A patient with multiple myeloma presents for extraction. What is the MOST important consideration?

Correct answer: D. Assess for antiresorptive therapy, immunosuppression, and bleeding risk in consultation with the oncologist

• A. Proceeding without modification ignores a high MRONJ risk and potentially severe cytopenias.
• B. Treatment is not contraindicated — it requires coordination, timing around chemotherapy cycles, and risk-appropriate technique.
• C. Multiple myeloma is not a cardiac condition and does not by itself indicate endocarditis prophylaxis; any antibiotic decision here is based on neutropenia, not valvular risk.
• D. CORRECT. Multiple myeloma creates SEVERAL simultaneous concerns, and a medical consultation is what resolves them. Nearly all these patients receive IV BISPHOSPHONATES or denosumab for skeletal-related events, placing them in the HIGH-RISK MRONJ category. Marrow replacement by plasma cells causes anemia, neutropenia (infection risk), and thrombocytopenia (bleeding risk), so a current CBC is essential. Renal impairment from light-chain deposition alters drug selection and dosing, and hypercalcemia may be present.

Note: The defensible answer is neither a blanket yes nor no — it is medical consultation, with any antibiotic decision driven by the absolute neutrophil count. Discuss with the group.