A Troublesome Unerupted Tooth:an Interesting Presentation of Multiple Myeloma

Background
We report the case of a 63-year-old male referred to the oral and maxillofacial department with new
intermittent headaches and paraesthesia of his lower right lip associated with an unerupted LR5. This
patient had been known to the department due to a previous referral around 3 years prior for treatment
of a dentigerous cyst associated with unerupted LL2 and LL3.
Materals and Methods
The patient was previously fit and well. Radiographic imaging showed the LR4 retained root associated
with an area of inflammatory bone loss involving the right mental foramen and an unerupted LR5 in
close association with the right inferior alveolar canal. The patient was listed for surgery for removal of
the retained root and debridement of the affected area. During his pre-op assessment, it was noted that
the patient was anaemic (88 g/L). With the patient experiencing increasingly shortness of breath, further
investigations showed several bony lesions in his ribcage and skull. An ultrasound-guided FNA of these
chest lesions returned a working diagnosis of plasma cell tumours suggestive of either myeloma or
cytoma. A further biopsy of the mandibular fibrous mass within the bone cyst helped confirm a
diagnosis of multiple myeloma.
Results
The patient was treated with four rounds of chemotherapy (the Dara-BTD regime) and monthly
bisphosphates in view of an autonomous stem cell transplant. Since the initiation of treatment, his
dental complaints have mostly been resolved, with an updated radiograph showing good bony infill in
the region of his LR4.
Conclusion
Although rare, multiple myeloma, should not be discounted as a possible differential diagnosis of
mandibular radiolucencies.