Multiple myeloma, also called myeloma, is a cancer that develops in a type of white blood cell known as a plasma cell. It makes up about 10 percent of blood cancers and half of cancers that start in the bone.

Some people with multiple myeloma develop symptoms that affect their mouth. Researchers have come to varying estimates of how common oral symptoms are, but one 2018 study estimated that they affect 14 percent of people with myeloma.

Multiple myeloma often does not cause any symptoms in the early stages. The hallmark symptoms are often abbreviated with the acronym CRAB:

  • C: calcium elevation
  • R: renal (kidney) insufficiency
  • A: anemia
  • B: bone irregularities

In rare cases, oral symptoms may be the only noticeable symptoms of myeloma. When this happens, they can easily be overlooked.

Keep reading to learn more about how multiple myeloma affects your mouth and how oral symptoms are treated.

Multiple myeloma can cause a variety of oral problems, such as:

  • dental issues
  • bone damage
  • jaw pain
  • swelling

The oral symptoms of multiple myeloma can be difficult to differentiate from other conditions.

If you develop jaw pain or other concerning symptoms with no obvious cause, it’s a good idea to visit a dentist or doctor. They can examine your mouth and look for the underlying causes.

Most common signs and symptoms

In a 2018 study, researchers found swelling was the most common oral symptom among 81 people with myeloma who experienced mouth problems. Swelling affected 65.4 percent of people in the group.

The most common oral sign of myeloma discovered with imaging was the presence of osteolytic lesions.

Osteolytic lesions are areas of damaged and weak bone caused by an imbalance between the cells that break down and build new bone tissue.

Here’s a complete look at the signs and symptoms reported among the 81 people in the study:

Of people who had osteolytic bone lesions:

  • 80.2 percent had plasmacytomas, or bone tumors, from the buildup of plasma cells
  • 9.8 percent had punched-out lesions, which resemble a raindrop hitting the bone and splashing
  • half of people reported bone pain

In a 2020 study, researchers found a higher prevalence of oral symptoms than most other studies. In a group of 42 people with multiple myeloma, researchers found that 54.7 percent of people had symptoms in the soft tissue of their mouth, and 78.5 percent had symptoms in their hard tissue.

Pale mouth lining was the most common soft tissue symptom. It’s believed to occur due to anemia or a low red blood cell count.

The researchers found that 73.8 percent of people with multiple myeloma had jawbone lesions. Almost half of the people had lesions in their jaw, while the other half had lesions in both their lower and upper jaws.

According to the researchers, neurological symptoms are less common and estimated to occur in 1 percent of people. Two people in the study had facial paralysis.

Bisphosphonates and osteonecrosis

Bisphosphonates are a group of medications used to prevent bone damage in people with myeloma. They’ve been linked to a very rare side effect known as osteonecrosis of the jaw, according to 2017 research.

Osteonecrosis is a chronic condition that causes ulcers in the lining of your mouth that expose dead bone tissue. It may cause:

  • pain in your jaw or tooth
  • swelling
  • infection
  • teeth shifting

It’s critical to visit a doctor if you develop symptoms of osteonecrosis since they can also be symptoms of oral cancer.

Oral symptoms of multiple myeloma can often be overlooked since they can replicate symptoms of other conditions.

Multiple myeloma cannot be diagnosed solely with oral symptoms. If a doctor or dentist suspects you may have myeloma, they will likely want to do further testing.

A bone marrow biopsy is usually needed to confirm the diagnosis. It involves injecting a thin needle into a bone, usually your pelvis, and removing a small sample of the bone marrow for analysis.

Other tests might include:

Oral symptoms are treated on a case-by-case basis depending on which symptoms you’re experiencing. For example, osteolytic lesions may be treated with bisphosphates combined with specific treatments for cancer, like chemotherapy or radiation therapy.

A doctor can help you develop a treatment plan for myeloma. They may recommend a number of treatments for managing your symptoms, such as:

Learn more about multiple myeloma treatment.

Symptoms usually do not appear in the early stages. When they do appear, myeloma symptoms commonly include:

Are oral signs and symptoms of multiple myeloma rare or common?

Estimates vary widely about the prevalence of oral symptoms in people with myeloma. One 2013 review of studies estimated that 14 percent of people with myeloma develop oral symptoms.

Do oral signs and symptoms of multiple myeloma develop early or late?

Myeloma rarely initially presents with oral symptoms, but they may be the primary signs of disease in the advanced stages. Often, myeloma does not cause any noticeable symptoms in the early stages.

Can a dentist diagnose multiple myeloma at a regular checkup?

A dentist may suspect that some of your symptoms could be caused by myeloma or oral cancer. If this is the case, they’ll likely refer you for further testing to confirm the diagnosis.

What other conditions might these oral signs be confused with?

Jaw lesions caused by myeloma can be difficult to diagnose. They can mimic other conditions, such as:

Multiple myeloma does not usually cause symptoms in the early stages. Rarely, oral symptoms like jaw pain, swelling, or dental issues may be the initial symptoms of late-stage myeloma.

It’s not clear how many people with myeloma develop oral symptoms, but research suggests oral symptoms are not uncommon. It’s a good idea to visit a doctor or dentist if you experience jaw pain, swelling, or dental problems for a proper evaluation.