Jill Meyer-Lippert and Jennifer Brown are co-authors of a series of in-depth articles on the oral side effects of cancer treatment and the importance of getting prompt medical/dental treatment. Treatment delays can compromise outcomes. Being a knowledgeable patient is a must!
This article focuses on the impact of multiple myeloma on oral health.
Multiple Myeloma is considered a blood cancer that affects plasma cells within the bone marrow. Plasma cells play an important role in the immune system. The overgrowth of cancerous plasma cells can crowd out normal cells resulting in a weakened immune system and putting the survivor at risk for developing infections.
Tumors associated with Multiple Myeloma normally occur in bone, weakening the area around the tumor. The disease can also weaken bones by interfering with the natural process of remodeling that occurs in our bodies throughout our lifetime. These characteristics of Multiple Myeloma can result in the risk of Skeletal Related Events. Skeletal Related Events include bone pain, bone fractures and spinal compressions.
So, how can this affect your mouth?
Not only can the disease itself put one at risk for oral infections due to a weakened immune system, many treatments for Multiple Myeloma can also carry significant risks for acute and long-term adverse changes to one’s oral health. We will focus on a few treatments commonly used for Multiple Myeloma that pose the greatest risks for oral complications.
Chemotherapy can induce several side effects, including dry mouth, mouth sores (oral mucositis), loss of taste/taste changes and an increased risk for tooth decay and infections. While these complications may be limited to the time while in active treatment, they can cause pain and discomfort, compromise nutrition and potentially cause alterations or delays in treatment. Long-term damage to teeth and gum health is also possible, requiring time consuming and costly dental care long after cancer treatments are complete.
Many factors determine which side effects occur, including the type of chemotherapy, the dosage, the duration of treatments, and current status of overall and oral health of the patient. Lifestyle habits including oral care, tobacco and alcohol use can also have a tremendous impact.
Short-term and long-term oral side effects of chemotherapy may be minimized or possibly prevented with a combination of preventive professional dental care, diligent homecare and product selection.
Stem Cell Transplant
Stem cell transplants, also known as bone marrow transplants, are a common treatment consideration for Multiple Myeloma. Preparing for a stem cell transplant requires high doses of chemotherapy and, in some cases, full body radiation to kill the cancer cells within the bone marrow. Healthy blood-forming cells are then infused to replace the cancerous cells and rebuild a stronger immune system.
The process to prepare for a transplant leaves the patient at very high risk for all of the above-mentioned side effects associated with chemotherapy. It is estimated that while approximately 40% of those receiving standard dose chemotherapy will experience problems with mouth sores, up to 80% of those receiving a stem cell transplant will develop some level of oral mucositis. The sores are not only a pain and nutrition concern but also a significant source for infection.
Multiple Myeloma patients may be given medications called bisphosphonates to help build and maintain bone strength. Bisphosphonates change the complex process and balance of natural bone formation and resorption. While this is important for the management of the disease these medications can lead to a rare complication referred to as Medication Related Osteonecrosis of the Jaw, also known as MRONJ. Osteonecrosis means “bone death”. MRONJ can occur in areas that support upper and lower teeth resulting in exposed bone creating high potential for secondary infections to develop. Symptoms include:
- Pain in the mouth
- A feeling of numbness or heaviness in the jaw
- Swelling in the mouth
- Drainage in the mouth
- Loosening of teeth
- Exposed bone in the mouth
While MRONJ is considered a rare side effect, it is extremely difficult to manage and in some cases, attempts to treat this condition is a lifelong process. MRONJ can result in pain, infections, tooth loss and disfigurement. Most cases occur as a result of some type of trauma or invasive dental procedure like a tooth extraction but rarely can occur spontaneously. This is why a thorough dental examination and preventive dental care is so essential BEFORE starting these medications.
Also, a “new normal” of oral health care and prevention will be essential. A meticulous and proactive approach to your daily oral care routine will help avoid dental complications that make invasive dental treatments necessary. You should develop a close relationship with your dental professional team that can help identify your unique needs to prevent oral disease and monitor for early signs of MRONJ increasing the chance for successful treatment. More information about Bisphosphonates can be found at What Are Bisphosphonates?
Ideally, treatment for Multiple Myeloma would be approached by a team of professionals, including oral healthcare professionals to address dental needs and provide education with individualized prevention and management protocols. When possible, this should be done prior to the start of treatment to minimize risk and the severity of side effects. If this is not offered through the facility and physicians who are providing cancer therapy, it is wise for the newly diagnosed to seek guidance from dental professionals who are knowledgeable in the field known as Dental Oncology.
Knowledge is power.
Understanding potential complications of cancer therapies is the best defense to reduce your risks. A proactive and preventive approach to oral health is vital to reduce the impact of these life changing side effects.