Can dentists detect multiple myeloma through oral manifestations?

Almeida, Thaís Miranda Xavier de; Cavalcanti, Édila Figuerêdo Feitosa; Freitas, Alessandra da Silva; Magalhães, Roberto José Pessoa de; Maiolino, Angelo; Torres, Sandra Regina

doi:10.1016/j.bjhh.2017.08.006

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Review article • Hematol., Transfus. Cell Ther. 40 (1) • Jan-Mar 2018 • https://doi.org/10.1016/j.bjhh.2017.08.006 linkcopy

Can dentists detect multiple myeloma through oral manifestations?

Authorship SCIMAGO INSTITUTIONS RANKINGS

Objective: To review published data on oral manifestations of multiple myeloma.

Methods: 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.⁸	Case report	1/1	Pain	Swelling	Multiple diffuse lytic	Non specified	No
Yoshimura et al.⁹	Case report	2/2	Pain	Swelling	Multiple diffuse lytic Punch-out	Skull and periapical radiograph CT	Yes
Kraut et al.¹⁰	Case report	1/1	Difficulty chewing	Amyloidosis in upper lip	Multiple diffuse lytic	Skull radiograph	No
Flick et al.⁴⁰	Case report	1/1	None	Amyloidosis in the tongue	-	-	Yes
Salisbury et al.⁴⁴	Case report	1/1	Pain Bleeding on the buccal mucosa	Amyloidosis in the tongue	-	-	No
Epstein et al.¹¹	Case report	1/1	Pain Trismus	None	Punch-out lytic with root resorption	Pantomographic radiograph	No
Babajews et al.⁴¹	Case report	1/1	None	Amyloidosis in the tongue	-	-	Yes
Raubenheimer et al.⁴²	Case report	1/1	Pain Dysphagia	Amyloidosis in the tongue, Parotid gland and gum Hyposalivation	-	-	Yes
Jacobs et al.⁴⁵	Case report	1/1	Dyslalia Dysphagia	Amyloidosis in the tongue	-	-	No
Lambertenghi et al.¹²	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.¹³	Case report	3/3	None	Swelling in the mandible Amyloidosis	Multiple lytic	Panoramic radiograph CT	Yes
Reinish et al.³⁷	Case report	1/1	Dysphagia Pain Xerostomia	Amyloidosis	-	-	Yes
Furutani et al.¹⁴	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.⁵	Case report	2/2	Pain Paresthesia in the lower lip	Bleeding gum Tooth mobility	Multiple lytic Punch-out	Panoramic radiograph	Yes
Witt et al.⁷	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.³¹	Case report	1/1	Pain Paresthesia	Swelling in the left maxilla	Single lytic	Panoramic and periapical radiographs	No
Ho et al.¹⁵	Case report	1/1	None	Swelling in the mandible	Single lytic	CT	No
Mozaffari et al.¹⁶	Case report	1/1	None	Swelling Gum bleeding	Multiple lytic Punch-out	Skull and panoramic radiographs	Yes
Anacak et al.¹⁷	Case report	1/1	None	Swelling in the mandible	Single lytic Root resorption	Panoramic radiograph	No
Lae et al.¹⁸	Case series	12/12	None	Swelling Pathological fracture amyloidosis	Multiple lytic	Panoramic radiograph	No
Vucicevic-Boras et al.⁴³	Case report	1/1	None	Candidiasis	-	-	Yes
Baykul et al.¹⁹	Case report	1/1	Paresthesia in the mandible	None	Multiple diffuse lytic punch-out	Panoramic and periapical radiograph CT	Yes
Owotadeet al.²⁰	Case series	30/3	None	Bleeding gum Swelling (3 cases)	Multiple lytic	CT	No
Pinto et al.²¹	Case report	1/1	Pain	Swelling in the maxilla bleeding gum	Single lytic	Periapical radiograph	Yes
Segundo et al.²²	Case report	1/1	Paresthesia in the lower lip	Swelling	Multiple lytic	Panoramic radiograph CT	Yes
Talamo et al.⁶	Case series	170/1	None	Amyloidosis in the tongue	-	-	No
Shah et al.²²	Case report	1/1	None	Swelling in the maxilla tooth mobility	Single lytic	Panoramic radiograph	Yes
Ghosh et al.²⁴	Case report	1/1	None	Swelling	Lytic	Skull and panoramic radiographs	Yes
Vinayachandran and Sankarapandian²⁵	Case report	1/1	None	Swelling	Single lytic	Occlusal and panoramic radiograph CT	Yes
Cardoso et al.²⁶	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.²⁷	Case report	1/1	None	Tooth mobility in the mandible	Single lytic Root resorption	Non specified	No
Zhao et al.⁶	Case report	1/1	Pain	Ulcerated lesion Swelling Trismus	Single lytic	CT MRI	Yes
Ramaiah et al.¹	Case report	1/1	Pain	Swelling in the maxilla tooth mobility	Punch-out	Panoramic radiograph CT	Yes
Jain et al.⁴	Case report	1/1	None	Gingival swelling and tooth mobility	None	Skull radiograph	Yes
Kasamatsu et al.³³	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.³²	Case report	1/1	Pain	Swelling in the mandible Amyloidosis	Multiple lesions punch-out	Skull radiograph	No
Fregnani et al.³⁴	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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[TFN1] ^a
Patients may present more than one oral manifestation.

MM: multiple myeloma; CT: Computed tomography; CBCT: cone beam computed tomography; MRI: Magnetic resonance imaging; NS: not specified.