I had a 'skeletal assay" which, according to my oncologist, showed no bone involvement; no lytic lesions. As a result, it has been decided to hold off on the bisphosphonates for awhile. However, I had a dental visit to day, and Dr. B_e made an offhand comment about the lytic lesions in my jaw causing some problems. He is aware, of course, of my multiple myeloma, and is working around the chemo dates with my treatment.
Of course my ears perked up...say what? I was told I didn't HAVE any lytic lesions! At least, I didn't as of two months ago, However, Dr. B_e showed me the X-ray and circled 8 of the little suckers in my jaw.
So now what do I do? Demand a retest? Yell at Dr. B the oncologist? Don't worry about it? Get really annoyed?
??????
Is this a big thing or a shrug it off thing?
Forums
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dianaiad - Who do you know with myeloma?: Me
- When were you/they diagnosed?: Officially...March 2013
- Age at diagnosis: 63
Re: Lytic lesions ... from the dentist???
Hello!
My history is solitary plasmacytoma. 2009 left femur. 2011 L1 Vertebra. I´m also a dentist, (Certified prosthodontist). There are plenty of possible reasons for small radiolocencies in the jaws. The X-ray you mentioned, was it a panoramic X-ray or small intra oral films?
Whatsoever I would inform your doctor about the findings.
Good luck and greetings from Sweden
My history is solitary plasmacytoma. 2009 left femur. 2011 L1 Vertebra. I´m also a dentist, (Certified prosthodontist). There are plenty of possible reasons for small radiolocencies in the jaws. The X-ray you mentioned, was it a panoramic X-ray or small intra oral films?
Whatsoever I would inform your doctor about the findings.
Good luck and greetings from Sweden
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Mattias - Name: Mattias
- Who do you know with myeloma?: Me
- When were you/they diagnosed?: Solitary plasmacytoma 2009. Myeloma 2013
- Age at diagnosis: 39
Re: Lytic lesions ... from the dentist???
Hello Mattias, would the panoramic xray be the best xray to have in this situation?
Best regards to you in Sweden,
Dana
Best regards to you in Sweden,
Dana
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DanaH - Who do you know with myeloma?: Myself, SMM as of 1/2012
- When were you/they diagnosed?: 1/2012
- Age at diagnosis: 54
Re: Lytic lesions ... from the dentist???
The panoramic x-ray is good for a simple survey of the mandible, maxilla, teeth and the temporomandibular joints. It will show you a layer of approximately 2mm width. Anything in front of or behind that layer will not show. (It will be out of focus). Regarding the best techniques for diagnosing lytic lesions, supposedly small plasmacytomas in the mandible or maxilla; MRI or CT would be a better choice, but I would strongly advice you to discuss the "dental" findings with your doctor. As I mentioned earlier, there are numerous reasons for lytic appearances in the jaws that have nothing to do with plasmacytomas.
// Mattias
// Mattias
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Mattias - Name: Mattias
- Who do you know with myeloma?: Me
- When were you/they diagnosed?: Solitary plasmacytoma 2009. Myeloma 2013
- Age at diagnosis: 39
Re: Lytic lesions ... from the dentist???
When I was undergoing treatments at our cancer centre, I had very thorough dental screening done there. I had several app'ts, that included very comprehensive X-rays. I told my regular dentist that I had never had such a thorough scan of my teeth. I think that the reason behind that was that I was taking bisphosphonate treatments. A risk of that is osteo necrosis of the jaw. Any dental surgery work had to be considered n that light. Luckily I had no issues that way. The dentists at the cancer centre told me that they wouldn't be needed if everyone took really good care of their teeth. Because I was very nervous about getting ONJ with the bisphosphonate treatments, I started flossing twice a day. My usual dentist says I take very good care of my teeth!
I do not know if I had lytic lesions on my jaw, but I did have a lot of them on other areas of my skeleton, hence the long term use of bisphosponates was indicated. It was interesting to me to find that the cancer centre also has a dental clinic.
I do not know if I had lytic lesions on my jaw, but I did have a lot of them on other areas of my skeleton, hence the long term use of bisphosponates was indicated. It was interesting to me to find that the cancer centre also has a dental clinic.
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Nancy Shamanna - Name: Nancy Shamanna
- Who do you know with myeloma?: Self and others too
- When were you/they diagnosed?: July 2009
Re: Lytic lesions ... from the dentist???
Thank you, Matthias, for answering this! It was a panoramic X-ray, taken just before all my teeth were yanked so that I could have dentures. I WAS saving up for implants, but the implant people told me that they wouldn't do that because of the multiple myeloma, and that given the proposed chemo, dentures were about my only option.
It was at one of the 'fix the dentures so that they'll fit so she can chew pancakes" sessions that the lytic lesions in the jaw came up.
Thank you very much for the information! I sent an email to my oncologist about it, with the dentist's contact info.
