Can dentists detect multiple myeloma through oral manifestations?

An electronic database search was performed of articles published from 1971 to November 2016 in order to identify studies that reported oral manifestations of patients with multiple myeloma. Case reports and case series with oral manifestations of multiple myeloma in English were included in the study. An additional search was performed of the references of the selected articles.

Results:

Thirty-seven articles that reported 81 patients with oral manifestations of multiple myeloma were selected: 30 case reports (82%) and seven case series (18%). The most common clinical features in the dental cavity were swelling (65.4%), bone pain (33.3%), paresthesia (27.1%) and amyloidosis lesions (11.1%). Osteolytic lesions detected on imaging exams were reported in the majority of the patients (90.1%) as plasmacytomas or ‘punched-out’ lesions.

Conclusions:

Swelling and osteolytic lesions represent the most common clinical and radiographic signs of the jaws relating to multiple myeloma, respectively.

Keywords:
Multiple Myeloma; Oral Manifestations; Mouth; Jaws

Author	Study type	Sample size/number of patients with oral manifestations	Symptom	Clinical sign	Imaging aspects of lesions	Type of image	First detected sign of MM
Barret al.⁸8 Barr GS, Zweig B, Itkin AB. Intraoral corroboration of systemic plasma-cell myeloma. Abbreviated case report. Oral Surg Oral Med Oral Pathol. 1976;42(1):22-5.	Case report	1/1	Pain	Swelling	Multiple diffuse lytic	Non specified	No
Yoshimura et al.⁹9 Yoshimura Y, Takada K, Kawai N, Hasegawa K, Ishikawa T. Two cases of plasmacytoma in the oral cavity. Int J Oral Surg. 1976;5(2):82-91.	Case report	2/2	Pain	Swelling	Multiple diffuse lytic Punch-out	Skull and periapical radiograph CT	Yes
Kraut et al.¹⁰10 Kraut RA, Buhler JE, LaRue JR, Acevedo A. Amyloidosis associated with multiple myeloma. Oral Surg Oral Med Oral Pathol. 1977;43(1):63-8.	Case report	1/1	Difficulty chewing	Amyloidosis in upper lip	Multiple diffuse lytic	Skull radiograph	No
Flick et al.⁴⁰40 Flick WG, Lawrence FR. Oral amyloidosis as initial symptom of multiple myeloma. A case report. Oral Surg Oral Med Oral Pathol. 1980;49(1):18-20.	Case report	1/1	None	Amyloidosis in the tongue	-	-	Yes
Salisbury et al.⁴⁴44 Salisbury PL, Jacoway JR. Oral amyloidosis: a late complication of multiple myeloma. Oral Surg Oral Med Oral Pathol. 1983;56:48-50.	Case report	1/1	Pain Bleeding on the buccal mucosa	Amyloidosis in the tongue	-	-	No
Epstein et al.¹¹11 Epstein JB, Voss NJ, Stevenson-Moore P. Maxillofacial manifestations of multiple myeloma. Oral Surg Oral Med Oral Pathol. 1984;57(3):267-71.	Case report	1/1	Pain Trismus	None	Punch-out lytic with root resorption	Pantomographic radiograph	No
Babajews et al.⁴¹41 Babajews A. Occult multiple myeloma associated with amyloid of the tongue. Br J Oral Maxillofac Surg. 1985;23(4):298-303.	Case report	1/1	None	Amyloidosis in the tongue	-	-	Yes
Raubenheimer et al.⁴²42 Raubenheimer EJ, Dauth J, Coning JP. Short communications & case reports Multiple myeloma presenting with extensive oral and perioral amyloidosis. Oral Surg Oral Med Oral Pathol. 1986;61(5):492-7.	Case report	1/1	Pain Dysphagia	Amyloidosis in the tongue, Parotid gland and gum Hyposalivation	-	-	Yes
Jacobs et al.⁴⁵45 Jacobs P, Sellars S, King HS. Massive macroglossia, amyloidosis and myeloma. Postgrad Med J. 1988;64(755):696-8.	Case report	1/1	Dyslalia Dysphagia	Amyloidosis in the tongue	-	-	No
Lambertenghi et al.¹²12 Lambertenghi-Deliliers G, Bruno E, Cortelezzi A, Fumagalli L, Morosini A. Incidence of jaw lesions in 193 patients with multiple myeloma. Oral Surg Oral Med Oral Pathol. 1988;65(5):533-7.	Case series	193/10	Pain Paresthesia	Swelling in the mandible (2 cases)	Multiple lytic (9 cases) Single (1 case) Diffuse (8 cases)	Skull radiograph Lateral skull tomogram	No
Tamir et al.¹³13 Tamir R, Pick a I, Calderon S. Plasmacytoma of the mandible: a primary presentation of multiple myeloma. J Oral Maxillofac Surg. 1992;50(4):408-13.	Case report	3/3	None	Swelling in the mandible Amyloidosis	Multiple lytic	Panoramic radiograph CT	Yes
