1. Dental Care for the Myeloma Patient
Andrew Bolas BDS FFDRCSI FDSRCS(Ed) MSc

2. What worries Dentists about Myeloma Patients?

3. History of “Medication Related Osteonecrosis of the jaws (MRONJ)
“Phossy Jaw” first described in young girls working in match factories
Marx described the presentation of exposed bone in a group of patients receiving bisphosphonates for cancer treatment 2002 – 2003
First case here in Sligo 2006
Ongoing debate as to why this mainly affects the jaws.
Guidance to all Irish dentists through the Irish Dental Journal 2010/2018

4. Risk factors Intravenous Bisphosphonates Long Half life of drugs
Dental extractions
Trauma from dentures
Dental infection
Poor oral hygiene
Smoking
Other chemotherapy drugs

5. Why are extractions a risk factor?

8. Clasts vs Blasts

9. 1% 0.1% What are the risks? Oral Bisphosphonates
Intravenous Bisphosphonates
Oral Bisphosphonates 1%
0.1%

10. How to reduce the risks
Dental check up before starting treatment, and regular check ups during treatment
Good oral hygiene
Any problems – get them checked as soon as possible – little problems are easier to fix than big ones
Tell the dentist the treatment you are on – dental treatment can be changed to suit this
Any sore spots/tight areas on dentures should be eased
Smoking cessation

11. The dental dilemma

12. Prevention is better than cure

13. What the dentist might do
Extract high risk teeth before treatment starts
Arrange for cleaning and a maintenance program
Fill any urgent teeth
Refer you

15. Signs to look out for: Exposed bone Non healing ulcers or sores
Teeth becoming loose
Discharge from the gums
Numbness or tingling of the lips or gums
A “heavy or dead” sensation on one side of the jaw

17. Antiseptic mouthwashes Conservative debridement Radical debridement
Treatment options
Antibiotics
Antiseptic mouthwashes
Conservative debridement
Radical debridement
Watch and wait

19. Good oral care Brush twice a day
You don’t have to brush all your teeth, just the ones you want to keep!
Use a fluoride toothpaste
Mouthwash or floss
Reduce your sugar intake
Avoid sticky or hard sweets

20. But I’m scared of the dentist

22. This is avoidable in most cases

23. Any Questions?