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Does Suboxone Affect My Teeth?

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In January 2022, the Food & Drug Administration announced that some patients receiving Suboxone were developing dental problems, including tooth decay.[1]

This has led to doctors and dentists fielding questions about how Suboxone affects the teeth and whether it causes tooth decay, since it’s still not clear whether the tooth decay was from the Suboxone or other causes. For example, some studies show that people with opioid use disorder whether they are on Suboxone or not often struggle with teeth problems.[6] The good news is that most patients with Suboxone prescriptions don’t incur damage to the mouth and teeth.

Method of Administration

Suboxone remains the gold standard for treating opioid use disorder, but some doctors and patients have expressed concern that the method of administration — putting the suboxone film under the tongue, allowing the medication to be absorbed in the mouth —sets the stage for tooth decay.[2]

This is because even as the medication is dispensed, the suboxone films themselves are acidic — with a low pH of 3.4— and the acid remains in the mouth.

What Can Cause Tooth Decay?

Suboxone strips are made to be placed under the tongue or in the cheek, and then held in place until they are fully dissolved, which can take up to 10 minutes.[3]

This means that there is significant contact between your teeth and the Suboxone strip, especially considering that you might have multiple doses of Suboxone every day. The slow, long-term exposure of your teeth to Suboxone is theorized to trigger tooth decay. Symptoms of tooth decay include dry mouth, significant buildup of plaque, and decay at the gumline. 

Some patients also have other factors that can contribute to tooth decay. Behaviors commonly engaged in by people with opioid use disorder, such as smoking and drinking sugary and acidic drinks, can also cause tooth problems. Many others struggle with unstable home environments or lack access to dental care.

In sum, based on the information available, there is no guarantee that your use of Suboxone will lead to tooth decay, but it could raise the likelihood of tooth decay.

Preventing & Avoiding Tooth Decay

How can people who are receiving Suboxone treatment guard against tooth decay?[4]

A simple method is to drink more water, and cut out carbonated and acidic beverages. For patients who like coffee, doctors recommend 12 ounces or less, and only drinking for a short period of time (no more than 30 minutes).

The longer the teeth are exposed to the sugar in soft drinks, the greater the risk for irreversible tooth decay. Another thing to cut out, or reduce, is smoking.

Patients can also chew sugar-free gum, especially gum that has xylitol in it. Xylitol neutralizes acid by stimulating your body to make more saliva. Chewing gum with xylitol can negate the dry mouth caused by Suboxone, raising the acidity of the mouth to safe levels and slowing the onset of tooth decay.[5] Certain brands of breath mints also contain xylitol.

Brushing & Dental Care

Regular tooth brushing and flossing, twice a day for two full minutes at a time, will remove plaque that gets stored along the gumline.

If Suboxone is affecting your dental health, you should brush your teeth after your Suboxone strips dissolve (which should be about 10 minutes after they are put in place). Make sure not to brush your teeth or use mouthwash while the Suboxone is still in the process of dissolving.

When possible, get dental care. If you are underinsured or uninsured, look for low-income dental clinics or dental students who need patients for their training. Getting a professional cleaning is the only way to thoroughly remove plaque that even regular brushing cannot get. Twice-yearly examinations by a dentist can detect any developing problems with your teeth. Regular monitoring is especially important if you are on Suboxone.

Limiting Suboxone Exposure

It might be possible to take your doses of Suboxone (whether in pill or strip form) all at once instead of spreading them out over the course of the day. However, this should be done only with your doctor’s approval. Talk to your doctor before you make any changes to your Suboxone administration schedule.

The idea is that by  limiting the number of times your teeth are be exposed to the acidic content of Suboxone you will slow down the advancement of tooth decay. It is still important however to regularly see your dentist for a teeth cleaning and to make changes in your own dental hygiene, like regular brushing and flossing, to protect your teeth and gums.

In their announcement warning about the links between Suboxone and dental problems, the FDA noted that when it comes to Suboxone, the benefits far outweigh the risks. For opioid use disorder  treatment, the FDA recommends that unless otherwise instructed by their dentists and addiction treatment providers, patients should continue to stay on their Suboxone prescription and receive other forms of therapy and counseling. While doing so, they should continue to practice good dental care at home, and see their dentists regularly for monitoring. They should also tell their dentists if they are on Suboxone, and they should inform all their providers  about any discomfort or changes they notice with their teeth and gums.

SOURCES

  1. FDA Warns About Dental Problems With Buprenorphine Medicines Dissolved in the Mouth to Treat Opioid Use Disorder and Pain. Food & Drug Administration. https://www.fda.gov/drugs/drug-safety-and-availability/fda-warns-about-dental-problems-buprenorphine-medicines-dissolved-mouth-treat-opioid-use-disorder. 2022. Accessed January 2022. 
  2. Medication-Assisted Treatment of Opioid Use Disorder: Review of the Evidence and Future Directions. Harvard Review of Psychiatry. https://pubmed.ncbi.nlm.nih.gov/25747920/. 2015. Accessed January 2022.
  3. Sublingual Buprenorphine and Dental Problems: A Case Series. Primary Care Companion for CNS Disorders. https://pubmed.ncbi.nlm.nih.gov/24511440/. 2013. Accessed January 2022.
  4. The Tooth Decay Process: How to Reverse It and Avoid a Cavity. National Institute of Dental and Craniofacial Research. https://www.nidcr.nih.gov/health-info/tooth-decay/more-info/tooth-decay-process. July 2018. Accessed January 2022.
  5. The Effect of Two Types of Chewing Gum Containing Casein Phosphopeptide-Amorphous Calcium Phosphate and Xylitol on Salivary Streptococcus Mutans. JournalofConservativeDentistry. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4450522/. 2015. Accessed January 2022.
  6. Winstock AR, Lea T, Sheridan J. Patients’ help-seeking behaviours for health problems associated with methadone and buprenorphine treatment. Drug Alcohol Rev. 2008;27(4):393–397. [PubMed] [Google Scholar]

Medically Reviewed By Claire Wilcox, MD

Claire Wilcox, MD, is a general and addiction psychiatrist in private practice and an associate professor of translational neuroscience at the Mind Research Network in New Mexico; and has completed an addictions fellowship, psychiatry residency, and internal medicine residency. Having done extensive research in the area, she is an expert in the neuroscience of substance use disorders. Although she is interested in several topics in medicine and psychiatry, with a particular focus on substance use disorders, obesity, eating disorders, and chronic pain, her primary career goal is to help promote recovery and wellbeing for people with a range of mental health challenges.

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