A patient with multiple myeloma presents to the dental office. Which complication of multiple myeloma should the dentist be most concerned about during treatment?

Correct answer: B. Increased risk of myocardial infarction (MI) from amyloid cardiac involvement

• A. Oral candidiasis is more associated with HIV, immunosuppressive therapy, or poorly controlled diabetes. While myeloma patients may be immunocompromised from chemotherapy, MI from amyloid cardiomyopathy is the most critical systemic concern.
• B. CORRECT. Multiple myeloma causes AMYLOIDOSIS (light chain deposition) which can infiltrate the myocardium, causing restrictive cardiomyopathy and increased risk of myocardial infarction, arrhythmias, and sudden cardiac death. This systemic complication makes cardiac assessment critical before dental procedures. Amyloidosis-related macroglossia is the classic oral finding.
• C. Hypercalcemia (not hypocalcemia) occurs in myeloma from osteoclast activation and bone destruction. Dental concern: jaw 'punched-out' radiolucencies from myeloma deposits.
• D. Thrombocytopenia (decreased platelets) — not thrombocytosis — occurs in myeloma from marrow infiltration, increasing bleeding risk. However, MI is the more life-threatening concern.