Reinish et al.³⁷37 Reinish EI, Raviv M, Srolovitz H, Gornitsky M. Tongue, primary amyloidosis, and multiple myeloma. Oral Surg Oral Med Oral Pathol. 1994;77(2):121-5.	Case report	1/1	Dysphagia Pain Xerostomia	Amyloidosis	-	-	Yes
Furutani et al.¹⁴14 Furutani M, Ohnishi M, Tanaka Y. Mandibular involvement in patients with multiple myeloma. J Oral Maxillofac Surg. 1994;52(1):23-5.	Case series	38/5	Pain	Pathological fracture in the mandible (1 case)	Multiple lytic (4 cases) single (1 case)	Skull and panoramic radiographs	No
Lee et al.⁵5 Lee SH, Huang JJ, Pan WL, Chan CP. Gingival mass as the primary manifestation of multiple myeloma: report of two cases. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 1996;82(1):75-9.	Case report	2/2	Pain Paresthesia in the lower lip	Bleeding gum Tooth mobility	Multiple lytic Punch-out	Panoramic radiograph	Yes
Witt et al.⁷7 Witt C, Borges AC, Klein K, Neumann HJ. Radiographic manifestations of multiple myeloma in the mandible: a retrospective study of 77 patients. J Oral Maxillofac Surg. 1997;55(5):450-3.	Case series	77/12	Paresthesia in the mandible	Bleeding gum	Single lytic (1 case) multiple (11 cases)	Skull, panoramic and periapical radiographs	No
Gray et al.³¹31 Gray ST, Antunovic DM, White AE. Non secretory multiple myeloma involving the maxilla: report of a case with update of biology and new approaches to management. Oral Oncol. 1997;33(2):136-40.	Case report	1/1	Pain Paresthesia	Swelling in the left maxilla	Single lytic	Panoramic and periapical radiographs	No
Ho et al.¹⁵15 Ho CL, Chen YC, Yiang YT, Kao WY, Chao TY. Mandibular mass as the presenting manifestation of IgM myeloma in a 22-year-old man. Ann Hematol. 1999;78(2):93-5.	Case report	1/1	None	Swelling in the mandible	Single lytic	CT	No
Mozaffari et al.¹⁶16 Mozaffari E, Mupparapu M, Otis L. Undiagnosed multiple myeloma causing extensive dental bleeding: report of a case and review. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2002;94(4):448-53.	Case report	1/1	None	Swelling Gum bleeding	Multiple lytic Punch-out	Skull and panoramic radiographs	Yes
Anacak et al.¹⁷17 Anacak Y, Kamer S, Donmez A, Haydaroglu A. Destruction of molar roots by metastasis of multiple myeloma. Br J Oral Maxillofac Surg. 2002;40(6):515.	Case report	1/1	None	Swelling in the mandible	Single lytic Root resorption	Panoramic radiograph	No
Lae et al.¹⁸18 Lae ME, Vencio EF, Inwards CY, Unni KK, Nascimento AG. Myeloma of the jaw bones: a clinicopathologic study of 33 cases. Head Neck. 2003;25(5):373-81.	Case series	12/12	None	Swelling Pathological fracture amyloidosis	Multiple lytic	Panoramic radiograph	No
Vucicevic-Boras et al.⁴³43 Vučićević-Boras V, Alajbeg I, Brozovic S, Mravak-Stipetic M. Burning mouth syndrome as the initial sign of multiple myeloma. Oral Oncol Extra. 2004;40(1):13-5.	Case report	1/1	None	Candidiasis	-	-	Yes
Baykul et al.¹⁹19 Baykul T, Aydin U, OCarroll MK. Unusual combination of presenting features in multiple myeloma. Dentomaxillofac Radiol. 2004;33(6):413-9.	Case report	1/1	Paresthesia in the mandible	None	Multiple diffuse lytic punch-out	Panoramic and periapical radiograph CT	Yes
Owotadeet al.²⁰20 Owotade F, Ugboko V, Ajike S, Salawu L, Amusa Y, Omole M. Head and neck manifestations of myeloma in Nigerians. Int J Oral Maxillofac Surg. 2005;34(7):761-5.	Case series	30/3	None	Bleeding gum Swelling (3 cases)	Multiple lytic	CT	No
Pinto et al.²¹21 Pinto LS, Campagnoli EB, Leon JE, Lopes MA, Jorge J. Maxillary lesion presenting as a first sign of multiple myeloma: case report. Med Oral Patol Oral Cir Bucal. 2007;12(5):344-7.	Case report	1/1	Pain	Swelling in the maxilla bleeding gum	Single lytic	Periapical radiograph	Yes
Segundo et al.²²22 Segundo AV, Falcão MF, Correia-Lins Filho R, Soares MS, López J, Küstner EC. Multiple Myeloma with primary manifestation in the mandible: a case report. Med Oral Patol Oral Cir Bucal. 2008;13(4):232-4.	Case report	1/1	Paresthesia in the lower lip	Swelling	Multiple lytic	Panoramic radiograph CT	Yes
