Invasive dental procedures can delay bisphosphonate and antimyeloma therapies in patients with multiple myeloma, findings from a case series study presented at ESMO Congress 2019 in Barcelona, Spain, have shown.1

Bisphosphonates, which can slow bone loss and reduce bone pain, are considered to be a critical component of supportive care for patients with myeloma-related bone disease. Nevertheless, the administration of bone-modifying agents (eg, zoledronic acid, denosumab) for oncologic indications has been associated with an increased risk of medication-related osteonecrosis of the jaw, particularly for patients undergoing invasive dental procedures.2

This study included 32 patients with multiple myeloma receiving intravenous bisphosphonate therapy between October 2018 and March 2019. Within this cohort, 4 patients (12.5%) required dental treatment: dental extraction in 2 patients, dental extraction with infection in 1 patient, and a dental fistula requiring surgical intervention in 1 patient.

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For the 2 patients requiring dental extraction, bisphosphonate treatment was interrupted for 6 months. In the other 2 patient cases, the need for dental intervention resulted in delays of planned autologous stem cell transplantation of 15 days and 1 month, respectively.

The importance of preventive dental care (eg, dental assessment and performance of any needed dental treatment) prior to administration of bisphosphonate treatment, as well as optimal routine oral care during such treatment was emphasized by the study authors.

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They suggest “a preventive approach with oral care before and during treatment with bisphosphonates can minimize the occurrence of complications associated with treatment and avoid interruptions.”1


1. Puigmarti CL, Santos N, Mostacedo S, Gonzalez Y. Prevention of dental complications in patients with multiple myeloma (MM) receiving bisphosphonates treatment. Presented at: ESMO Congress 2019; September 27-October 1, 2019; Barcelona, Spain. Abstract CN80.

2. Shapiro CL, Yarom N, Peterson DE, et al.  Medication-related osteonecrosis of the Jaw: MASCC/ISOO/ASCO clinical practice guideline summary [published online August 26, 2019]. J Oncol Pract. doi: 10.1200/JOP.19.00384