You are treating a patient with a diagnosis of multiple myeloma. Which question is MOST important to ask the treating oncologist before proceeding?

Correct answer: A. Whether the patient is receiving antiresorptive therapy and the radiation dose delivered to the jaws

• A. CORRECT. Two treatment-related exposures directly determine what you can safely do. First, multiple myeloma patients are routinely maintained on high-dose intravenous ANTIRESORPTIVE agents (zoledronate, pamidronate, denosumab) for skeletal protection — this is the single highest-risk group for MEDICATION-RELATED OSTEONECROSIS OF THE JAW, far exceeding oral bisphosphonate users. Second, if the jaws were within a RADIATION field, osteoradionecrosis risk depends on the dose delivered, with risk rising sharply above roughly 60 Gy. Both dictate whether extraction is acceptable and whether restorative or endodontic alternatives should be chosen instead.
• B. Hemoglobin alone is insufficient. Myeloma causes pancytopenia — you need the full count including PLATELETS (bleeding risk) and NEUTROPHILS (infection risk), plus renal function.
• C. The immunoglobulin subtype is important for oncological staging and prognosis but does not change dental management.
• D. The diagnostic modality has no bearing on dental treatment planning.

Note: Before invasive treatment in any myeloma patient, obtain: current antiresorptive drug, dose and duration; radiation dose and fields; complete blood count with differential and platelets; and renal function (myeloma causes renal impairment, which alters drug dosing).