What Myeloma Treatment Can Do to Your Teeth—and Why Nobody Talks About It

The unexpected connection between myeloma treatment, dry mouth, dental problems, and the health of your jaw.

There are some side effects of myeloma treatment everyone warns you about.

Fatigue. Nausea. Hair loss. Neuropathy. Low blood counts.

Your teeth? Not so much.

I was fortunate. I went through chemotherapy, high-dose melphalan, and a stem cell transplant without developing significant problems with my teeth.

But over the years, I've watched patient after patient describe something very different.

“My teeth have gotten terrible since treatment.”

“I never had cavities like this before.”

“My teeth are breaking.”

“My mouth is constantly dry.”

“My dentist says I need an extraction, but my oncologist is concerned about my bone medication.”

When you hear the same complaints often enough, you start wondering whether there's actually a connection.

There is.

And like so many things with multiple myeloma, there isn't just one explanation.

It May Start with Something as Simple as Saliva

We don't give saliva much thought until we don't have enough of it.

Saliva does much more than keep your mouth wet. It helps wash food particles from your teeth, control bacteria, neutralize acids, and protect tooth enamel.

Cancer treatment and many of the medications used during treatment can contribute to dry mouth, or xerostomia.

That can create the perfect environment for dental problems.

With less saliva protecting the mouth, bacteria and acids have more opportunity to damage teeth. Over time, that can contribute to cavities, tooth decay, gum problems, sensitivity, and oral infections.

So, when someone says, “My teeth went downhill after cancer treatment,” it doesn't necessarily mean the treatment directly attacked their teeth.

Sometimes treatment changes the environment that had been protecting those teeth every day.

Chemotherapy Affects More Than Cancer Cells

Chemotherapy targets rapidly dividing cells. Unfortunately, cancer cells aren't the only rapidly dividing cells in our bodies.

The cells lining our mouths can be affected, too.

That's one reason chemotherapy can cause mouth sores, inflammation, changes in taste, infections, and other oral problems.

During a stem cell transplant, there is another concern: our blood counts can become extremely low.

Low white blood cells can make infections more dangerous. Low platelets can increase the risk of bleeding. Meanwhile, tissues in the mouth may not heal as normally as they would when the immune system and blood counts are healthy.

That means dental care during treatment sometimes requires coordination between the dentist and oncology team rather than simply making an appointment and having a procedure done.

Then There Are the Bone-Strengthening Drugs

This is one every myeloma patient should know about.

Many of us are offered medications specifically to protect our bones because myeloma can interfere with normal bone remodeling and cause lytic lesions, fractures, and other skeletal damage.

These medications may include zoledronic acid (Zometa), pamidronate (Aredia), or denosumab (Xgeva).

They can provide important protection for myeloma-damaged bones, but they also carry a risk of a serious complication called medication-related osteonecrosis of the jaw, or MRONJ.

In simple terms, an area of jawbone can become exposed or damaged and fail to heal normally.

The risk is particularly important when someone needs an invasive dental procedure, such as a tooth extraction.

This doesn't mean people receiving these medications can't have dental care. Quite the opposite. Good preventive dental care becomes especially important. But your dentist needs to know about these medications, and invasive procedures may require coordination with your oncology team.

And don't assume it no longer matters simply because you finished treatment.

Tell your dentist about your myeloma history and any bone-modifying medications you've received, including medications you received in the past.

This One Was Personal for Me

When I was diagnosed with multiple myeloma, Zometa was one of the medications I was told I had to have because of the damage myeloma can cause to the bones.

I did what I tend to do.

I researched it.

I understood why it was recommended and the benefits it could provide, but I also learned about osteonecrosis of the jaw and the potential complications surrounding invasive dental work.

I didn't like that risk.

So, when it came time to make the decision for myself, I refused Zometa.

A few months after my myeloma diagnosis, my brother-in-law was diagnosed with non-Hodgkin lymphoma. Zometa became part of his treatment, and unlike me, he chose to receive it.

Later, he developed serious dental problems and eventually had to have all of his teeth removed. His history with Zometa added another layer of concern because invasive dental procedures can be more complicated for someone who has received these types of bone-modifying medications.

We were two cancer patients in the same family who made different decisions.

I refused Zometa because I wasn't comfortable accepting the risk. He received it and later faced serious dental problems that ultimately required the removal of his teeth.

I can't say Zometa alone caused what happened to my brother-in-law. Cancer patients can develop serious dental problems for many reasons, and receiving Zometa certainly doesn't mean someone will lose their teeth.

But what he went through reinforced the concerns I already had when I made my own decision.

Zometa and other bone-modifying medications can be extremely valuable for people with myeloma, particularly when the disease has weakened or damaged their bones. Every treatment decision involves weighing potential benefits against potential risks.

For me, this was one risk I wasn't willing to take.

Years later, I still haven't experienced the significant dental problems I worried about when I made that decision.

Does that prove I made the right decision for everyone?

Absolutely not.

It simply means I made the decision that was right for me.

Why Doesn't Everyone Have Dental Problems?

That's another important part of this conversation.

I didn't have them.

And that doesn't contradict the experiences of patients who have.

Multiple myeloma has taught me repeatedly that two people can receive similar treatments and walk away with completely different side effects.

One person develops severe neuropathy. Another doesn't.

One struggles with gastrointestinal problems. Another barely does.

One develops significant dental problems. Another finishes treatment with their teeth seemingly unchanged.

Treatment history, medications, age, existing dental health, saliva production, immune function, oral hygiene, nutrition, hydration, and individual biology can all play a role.

That's why I don't think we should dismiss someone's experience simply because it didn't happen to us.

Your Dentist Is Part of Your Cancer Care, Too

We spend so much time thinking about oncologists, hematologists, transplant specialists, nurses, pharmacists, and lab results that it's easy to forget about the dentist.

But oral health matters during cancer treatment and survivorship.

Your dentist should know:

• that you have or have had multiple myeloma;
• whether you've had chemotherapy or a stem cell transplant;
• which medications you're currently taking;
• whether you've received Zometa, Aredia, Xgeva, or another bone-modifying medication; and
• whether your blood counts or immune system are currently suppressed.

Your oncology team should also know when you're facing a significant dental procedure. Particularly an extraction or another procedure involving the jaw.

The goal isn't to make people afraid of going to the dentist.

It's exactly the opposite.

Preventive dental care can help identify smaller problems before they become bigger problems that may require invasive treatment.

Another Part of Life After Myeloma

Cancer treatment doesn't always end when the infusion stops.

Sometimes its effects show up in places where we never expected—our nerves, our eyes, our kidneys, our bones, our energy levels and, yes, even our mouths.

I was fortunate when it came to my teeth.

Other myeloma patients haven't been.

Their experiences are worth talking about because someone preparing for treatment today may be able to better protect their oral health tomorrow simply because another patient spoke up.

That's one of the reasons I continue writing about these seemingly little things.

Because after cancer, you discover that they really aren't little things at all.

Surviving cancer and living after cancer really are two different things.

And sometimes living after cancer means learning that something as ordinary as taking care of your teeth deserves a place in the cancer conversation, too.

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Medical disclaimer: This article reflects my personal experience and is for educational purposes only. It is not a substitute for medical or dental advice. Bone-modifying medications can provide important benefits for people with myeloma, and treatment decisions should be made with your healthcare team. Always tell your dentist and oncology team about current or previous bone-modifying medications before invasive dental procedures.