Expensive Dr. Roach: Assist! I’m caught in a feud between my major care physician and my oral surgeon. For quite a lot of years, I’ve been on Prolia for osteopenia. A few yr in the past, I needed to have a tooth pulled; my oral surgeon stated I have to be off Prolia for at the least 4 months; my physician disagreed, saying it’s extra dangerous to cease the Prolia. I really feel a bit like a ping-pong ball between the 2 of them and want some pointers on Prolia and dental work.
Expensive Anon.: The priority right here is of a situation referred to as osteonecrosis of the jaw. It is a uncommon (round one particular person per 10,000 taking Prolia, or an identical drugs, for 10 years) situation inflicting ache and swelling of the jaw, which may result in uncovered bone, an infection and fracture of the jaw.
Every time potential, a complete dental analysis ought to be achieved earlier than an individual begins on this type of remedy. Additionally, each time potential, extractions and implants ought to be deferred. However generally that simply isn’t potential, and the process must be achieved whereas on the remedy.
The American Affiliation of Oral and Maxillofacial Surgeons suggests performing surgical procedure, reminiscent of extractions and implants, as common in sufferers who’ve been handled with Prolia or related medicine for lower than 4 years and haven’t any medical danger elements. It additionally suggests discontinuing the osteoporosis drugs for 2 months previous to performing the dental surgical procedure if a affected person has been handled with it for greater than 4 years, or has been handled with steroids. Osteoporosis medicines are restarted when the bone has healed.
Expensive Dr. Roach: I visited an eye fixed physician, and I’ve a posterior vitreous detachment (PVD). I’m a 59-year-old feminine. Are you able to advise me? Can I am going blind? I’m very, very scared.
Expensive T.R.: The posterior chamber of the attention comprises a big, gel-filled construction referred to as the vitreous physique, which is in touch with the retina, the a part of the attention with the sunshine sensors. There’s a skinny membrane that separates the vitreous from the retina, and this will turn out to be indifferent. Posterior vitreous detachments are frequent, particularly as we age. This isn’t the identical as a retinal detachment, as a result of in a PVD, the retina stays in place, and so the imaginative and prescient isn’t essentially threatened in an individual with PVD, whereas a retinal detachment is an emergency that wants rapid care. Floaters and flashing lights may be signs each of a retina tear and a PVD, so these signs ought to be promptly evaluated.
The principle concern with a PVD are issues, particularly a tear of the retina, which occurs roughly 15% of the time in folks with a PVD. A retina tear often occurs similtaneously the PVD. One other complication known as an epiretinal membrane, a kind of scar tissue that may generally have an effect on imaginative and prescient. This often wants surgical procedure.
Modifications within the eye can undoubtedly be scary, however the signs of a posterior vitreous detachment subside in a couple of months for most individuals, and no particular therapy is required.
Readers might electronic mail inquiries to ToYourGoodHealth@med.cornell.edu.