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Multiple Myeloma and Dental Problems

Medically Reviewed by Neha Pathak, MD on April 19, 2021

Multiple myeloma is a rare type of cancer that affects your plasma cells, a type of white blood cell found mainly in the bone marrow that plays an important role in your body’s immunity. But when these cells become out of control and cancerous, they interfere with healthy cells in different parts of the body.

The cancer, which affects more men than women, may have varying symptoms. But it’s more widely known for things like bone pain, calcium problems, low blood count, infections, and kidney issues. However, complications from multiple myeloma can, for some people, lead to dental problems.

How Does Multiple Myeloma Affect Your Teeth?

Dental problems, while rare, can sometimes be the first sign of the disease. In fact, in about 30% of the cases, it can affect your mouth cavities and facial bones like the jaw.

It can show up as:

  • Toothache
  • Loose teeth
  • Gingival masses -- lumps or growths on gums
  • Swelling in the dental cavity
  • Bone pain in the mouth
  • Burning (paresthesia)
  • Osteolytic lesions -- “punched out” looking bone loss

If this happens, tell your dentist or doctor about it. They can see if there are underlying issues causing the problems and treat you accordingly.

But you may also have serious dental problems like jaw pain as a side effect when you get treatment for bone damage caused by multiple myeloma cells.

How Is Bone Damage Linked With Jaw Pain?

To understand why this may happen, it’s important to know that bone damage happens with multiple myeloma when two cell functions go wrong. The cancerous plasma cells interfere with two types of bone cells responsible for bone growth: osteoclasts, which remove old bone cells, and osteoblasts, which replace them with new bone cells.

Multiple myeloma speeds up the osteoclasts’ job of dissolving your old bones. But this happens faster and before good bone cells can take their place. This can lead to osteolytic lesions or spots of bone damage that may cause pain. It also makes your bones weak and brittle and may cause fractures easily. About 80% of people with multiple myeloma get bone disease.

To slow down the bone breakdown and help them stay strong, your doctor may prescribe you drug therapies. One of them is called bisphosphonates. The drug is given once a month through your vein or by mouth. The dosage may be reduced if works well for you.

Drugs commonly used include:

Bisphosphonate helps to prevent more bone damage if you have MM. However, it does have one rare, serious side effect called osteonecrosis of the jaw (ONJ). It happens when the bone cells in your jawbone break down a lot or die. It may look like you have an exposed area on bone in your mouth.

ONJ as a side effect is a relatively new discovery in medicine. It was first seen in 2002, and the American Association of Oral and Maxillofacial Surgeons uses the term "medication-related osteonecrosis of the jaw” to describe it.

The symptoms may vary from mild to severe. It can include:

  • Tooth pain
  • Jaw pain
  • Swelling in the jaw
  • In severe cases, infection

The risk of getting ONJ is higher if you take bisphosphonates through your veins. You can also trigger ONJ after you get dental surgery or a tooth pulled. If this happens, it may take a while for your jaw to heal.

Depending on the severity, your doctor may put you on a treatment plan that includes:

  • Mouthwash
  • Antibiotics if you have an infection
  • Gels to put directly on your gums
  • Dental work to remove the affected area

Experts aren’t sure why ONJ happens when you take multiple myeloma drugs and don’t know what may prevent this. If you're taking multiple myeloma medications and you develop ONJ in the mouth, your doctor may stop your treatment.

What You Can Do

If you have dental problems as the first sign of multiple myeloma, your dentist may refer you to a cancer specialist called an oncologist. The doctor may perform a physical exam, take a detailed medical history, and do lab urine tests to confirm the cancer. Depending on the severity of your cancer, your health care team may come up with a treatment plan to address the cancer.

If you’ve already been diagnosed with multiple myeloma, tell your doctor if you have plans to get some dental work done. It’s best to avoid dental procedures while you’re taking bisphosphonates to treat multiple myeloma.

It may be a good idea to get your dental work before you even start the treatment. But research shows that things like teeth fillings, root canal procedures, and tooth crowns don’t seem to cause ONJ.

But if you’re looking to avoid a trip to the dentist altogether, practice oral hygiene in your day-to-day routine. You can:

  • Brush twice a day.
  • Floss.
  • See to it that dentures fit properly.
  • Have regular dental checkups.
WebMD Medical Reference

Sources

SOURCES:

UpToDate: “Medication-related osteonecrosis of the jaw in patients with cancer.”

American Cancer Society: “Drug Therapy for Multiple Myeloma,” “What is Multiple Myeloma?”

European Journal of Dentistry: “Toothache as the initial symptom of plasma cell myeloma.”

Journal of Maxillofacial and Oral Surgery: “Multiple Myeloma presenting as Gingival mass.”

Hematology, Transfusion, and Cell Therapy: “Can dentists detect multiple myeloma through oral manifestations?”

Cancer Growth and Metastasis: “Bone Disease in Multiple Myeloma: Pathophysiology and Management.”

Memorial Sloan Kettering Cancer Center: “Osteonecrosis of the Jaw (ONJ).”

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