Dental complications like tooth decay and gum disease are usually caused by treatments for Hodgkin’s lymphoma rather than the cancer itself. Prevention strategies can help reduce these complications.

Hodgkin’s lymphoma is a cancer that develops in a group of white blood cells called lymphocytes. It makes up about 11% of lymphomas in the United States.

The other major category of lymphoma is called non-Hodgkin’s lymphoma. The two conditions are differentiated by the way cancer cells appear under a microscope.

People with lymphoma are at risk of developing dental or mouth complications. Many of these complications are a result of cancer treatments, such as chemotherapy or radiation therapy, not the cancer itself.

Dental complications can also occur if the cancer starts in your mouth. However, about 97% of lymphomas of the head or neck are classified as non-Hodgkin’s. Lymphoma makes up about 2.2% of cancers of the head or neck and is the third most common cancer of the mouth.

Read on to learn more about the dental complications of Hodgkin’s lymphoma and how to prevent and manage them.

Hodgkin’s lymphoma treatment is much more likely to cause dental complications than the cancer itself.

Cancer treatments like chemotherapy and radiation therapy are critical for treating many types of cancer, but they can also damage healthy cells in different parts of your body, including your mouth.

For example, a 2022 study found that 37.3% of people who receive chemotherapy develop dental disease. A 2010 study found that 20.3% develop severe gingivitis (gum disease).

Dental symptoms directly caused by Hodgkin’s lymphoma are exceedingly rare. Non-Hodgkin’s lymphoma is much more likely to cause symptoms in the mouth.

For example, in a 2021 study, researchers described a case of a 37-year-old woman with non-Hodgkin’s lymphoma who developed pain and numbness in the right side of her jaw.

According to the Leukemia & Lymphoma Society, most of the oral complications caused by chemotherapy are short term and resolve once treatment is finished.

Oral complications can include:

Potential dental and oral complications from radiation therapy of your head or neck include:

  • breakdown of bone or muscle around the radiation site
  • changes in tooth development, in children
  • tooth decay
  • gum disease
  • mouth sores
  • infection
  • pain
  • mouth dryness
  • trouble swallowing
  • taste changes

An allogeneic stem cell transplant is a procedure that replaces the cells inside your bone marrow with cells from a donor. It can cause a condition called graft-versus-host disease, in which transplanted cells attack healthy tissue in your body.

Graft-versus-host-disease can cause oral symptoms, such as:

  • mouth sores
  • dry mouth
  • pain after consuming alcohol, spices, and other flavors
  • trouble swallowing
  • taste changes
  • tightness in the skin that lines your mouth

Bisphosphonates are a group of drugs that help reduce bone loss. They can cause a rare complication called osteonecrosis of the jaw, which is when part of your jawbone dies. It can cause:

  • pain
  • open sores
  • tooth loss
  • infection

In a 2020 review of 137 articles, researchers found that using a bisphosphonate called zoledronic acid for more than 4 years and over 22.6 doses was associated with a higher chance of developing osteonecrosis of the jaw.

Following good dental hygiene before and during your treatment may help minimize the number of dental complications you develop.

Before treatment

Maintaining good dental hygiene can help you minimize complications. It’s also a good idea to treat any preexisting problems before cancer treatment begins.

When possible, visit a dentist at least 4 weeks before treatment to remove braces that might irritate your gums and treat problems like:

Your doctor will likely recommend avoiding nonessential dental work:

  • 6 months after a stem cell transplant
  • during current chemotherapy or radiation therapy of the head or neck
  • within 6 months of receiving chemotherapy or radiation therapy of the head or neck

Your doctor may also encourage you to reduce the bacteria in your mouth with an antiseptic mouthwash containing chlorhexidine gluconate 2 weeks before your treatment.

It’s generally recommended that at least 2 weeks should elapse between dental surgery and cancer treatment.

During treatment

You may be able to reduce your risk of dental problems during your treatment by:

  • brushing your teeth two to three times per day
  • using fluoride toothpaste and avoiding toothpaste with strong flavors, since they might irritate your mouth
  • flossing once a day
  • eating an overall nutritious diet
  • rinsing with a solution of water, salt, and baking soda every 2 hours
  • using an antibacterial mouthwash two to four times per day
  • brushing your dentures every day
  • avoiding foods that might irritate your mouth, like highly acidic or spicy foods
  • avoiding sugary foods that increase your risk of cavities
  • drinking mostly water and other sugar-free drinks
  • avoiding tobacco
  • chewing sugar-free gum to keep your mouth moist
  • staying hydrated
  • talking with your doctor about how to improve your bone health with vitamin D or calcium supplements

It’s important to continue regularly communicating with your cancer team and dentist during your treatment and to alert them of any dental complications you develop.

If you visit a dentist during your cancer treatment, it’s important for them to talk with your cancer team beforehand.

Your immune system will be weakened during your cancer treatment. Performing invasive procedures, like extracting a tooth, may not be possible due to the increased risk of bleeding, delayed wound healing, and infection. All nonessential dental work will be paused while you’re undergoing treatment.

Your dentist may recommend against wearing removable dental appliances during your treatment. They may increase your risk of infection.

Dental and oral complications are common in people with Hodgkin’s lymphoma. Most of these complications are caused by cancer treatment and not the lymphoma itself.

Lymphoma that develops in your mouth can also cause dental complications, but the vast majority of oral lymphomas are non-Hodgkin’s lymphoma.

Maintaining good oral hygiene through your treatment can help you minimize your risk of complications. Your cancer team and dentist can offer you specific advice about how to protect your oral health.