Diana
It was at one of the 'fix the dentures so that they'll fit so she can chew pancakes" sessions that the lytic lesions in the jaw came up.
Thank you very much for the information! I sent an email to my oncologist about it, with the dentist's contact info.
Diana
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dianaiad - Who do you know with myeloma?: Me
- When were you/they diagnosed?: Officially...March 2013
- Age at diagnosis: 63
Re: Lytic lesions ... from the dentist???
Sorry Dianalad...I did not realize you had to get dentures. That was insensitive of me to talk about those dental issues. i hope you are doing well...it has been a confusing few months for you I know.
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Nancy Shamanna - Name: Nancy Shamanna
- Who do you know with myeloma?: Self and others too
- When were you/they diagnosed?: July 2009
Re: Lytic lesions ... from the dentist???
Nancy Shamanna wrote:
> Sorry Dianalad...I did not realize you had to get dentures. That was
> insensitive of me to talk about those dental issues. i hope you are doing
> well...it has been a confusing few months for you I know.
Oh, good heavens, how was your post 'insensitive?" I look at it this way: it's been a long time since I could smile and feel comfortable...or let anybody take my picture smiling. Now I have a GREAT smile! Even if I can't chew, I can sure smile...and this morning (just before I took all those !#$!@ chemo pills) I was able to chew a pancake and a fried egg.
Amazing the joy little things can give you, isn't it?
I really do have a great smile now. Fun to flash it!
> Sorry Dianalad...I did not realize you had to get dentures. That was
> insensitive of me to talk about those dental issues. i hope you are doing
> well...it has been a confusing few months for you I know.
Oh, good heavens, how was your post 'insensitive?" I look at it this way: it's been a long time since I could smile and feel comfortable...or let anybody take my picture smiling. Now I have a GREAT smile! Even if I can't chew, I can sure smile...and this morning (just before I took all those !#$!@ chemo pills) I was able to chew a pancake and a fried egg.
Amazing the joy little things can give you, isn't it?
I really do have a great smile now. Fun to flash it!
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dianaiad - Who do you know with myeloma?: Me
- When were you/they diagnosed?: Officially...March 2013
- Age at diagnosis: 63
Re: Lytic lesions ... from the dentist???
Well, I am glad it's working out! Smile and the world smiles with you, as they say! You take care of yourself!
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Nancy Shamanna - Name: Nancy Shamanna
- Who do you know with myeloma?: Self and others too
- When were you/they diagnosed?: July 2009
Re: Lytic lesions ... from the dentist???
UPDATE:
Saw Dr. B today, and he e-mailed the dentist to get a digital copy of the X-ray. (I had to show him how to get his own e-mail address, for crying out loud!) At any rate, he looked at them and said yep, there they are, in living little dark dots. He's sending the x-ray to Dr. Cai at the City of Hope (who said I didn't require bisphosphonate therapy because I didn't have any lytic lesions) and has ordered an 'urgent' PET scan.
Don't know why; he's still not going to put me on bisphosphonate therapy until after the BMT, but I got the twinkle in his eye. The whole thing to him, I think, is a sort of 'nya, nya, I was right, she does TOO have bone involvement and needs bisphosphonates!"
I did pin him down today to make it official; I have high risk multiple myeloma. Not that he needed to TELL me that; I figured it out by myself, but it's--I guess 'nice' isn't quite the right word--to have the doc confirm it.
Maybe 'satisfied' is the word. Or 'justified.' ......or the feeling Dr. B had when he saw those lesions and had his OWN feelings/opinion confirmed by them.
Oh, what the heck, we have to take our successes however we find them, no matter how weird they are, right?
Saw Dr. B today, and he e-mailed the dentist to get a digital copy of the X-ray. (I had to show him how to get his own e-mail address, for crying out loud!) At any rate, he looked at them and said yep, there they are, in living little dark dots. He's sending the x-ray to Dr. Cai at the City of Hope (who said I didn't require bisphosphonate therapy because I didn't have any lytic lesions) and has ordered an 'urgent' PET scan.
Don't know why; he's still not going to put me on bisphosphonate therapy until after the BMT, but I got the twinkle in his eye. The whole thing to him, I think, is a sort of 'nya, nya, I was right, she does TOO have bone involvement and needs bisphosphonates!"
I did pin him down today to make it official; I have high risk multiple myeloma. Not that he needed to TELL me that; I figured it out by myself, but it's--I guess 'nice' isn't quite the right word--to have the doc confirm it.
Maybe 'satisfied' is the word. Or 'justified.' ......or the feeling Dr. B had when he saw those lesions and had his OWN feelings/opinion confirmed by them.
Oh, what the heck, we have to take our successes however we find them, no matter how weird they are, right?
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dianaiad - Who do you know with myeloma?: Me
- When were you/they diagnosed?: Officially...March 2013
- Age at diagnosis: 63
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