Prevention of dental complications in patients with multiple myeloma (MM) receiving bisphosphonates treatment

Abstract

Background: Thanks to the new therapeutic strategies, the patients withMMlive longer, but with complex chronic disease and with a diversity of supportive treatments that are increasingly complex. The bisphosphonates are important part of these therapeutic options for them. The aim of this study is to describe four clinical cases presenting dental complications and to define the prevention actions they needed. Method(s): A series of cases study. Sample 4 cases withMMpatients in treatment with bisphosphonates attended by Functional Unit during 6 months in 2018. Variables recruited were dental complications, nurses' activities, clinical implications and type of treatment received. Result(s): From October-2018 to March-2019, a total of 32 patients withMMhave been received intravenous bisphosphonates treatment. Four of them (12.5%) have presented dental complications that are following: Two patients ( 68 years old and 68) have needed a 6 months of bisphosphonates interruption to have a dental extraction One patient ( 51 years) has delayed 15 days his autologous stem cell transplantation due to dental extraction with infection One patient ( 69 years) has delayed one month his autologous stem cell because of a dental fistula that needed surgical intervention Preventive nurses' measures included: dental assessment prior to bisphosphonate initiation so that any invasive dental procedures could be completed prior to initiation the therapy. It is crucial to include prevention in the health systemto avoid increasing financial toxicity for patients & families. Conclusion(s): All the patients with dental complications affected and delayed the planned treatment. A preventive approach with oral care before and during treatment with bisphosphonates can minimize the occurrence of complications associated with treatment and avoid interruptions since extractions are contraindicated and endodontic treatment should be performed under conditions that ensure no trauma to bone tissue. Nurses should be aware that MM patient treatment depends not only on antimyeloma treatments but, also on supportive measures to improve their quality of life and avoid complications.