Ask the Nurse: Oral health and myeloma

Why does myeloma affect oral health?

People living with myeloma are more likely to have problems with their teeth, gums and mouth. This is partly because myeloma can weaken bones, including those in your jaw, which may affect your dental health. Read more about myeloma bone disease here. Myeloma also weakens your immune system, which can cause mouth ulcers and make it harder for your body to fight infections like gum disease.

How do myeloma treatments affect oral health

Some myeloma treatments can also impact your oral health:

• Chemotherapy and steroids can lower your body’s ability to fight off infections and heal.
• Immunomodulatory drugs such as lenalidomide (Revlimid®) may cause inflammation or other changes in the mouth.
• Bisphosphonates, which are prescribed to strengthen and protect bones, can in rare cases lead to a condition called osteonecrosis of the jaw, where the jaw bone doesn’t heal properly after major dental procedures or injury.
• Some treatments can cause dry mouth (xerostomia) which can increase the risk of tooth decay, mouth sores and discomfort.

If you notice any changes in your mouth be sure to report them to your healthcare team so they can investigate and help manage your symptoms.

What common oral health issues are associated with myeloma?

Myeloma and myeloma treatment can increase the likelihood of experiencing oral health issues. Common challenges people living with myeloma may face with their oral health include:

Infections

Because both myeloma and its treatments can affect how well a patient’s immune system works, infections are more common – including mouth infections. There are different types of infection – fungal infections like thrush (candidiasis) may cause soreness and white patches on the tongue or inside the mouth. Viral infections include herpes simplex, which causes cold sores. Bacterial infections often affect the gums and can lead to bleeding gums or bad breath. Good oral hygiene helps but it is important to contact your healthcare team if you suspect you have an infection.

Osteonecrosis of the jaw (ONJ)

Osteonecrosis of the jaw (ONJ) is a less common but serious complication of bisphosphonate treatment – a group of drugs used to treat and prevent myeloma bone disease. ONJ can cause one or more parts of the jawbone become exposed inside the mouth. Your healthcare team will discuss ONJ and preventative measures with you before you begin bisphosphonate treatment. Typically, it’s recommended to have a dental check-up to identify and  complete any necessary invasive dental work before starting bisphosphonate treatment to reduce this risk. Read more about ONJ, the causes and how to manage the condition in our Infosheet.

Mucositis

Some chemotherapy treatments, especially high-dose melphalan used before a stem cell transplant, can cause painful inflammation or ulcers in the mouth known as mucositis. This can make eating and drinking difficult. Your healthcare team will monitor mucositis symptoms and may be able to offer supportive treatments to relieve discomfort. You may find some useful tips for managing this in our Mouth care Infosheet

Bleeding gums and cracks at the corners of your mouth

Some treatments may cause gums to bleed more easily or cause painful cracks at the corners of your mouth. Your healthcare team should be notified so they can assess these.

Dry mouth (xerostomia)

Some treatments reduce saliva production, leading to a dry mouth which may cause discomfort and can increase the risk of tooth decay. Saliva substitutes – available as gels, sprays or mouth rinses can help relieve symptoms and maintain oral health.

Changes in taste

Certain treatments may cause changes in how food tastes, such as a decrease in flavour, familiar foods tasting different or everything having a metallic taste. This can affect your appetite, and you may find yourself eating less than usual. You can find tips on maintaining a healthy, balanced diet in our Infopack for Living Well with Myeloma (Section 6) and in the Diet and exercise section of our website.

While these side effects can be unpleasant and uncomfortable, they are usually only temporary and improve once treatment has finished or the myeloma is brought under control. Always discuss them with your healthcare team so they can help develop a management plan.

Why is it important to see a dentist?

It is recommended to continue having regular dental check-ups and hygienist appointments to ensure good oral health. It is important to tell your dentist or hygienist about your myeloma diagnosis and keep them updated with any treatments you are receiving.

It’s especially important to let them know if you’re receiving bisphosphonates, such as zoledronic acid (Zometa®), because of the risk of osteonecrosis of the jaw (ONJ). If you are planning any major dental work, let your healthcare team know in advance so they can help coordinate it safely.

How can I look after my oral health?

Taking good care of your oral health can help reduce the risk of many common problems, but some issues may still arise despite your best efforts. Here are some tips to help you maintain good oral health:

• Brush your teeth twice a day: use a soft toothbrush and fluoride toothpaste.
• Regular dental check-ups: keeping up with regular dental visits can help catch problems early and prevent them getting worse.
• Stay hydrated: drink plenty of clear fluids but keep within your daily allowance if your liquid intake is limited.
• Lip care: use lip balm to keep your lips moisturised and prevent them drying out.
• Keep your dentures clean: if you wear dentures be sure to clean them regularly and remove them at night.
• Inspect your mouth: regularly check your mouth for any changes, such as sores, bleeding or swelling and report any issues to your healthcare team.

If you are experiencing mouth problems it is important to let your healthcare team know, especially if you think you may have an infection. Some of the following tips may also help:

• Avoiding irritating foods: if you have a sore mouth, avoid spicy, acidic or salty foods that could irritate it more.
• Eat softer foods: choose foods that are easier to chew.
• Suck ice cubes or ice lollies: these can help to soothe sores and help a dry mouth.
• Saliva substitutes: over the counter gels, sprays and mouth rinses can be used to help lubricate the mouth. Sugar-free sweets and gum can also help stimulate saliva to relieve a dry mouth.

Oral health is an important part of living well with myeloma. You can find more information and support in our Infopack for Living well with myeloma and don’t hesitate to ask your healthcare team for further information on anything you may be unsure of.

If you have any further questions or need support, contact us through the Myeloma UK Infoline at 0800 980 3332 (UK) or use our Ask the Nurse email service.