Suboxone® and other forms of buprenorphine-naloxone are widely used to treat opioid use disorder (OUD) because they reduce cravings and withdrawal symptoms (important safety information). Suboxone is available in both film and tablet forms; it’s a sublingual medication, meaning patients take it by dissolving it under their tongues or against their cheeks.
Although this is a simple, convenient way to take medication, it can take 15 to 30 minutes for Suboxone to dissolve. This amount of time leads some patients to wonder whether the medication poses a risk to their oral health.
Recently, there has been an increase in lawsuits against Suboxone's manufacturer, Indivior, Inc., regarding dental hygiene issues, which has prompted more questions. OUD care professionals and patients need to understand the potential oral health risks associated with Suboxone to make informed decisions about treatment plans. Learn how Suboxone can affect oral health and how to protect against dental problems during OUD treatment.
Is Suboxone bad for your teeth?
In January 2022, the U.S. Food and Drug Administration (FDA) released a warning stating that patients using sublingual medicines containing buprenorphine—including Suboxone—have reported dental problems. These Suboxone effects on teeth may include:
- Oral infections
- Tooth decay
- Cavities
- Tooth loss
For some people, these issues may have developed earlier and been neglected during active drug use before starting Suboxone. Some patients notice dental health issues soon after they begin treatment. They may find that their teeth feel sore or loose. In other cases, they may not realize they have these oral problems until their next dental checkup.
It's also worth noting that such oral health problems are not unique to Suboxone. Experiencing dental health issues is a common side effect of many medications that dissolve in the mouth. Thankfully, dentists and other oral health professionals can identify and treat these issues.
Misconceptions about buprenorphine + tooth decay
A common misconception is that all Suboxone patients will experience some dental problems. In reality, there is no guarantee that someone using Suboxone will develop tooth decay. Anyone wondering, "Does Suboxone rot your teeth?" will be relieved to know that over 2 million Americans use Suboxone each year, and many report no dental pain or other oral health issues.
Some people also mistakenly think that the risks of using Suboxone, including potential oral health concerns, outweigh the benefits. However, the consensus from the addiction medicine community is that the benefits of OUD patients taking Suboxone are far greater than the risks.
A group that includes the American Academy of Addiction Psychiatry (AAAP), American College of Academic Addiction Medicine (ACAAM), and nine other organizations of addiction professionals wrote a letter to the Acting Commissioner of the FDA calling for the agency to retract its safety communication from January 2022 about buprenorphine. They argued that the FDA communication "has not been based on solid research evidence" and "can have predictable harmful effects," like increasing the stigma of taking Suboxone and presenting a false choice to patients between risking harm from opioids or severe dental problems.
The majority of patients in the cases the FDA reviewed only had one affected tooth. Since Suboxone dissolves in the patient's mouth and can touch all their teeth, it's "unlikely to harm only a single tooth," as the addiction professionals argued in their letter to the FDA. Other factors may be at play when patients taking Suboxone experience dental health concerns.
Recent oral health Suboxone lawsuits
In recent months, plaintiffs have filed a growing number of lawsuits against Suboxone's drug manufacturer, Indivior, Inc. (previously Reckitt Benckiser Pharmaceuticals), for oral health-related issues. Indivior did add a warning label to Suboxone about potential dental problems in 2022 after an FDA mandate. Still, these lawsuits allege that the manufacturer was negligent in not including a warning earlier. The plaintiffs argue that Indivior was responsible for warning Suboxone users about the risks of dental health problems and failed to do so adequately.
These lawsuits are still ongoing, and more research is required to determine exactly how Suboxone and teeth problems may be related. The FDA Communication from 2022 was based on only 305 cases of oral health problems since 2002 among patients using buprenorphine. Since then, millions of Americans have used buprenorphine. Given that over 40% of American adults have experienced some mouth pain in the last year, some cases of oral health concerns among Suboxone users are expected. The question that researchers and the judges on these lawsuits need to answer is whether Suboxone is the cause of or a contributor to a significant number of dental health problems.
Tips for reducing dental problems while using Suboxone
The good news is that you can take Suboxone and protect your oral health. As the FDA noted, the benefits of buprenorphine-naloxone as a treatment option for OUD outweigh the risks. Apply these tips to reduce your risk of dental problems while using Suboxone.
1. Follow the proper technique for taking Suboxone
Ask your clinical support team about the proper way to take your Suboxone dose. If you need to take multiple tablets or strips in each dose, consider applying both at once to reduce your acid exposure.
2. Rinse after your dose
After the Suboxone tablets or strips are fully dissolved, rinse your mouth out with a large sip of water. Swish it around your mouth to get rid of any of the remaining medication.
3. Wait to brush your teeth
The acid in Suboxone can soften your tooth enamel, making it vulnerable to abrasive toothpaste and brushing. Wait an hour or more after taking your dose to brush your teeth. The extra time allows the enamel to reharden, so it's less likely to be worn away when brushing.
4. Talk to your dentist
It's wise to share with your dentist that you're taking Suboxone. The American Dental Association even recommends visiting your dentist when your care team prescribes Suboxone. Make sure to go in for regular checkups and reach out immediately if you notice oral health problems.
Don't stop using Suboxone without consulting your care team, even if you have some dental concerns. Your care team and doctor can work together to address your dental issues without compromising your OUD treatment.
If you need a dental procedure while on Suboxone, work with your dentist and your healthcare professionals to develop a plan for treating any pain after the procedure. Some options your health team may consider include:
- Using NSAIDs (ibuprofen) or non-opioid analgesics like Tylenol to treat the pain
- Maintaining your current Suboxone dose and carefully introducing a short-acting opioid for extra pain relief
- Increasing your dose of Suboxone for a set period after the procedure
Your treatment plan for dealing with oral pain after the procedure will depend on the dental procedure, your recovery time, and the severity of your pain.
Ongoing support + real-world guidance for OUD
Starting buprenorphine-naloxone treatment is the first step to tackling opioid use disorder. Ophelia's care team will work with you to develop a personalized treatment plan that addresses your unique needs and focuses on establishing a safe, consistent routine with your medication. As your health needs change, including dental health, your clinical team will provide guidance to help keep you on track.
Find out if you're a candidate for our telehealth program and get the individualized care you deserve. We make it our mission to be responsive to patient needs and any legal questions or regulatory changes that can affect treatment. We always want to be certain that the plan we develop is the right one for you.
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