When someone is first diagnosed with myeloma, there's often a lot to think about, especially when it comes to dental care. In this video, we'll explore what types of dental work can be safely done during induction therapy and which procedures should be completed before starting bone strengthening treatments like bisphosphonates or denosumab. Understanding the right timing for dental care can help prevent complications, and keep your mouth and your myeloma treatment on the right track.

What types of dental work should be done before starting any bone strengthening therapies? For multiple myeloma, because it's the cancer that commonly affects the bones and causes your bones to be brittle or more fragile. We commonly use a bone strengthening agent called zometa or Xgeva or denosumab, basically, which are bone strengthening agents that help prevent bone breakdown. And so it's an important part of our management, especially for newly diagnosed myeloma patients, especially if you have a lot of bone lesions, we would want to use those drugs.

And unfortunately those drugs have a small side effect. I think it is about 5% or so of, causing something called is osteonecrosis of the jaw, especially. And so what that means is, some damage to your jaw bones and the risk of those complications occurring are higher if you have existing, poor dental hygiene or if you have any signs of infection in your teeth, or if you're going to get any invasive dental procedures like getting root canals or getting extractions. So this is absolutely not recommended while you are on the bone strengthening therapy with zometa or denosumab.

So I would really recommend that before we can start you on those bone strengthening agents, we strongly recommend that you get clearance from your dentist. So you basically get like a baseline dental exam. Make sure that you don't have any infection or any invasive procedures that need to be done. And if so, we would want you to be done with those procedures before we start you on these bone strengthening agents.

The other aspect of doing dental work, especially invasive dental work, would be to make sure that you're not actively on chemotherapy because most of the agents or drugs that we use as part of chemotherapy, when you diagnose myeloma, they can cause your blood counts to go down. So if your white blood cell count is low, that puts you at a higher risk of getting an infection from any invasive procedure. If your platelet count is low, that puts you at a higher risk of bleeding from any invasive procedure.

So, ideally, when patients are diagnosed with multiple myeloma and they are in the process of about to be starting chemotherapy, that would be a good time to go see your dentist, get like a baseline dental exam and make sure you don't need any invasive procedures. And sometimes, you know, you don't have that window, because your disease is out of control and you need to start chemotherapy right away. Or even bone strengthening agents right away.

And then at that point, we would basically, find a window where we can hold chemotherapy. A few months later, once your cancer is under control, we can find that gap in your chemotherapy schedule where we can give you a break off of chemotherapy so your blood counts are back up in the normal range. And we can give you a break off of the bone strengthening agents. And then you can get those dental procedures done.

Should you take preventive (prophylactic) antibiotics before dental work? If so, who needs them? Everyone or only certain people. if you are on active chemotherapy, it may be a good idea to take a course of antibiotics. But other than that, only if your dentist recommends you take a course of antibiotics. Cause if they when they're doing the procedure, they find some sort of deep rooted infection and they give you a course of antibiotics for that. Absolutely. You need to take that. Otherwise, we don't commonly need to take prophylactic antibiotics,

What type of dental work is okay while on treatment? Cleaning, getting fillings, anything that is not in reserve that doesn't involve the dentist going down deep down in your jaw bone and, doing any kind of invasive procedures is fine. So you can get routine, cleaning and fillings done even while on chemotherapy or while on the bone strengthening agents. There is no contraindication to that.

Why is good dental hygiene important? one thing is, again, as I said, like the, risk of the osteonecrosis of the jaw that is, high when you are on the bone strengthening agents. And, that happens, especially if you have, a deep rooted dental infection. So to prevent those kind of complications, and in general, whenever you are on chemotherapy, your immune system is a bit low. And so if you have any deep rooted infection, you know, those infections could worsen while you are on chemotherapy.

So in general, it is very highly recommended that, you maintain good dental hygiene, so that there is no seed of infection that could flare up or worsen when you get active chemotherapy. We absolutely recommend it before you are going to go through procedures like a stem cell transplant or CAR-T. It's highly, highly recommended that we get, like a baseline dental exam and make sure that your teeth like a baseline dental exam and make sure that your teeth are in good condition before we give you that big dose of chemotherapy for stem cell transplants or CAR-T cell therapy as your immune system would be quite down or low in those scenarios. And if you have a infection in your tooth, it could flare up quite easily.

Good dental care is an important part of myeloma treatment. By knowing which procedures are safe during induction therapy and making sure any major dental work is done before starting bone strengthening medications. You can help prevent serious complications. Always talk with your myeloma team and your dentist before any procedure so your care stays coordinated and safe.