The Union Democrat

Osteoporos­is meds must be paused before oral surgery

- To Your Good Health Keith Roach, M.D. Email Dr. Roach, M.D., at Toyourgood­

DEAR DR. ROACH: Help! I am caught in a feud between my primary care doctor and my oral surgeon. For a number of years, I have been on Prolia for osteopenia. About a year ago, I had to have a tooth pulled; my oral surgeon said I must be off Prolia for at least four months; my doctor disagreed, saying it is more risky to stop the Prolia. I feel a bit like a ping-pong ball between the two of them and need some guidelines on Prolia and dental work. — ANONYMOUS

ANSWER: The concern here is of a condition called osteonecro­sis of the jaw. This is a rare (around one person per 10,000 taking Prolia, or a similar medicine, for 10 years) condition causing pain and swelling of the jaw, which can lead to exposed bone, infection and fracture of the jaw.

Whenever possible, a comprehens­ive dental evaluation should be done before a person starts on this kind of medication. Also, whenever possible, extraction­s and implants should be deferred. But sometimes that just isn’t possible, and the procedure needs to be done while on the medication.

The American Associatio­n of Oral and Maxillofac­ial Surgeons suggests performing surgery, such as extraction­s and implants, as usual in patients who have been treated with Prolia or similar drugs for less than four years and have no clinical risk factors. It also suggests discontinu­ing the osteoporos­is medicine for two months prior to performing the dental surgery if a patient has been treated with it for more than four years, or has been treated with steroids. Osteoporos­is medicines are restarted when the bone has healed.

DEAR DR. ROACH: I visited an eye doctor, and I have a posterior vitreous detachment (PVD). I am a 59-year-old female. Can you advise me? Can I go blind? I am very, very scared. — T.R.

ANSWER: The posterior chamber of the eye contains a large, gel-filled structure called the vitreous body, which is in contact with the retina, the part of the eye with the light sensors. There is a thin membrane that separates the vitreous from the retina, and this may become detached. Posterior vitreous detachment­s are common, especially as we age. This is not the same as a retinal detachment, because in a PVD, the retina remains in place, and so the vision is not necessaril­y threatened in a person with PVD, whereas a retinal detachment is an emergency that needs immediate care. Floaters and flashing lights can be symptoms both of a retina tear and a PVD, so these symptoms should be promptly evaluated.

The main concern with a PVD are complicati­ons, especially a tear of the retina, which happens roughly 15% of the time in people with a PVD. A retina tear usually happens at the same time as the PVD. Another complicati­on is called an epiretinal membrane, a type of scar tissue that can sometimes affect vision. This occasional­ly needs surgery.

Changes in the eye can definitely be scary, but the symptoms of a posterior vitreous detachment subside in a few months for most people, and no specific treatment is needed.

 ?? ??

Newspapers in English

Newspapers from United States