You might not expect dental problems to be related to multiple myeloma, but they’re actually quite common. In up to 30 percent of cases, multiple myeloma can affect the bones in the face or mouth.

Exactly how many people with myeloma have dental issues overall is unknown, but understanding the risks can help you take steps to prevent problems. Here’s what you need to know about multiple myeloma and oral health — so you can protect your comfort, confidence, and overall quality of life.

Risk Factors for Dental Problems

People living with multiple myeloma already face a higher risk of dental problems. Other factors, such as age and myeloma treatment, can make these issues more or less likely.

Age

Multiple myeloma is more common in older adults, who also have a higher risk of treatment-related side effects. Older people may also have other health conditions or existing dental disease that can complicate oral health.

Treatment

Certain types of cancer treatments can raise the risk of dental problems. Researchers and doctors recommend that any existing dental issues be treated before starting therapy.

Bisphosphonates are often used to treat bone damage and systemic hypercalcemia (high levels of calcium in the blood) caused by multiple myeloma. Examples of bisphosphonate medications include zoledronic acid (Zometa) and pamidronate (Aredia).

Dental exams before bisphosphonate therapy can reveal problems that need surgical or invasive dental treatment. This is important because even though bisphosphonates help protect bones, they sometimes cause problems with bone healing, especially after dental surgery.

During bisphosphonate treatment, be sure both your oncologist (cancer doctor) and your dentist check your oral health at least once a year. Invasive procedures, such as tooth extractions, dental implants, and mandible (jawbone) surgery, should be avoided. If these procedures are needed, bisphosphonate treatment should be paused for 90 days before and after the dental work. Less invasive procedures, such as cleanings, fillings, and crowns, can usually be done safely during bisphosphonate therapy.

Another medication, denosumab (Xgeva), which is sometimes used in people with multiple myeloma, has also been linked to osteonecrosis. This condition occurs when part of the bone loses its blood supply, causing the bone tissue to die.

Dental Problems Related to Multiple Myeloma

Are you wondering, “How does multiple myeloma affect the mouth?” This condition can have an impact on oral health in several ways.

1. Myeloma-Associated Bone Disease

Between 70 percent and 80 percent of people with multiple myeloma develop bone disease. Myeloma causes bone to break down faster and also makes it harder for the body to rebuild bone. Over time, bones may become thinner, form holes, and weaken — and be more likely to break.

There’s no specific research on how often this happens in the jaw, which isn’t among the most commonly affected areas. However, the jaw is made of bone, so it’s possible that it could be affected by myeloma.

2. Tumors on the Gums

Gingival masses (tumors that form on gums) appear in about 8 percent to 15 percent of people with myeloma. Sometimes, these lesions may be among the first signs of the disease. These tumors can also be a sign that multiple myeloma has spread to new areas.

Estimates of how common gingival masses occur in multiple myeloma vary widely, from less than 2 percent to 70 percent. These tumors tend to be misdiagnosed, so it's important to mention any new or ongoing gum issues to your dentist or doctor.

3. Bone Lesions on the Jaw

In 30 percent to 35 percent of people with multiple myeloma, the disease spreads to the jaw. Symptoms may include:

• Jaw pain
• Loose teeth
• Swelling in the jaw or tongue
• Numbness or tingling in the mouth
• Jaw fractures
• Delayed healing after having a tooth pulled

If you notice any jaw symptoms, tell your dentist and your oncologist right away. Early treatment can help you feel better and prevent complications. 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.”

4. Osteonecrosis of the Jaw

Osteonecrosis of the jaw (ONJ) happens when the jaw becomes exposed inside the mouth and begins to die due to a lack of blood supply. Also called medication-related osteonecrosis of the jaw, this condition is linked to drugs that are sometimes used to treat multiple myeloma, including bisphosphonates and denosumab.

ONJ is rare, but the risk is slightly higher for people who receive bisphosphonates intravenously (into a vein). Estimates suggest that ONJ affects between 3 percent and 11 percent of people taking these drugs, and the risk rises the longer the medication is used. If you notice loose teeth, exposed jawbone, pus or discharge in your mouth, or unusual swelling or tenderness, talk to your dentist right away so you get treatment for ONJ.

Some members at MyMyelomaTeam have shared their experiences. “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.”

5. Other Issues Related to Multiple Myeloma Treatments

Cancer treatment, especially chemotherapy, can cause mouth problems that aren’t directly related to multiple myeloma. These oral issues may include:

• Unexplained pain
• Infections
• Mucositis (inflamed or irritated mouth linings)
• Changes in how foods taste
• Dry mouth

These side effects can happen during treatment or months or years later. Your doctor can give you more information about how long you should be watchful and what to do if these problems occur.

“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.”

The Importance of Regular Dental Care

Preventive dental care, including daily oral hygiene, regular oral checkups, teeth cleanings, and dental X-rays, can help lower your risk of serious dental problems. “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 have your dentist and oncologist speak with you and each other about dental checkups and any dental work you might need. Most dentists don’t regularly see people with multiple myeloma, so they may not know about the risks involved. Once they understand your needs, they can be a key part of your care team, protecting your dental health and supporting your overall treatment plan.

“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 member shared. “Also, from personal experience, if you have other ongoing issues, make sure to keep all of your physicians aware of their current state.”

Be sure to get regular cleanings and checkups. These preventive steps can help catch dental issues early and lower your risk of serious dental problems such as ONJ.

Talk With Others Who Understand

MyMyelomaTeam is the social network for people living with multiple myeloma and their loved ones. On MyMyelomaTeam, more than 28,000 members come together to ask questions, give advice, and share their stories with others who understand life with multiple myeloma.

Have you experienced dental issues while living with multiple myeloma? Do you take steps to help avoid problems with your jaw, teeth, and mouth? Share your experience in the comments below, or start a conversation by posting on your Activities page.