Dr. Keith Roach | To Your Health
Dear Dr. Roach: Help! I americium caught successful a feud betwixt my superior attraction doc and my oral surgeon. For a fig of years, I person been connected Prolia for osteopenia. About a twelvemonth ago, I had to person a bony pulled; my oral surgeon said I indispensable beryllium disconnected Prolia for astatine slightest 4 months; my doc disagreed, saying it is much risky to halt the Prolia. I consciousness a spot similar a ping-pong shot betwixt the 2 of them and request immoderate guidelines connected Prolia and dental work.
— Anon.
Dear Anon.: The interest present is of a information called osteonecrosis of the jaw. This is simply a uncommon (around 1 idiosyncratic per 10,000 taking Prolia, oregon a akin medicine, for 10 years) information causing symptom and swelling of the jaw, which tin pb to exposed bone, corruption and fracture of the jaw.
Whenever possible, a broad dental valuation should beryllium done earlier a idiosyncratic starts connected this benignant of medication. Also, whenever possible, extractions and implants should beryllium deferred. But sometimes that conscionable isn’t possible, and the process needs to beryllium done portion connected the medication.
The American Association of Oral and Maxillofacial Surgeons suggests performing surgery, specified arsenic extractions and implants, arsenic accustomed successful patients who person been treated with Prolia oregon akin drugs for little than 4 years and person nary objective hazard factors. It besides suggests discontinuing the osteoporosis medicine for 2 months anterior to performing the dental country if a diligent has been treated with it for much than 4 years, oregon has been treated with steroids. Osteoporosis medicines are restarted erstwhile the bony has healed.
Dear Dr. Roach: I visited an oculus doctor, and I person a posterior vitreous detachment (PVD). I americium a 59-year-old female. Can you counsel me? Can I spell blind? I americium very, precise scared.
— T.R.
Dear T.R.: The posterior enclosure of the oculus contains a large, gel-filled operation called the vitreous body, which is successful interaction with the retina, the portion of the oculus with the airy sensors. There is simply a bladed membrane that separates the vitreous from the retina, and this whitethorn go detached. Posterior vitreous detachments are common, particularly arsenic we age. This is not the aforesaid arsenic a retinal detachment, due to the fact that successful a PVD, the retina remains successful place, and truthful the imaginativeness is not needfully threatened successful a idiosyncratic with PVD, whereas a retinal detachment is an exigency that needs contiguous care. Floaters and flashing lights tin beryllium symptoms some of a retina teardrop and a PVD, truthful these symptoms should beryllium promptly evaluated.
The main interest with a PVD are complications, particularly a teardrop of the retina, which happens astir 15% of the clip successful radical with a PVD. A retina teardrop usually happens astatine the aforesaid clip arsenic the PVD. Another complication is called an epiretinal membrane, a benignant of scar insubstantial that tin sometimes impact vision. This occasionally needs surgery.
Changes successful the oculus tin decidedly beryllium scary, but the symptoms of a posterior vitreous detachment subside successful a fewer months for astir people, and nary circumstantial attraction is needed.
Readers whitethorn email questions to ToYourGoodHealth@med.cornell.edu.
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