Talamo et al.⁶6 Zhao XJ, Sun J, Wang YD, Wuang L. Maxillary pain is the first indication of the presence of multiple myeloma: a case report. Mol Clin Oncol. 2014;2(1):59-64.	Case series	170/1	None	Amyloidosis in the tongue	-	-	No
Shah et al.²²22 Segundo AV, Falcão MF, Correia-Lins Filho R, Soares MS, López J, Küstner EC. Multiple Myeloma with primary manifestation in the mandible: a case report. Med Oral Patol Oral Cir Bucal. 2008;13(4):232-4.	Case report	1/1	None	Swelling in the maxilla tooth mobility	Single lytic	Panoramic radiograph	Yes
Ghosh et al.²⁴24 Ghosh S, Wadhwa P, Kumar A, Pai KM, Seshadri S, Manohar C. Abnormal radiological features in a multiple myeloma patient: a case report and radiological review of myelomas. Dentomaxillofacial Radiol. 2011;40(8):513-8.	Case report	1/1	None	Swelling	Lytic	Skull and panoramic radiographs	Yes
Vinayachandran and Sankarapandian²⁵25 Vinayachandran D, Sankarapandian S. Multiple osteolytic lesions. J Clin Imaging Sci. 2013;3(Suppl. 1):6.	Case report	1/1	None	Swelling	Single lytic	Occlusal and panoramic radiograph CT	Yes
Cardoso et al.²⁶26 Cardoso RC, Gerngross PJ, Hofstede TM, Weber DM, Chambers MS. The multiple oral presentations of multiple myeloma. Support Care Cancer. 2014;22(1):259-67.	Case series	5/5	Pain Disphagia Paresthesia Lip anesthesia	Swelling	Multiple lytic (1 case) Single (4 cases)	Panoramic, CBCT, periapical radiographs and MRI	No
Troeltzsch et al.²⁷27 Troeltzsch M, Oduncu F, Mayr D, Ehrenfeld M, Pautke C, Otto S. Root resorption caused by jaw infiltration of multiple myeloma: report of a case and literature review. J Endod. 2014;40(8):1260-4.	Case report	1/1	None	Tooth mobility in the mandible	Single lytic Root resorption	Non specified	No
Zhao et al.⁶6 Zhao XJ, Sun J, Wang YD, Wuang L. Maxillary pain is the first indication of the presence of multiple myeloma: a case report. Mol Clin Oncol. 2014;2(1):59-64.	Case report	1/1	Pain	Ulcerated lesion Swelling Trismus	Single lytic	CT MRI	Yes
Ramaiah et al.¹1 Ramaiah KK, Joshi V, Thayi SR, Sathyanarayana P, Patil P, Ahmed Z. Multiple myeloma presenting with a maxillary lesion as the first sign. Imag Sci Dent. 2015;45(1):55-60.	Case report	1/1	Pain	Swelling in the maxilla tooth mobility	Punch-out	Panoramic radiograph CT	Yes
Jain et al.⁴4 Jain S, Kaur H, Kansal G, Gupta P. Multiple myeloma presenting as gingival hyperplasia. J Indian Soc Periodontol. 2013;17(3):391-3.	Case report	1/1	None	Gingival swelling and tooth mobility	None	Skull radiograph	Yes
Kasamatsu et al.³³33 Kasamatsu A, Kimura Y, Tsujimura H, Kanazawa H, Koide N, Miyamoto I, et al. Maxillary swelling as the first evidence of multiple myeloma. Case Reports in Dentistry, vol. 2015. Hindawi Publishing Corporation; 2015, 5 pp.	Case report	1/1	None	Swelling in the maxilla Tooth mobility	Single lytic with resorption of the floor of the maxillary Sinus	Panoramic radiograph CT MRI	Yes
Sreeja et al.³²32 Sreeja C, Vijayabanu B, Vijayalakshmi D, Devi M, Ramakrishnan K, Dhivya K. Multiple myeloma involving mandible: in an elderly female. J Pharm Bioallied Sci. 2015;7(2):763-5.	Case report	1/1	Pain	Swelling in the mandible Amyloidosis	Multiple lesions punch-out	Skull radiograph	No
Fregnani et al.³⁴34 Fregnani ER, Leite AA, Parahyba CJ, Nesrallah ACA, Ramos-Perez FMM, Cruz Perez DEC. Mandibular destructive radiolucent lesion: the first sign of multiple myeloma. J Clin Exp Dent. 2016;8(4):e465-8.	Case report	1/1	Trismus Paresthesia	Swelling in the mandible	Single lytic in the right mandibular ramus	Panoramic radiograph	Yes

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E-mail: htct@abhh.org.br

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[1] *Corresponding author at: Department of Oral Pathology and Diagnosis, Faculdade de Odontologia, Universidade Federal do Rio de Janeiro (UFRJ), Av. Carlos Chagas Filho 373, Prédio do CCS, Bloco K, 2° andar, Sala 56. Ilha da Cidade Universitária, 21941-902 Rio de Janeiro, RJ, Brazil. sandratorres@ufrj.br