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You might not expect dental problems to be related to multiple myeloma, but they can occur. Some research has shown that up to 30 percent of people with multiple myeloma have bone damage in the face or mouth.
However, there’s limited research on multiple myeloma and oral health, and many factors can affect whether dental problems develop.
Exactly how many people with myeloma have dental issues overall is unknown, but understanding the risks can help you take steps to protect your oral health. Here’s what you need to know about multiple myeloma and oral health so that you can protect your well-being, confidence, and overall quality of life.
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People living with multiple myeloma may face a higher risk of dental problems. Factors such as age and certain treatments may play a role.
Multiple myeloma is more common in older adults, who also have a higher risk of treatment-related side effects. Older adults may have other health conditions or existing dental problems such as dry mouth, cavities (tooth decay), and periodontitis (gum disease), which can add to their risk.
Certain types of cancer treatment can raise the risk of dental problems. For example, chemotherapy and radiation therapy can contribute to dry mouth, mouth sores, tooth decay, and gum disease. That’s why health experts recommend having any existing dental issues evaluated and treated before you start therapy.
Bisphosphonates, such as zoledronic acid and pamidronate, are recommended to help treat bone damage in multiple myeloma. Although bisphosphonates help prevent bone fractures, they sometimes cause problems with bone healing.
Bisphosphonates are linked to osteonecrosis of the jaw (ONJ), a serious condition in which part of the jawbone becomes damaged and dies. You may see it called medication-related osteonecrosis of the jaw (MRONJ) or bisphosphonate-related osteonecrosis of the jaw (BRONJ). The risk rises after invasive dental procedures or dental surgery.
You can reduce your risk of dental issues during bisphosphonate treatment through regular oral health monitoring with your oncologist and dentist.
Cleanings, fillings, and crowns can usually be done safely during bisphosphonate therapy. However, more invasive dental procedures, such as tooth extractions, dental implants, or jawbone surgery, should be discussed with your oncology team beforehand. They can assess your risks and help determine whether any changes to your bisphosphonate treatment are needed.
Multiple myeloma can affect oral health in several ways.
Between 70 percent and 80 percent of people with multiple myeloma develop bone disease. Myeloma causes bone to break down faster and makes it harder for the body to rebuild bone.
Over time, bones may become thinner, form holes, and weaken, making them more likely to break. When the jawbone is affected, it can cause dental issues such as bone pain.
Gingival masses (tumors that form on gums) can be an early symptom of multiple myeloma. They can also be a sign that multiple myeloma has spread to new areas. These tumors can be misdiagnosed, so it’s important to mention any new or ongoing gum issues to your healthcare team.
Multiple myeloma affects the jawbone in an estimated 14 percent to 30 percent of cases and may cause osteolytic lesions (areas of bone damage). Symptoms of jaw lesions include:
If you notice any jaw symptoms, tell your dentist and your oncologist right away. Early treatment of multiple myeloma can help slow disease progression and prevent complications, including worsening dental symptoms.
One MyMyelomaTeam member reported, “The pain in my jaw is getting better from the lesions in the skull, so the chemo from last weekend is working.”
Medication-related osteonecrosis of the jaw is an uncommon but serious condition associated with certain medications used to treat bone disease in multiple myeloma, such as bisphosphonates.
The risk of MRONJ is higher for people who receive bisphosphonates intravenously. Longer treatment and greater exposure to these medications also increase the risk.
MRONJ is estimated to affect about 5 percent of people with multiple myeloma. If you notice symptoms such as loose teeth, exposed jawbone, pus or discharge in your mouth, or unusual swelling or tenderness, talk with your dentist and care team right away about treatment.
Some members at MyMyelomaTeam have described their experiences with ONJ. “On Thursday I had a dental procedure for osteonecrosis of the jaw,” one member said. “The infection was scraped out and sent out for biopsy. I am doing well. I can only eat soft foods for now.”
Cancer treatment, especially chemotherapy, can cause mouth problems that aren’t directly caused by multiple myeloma. These oral problems may include:
Ask your doctor what to expect from your treatment, how to watch for possible complications, and what to do if you notice oral symptoms.
“After my first week of chemo, my gums have started bleeding,” one MyMyelomaTeam member said.
Another shared, “Still having side effect issues from my treatments — fatigue, headaches, and my gums and teeth hurt to the extent that it is hard to eat.”
Preventive dental care during and after multiple myeloma treatment can help protect your oral health. Daily oral hygiene, regular dental checkups and cleanings, and dental X-rays when needed can help prevent dental problems and catch them early.
“Make sure you get regular dental visits,” advised one MyMyelomaTeam member. “I developed osteonecrosis, and it was diagnosed on a routine dental exam.”
It’s a good idea to communicate with your dentist and oncologist about dental checkups and any dental work you might need. Your dentist may not regularly treat people with multiple myeloma, so make sure they know about your diagnosis and treatments.
“I believe it is critical for your general healthcare to build a relationship of mutual trust with your physicians, nurses, and all other medical and general support staff who are involved in your care,” one MyMyelomaTeam member said. “Also, from personal experience, if you have other ongoing issues, make sure to keep all your physicians aware of their current state.”
— A MyMyelomaTeam member
Once your healthcare team understands your multiple myeloma dental considerations, they can work together to support your dental health and myeloma treatment plan.
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I am 93 years old, and was diagnosed with Multiple Myeloma about a year ago, after about 10 years with MUGUS
My treatment is nat-lenalidomide and dexamethasone. I went from Chain blood results of… read more
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