Getting into recovery from opioids often means taking care of other aspects of your health after a period of neglecting them. So it can be frustrating to discover that the life-saving treatment supporting your recovery might not be great for your teeth. Let’s talk about how buprenorphine can affect your dental health, and ways to reduce the risk.
Does Suboxone damage your teeth?
Buprenorphine medications like Suboxone (buprenorphine/naloxone) are primarily dissolved sublingually (under the tongue) or buccally (against the cheek). This is because buprenorphine is absorbed really well through the membranes of the mouth but not well through the stomach. Meanwhile, the naloxone component, which is included in Suboxone to prevent misuse, is not absorbed through the mouth, so it has no effect when buprenorphine/naloxone medications are taken as prescribed.
In January 2022, the FDA published a statement warning about dental issues associated with buprenorphine medications that are dissolved in the mouth. These dangers can include “tooth decay, cavities, oral infections, and loss of teeth.” So the answer is yes, there is a risk that Suboxone or other buprenorphine medications could cause dental problems. This causes a lot of concern among people receiving medication-assisted treatment for opioid use disorder.
Are there ways to minimize the risk of tooth damage from Suboxone?
The FDA has several recommendations to minimize the risk of tooth damage from Suboxone (buprenorphine/naloxone):
- Wait until the tablet or film is completely dissolved, and then gently swish your mouth with water and swallow it.
- Hold off on brushing your teeth until at least an hour after the buprenorphine/naloxone has completely dissolved. When you do brush, the American Dental Association recommends that you be gentle and use a soft-bristled brush.
- Do brush and floss regularly, as long as it’s not within that window of one hour after your dose dissolves.
- See a dentist as soon as you can after starting Suboxone (buprenorphine/naloxone) and tell them that you’re taking buprenorphine.
- Go to regular dental cleanings and checkups. The standard recommendation is to get a cleaning and checkup every six months. (This is something a lot of us let slide when we’re misusing drugs, so it’s extra important to get back into a dental care routine.)
- If you start to notice any problems with your teeth or gums, tell your provider and dentist ASAP.
If I use Suboxone, can I still get dental work done?
Yes, you can still get dental work done if you’re taking Suboxone (buprenorphine/naloxone). Most dentists avoid using opioid pain medications nowadays, but if you have any dental surgery done, make sure that your dentist and oral surgeon are aware that you are taking buprenorphine. This may affect which medications they use during the procedure and prescribe afterward.
I heard there were lawsuits about Suboxone causing dental issues
This is true. Currently (early 2024) lawsuits are underway against Indivior, the company that manufactures Suboxone. The primary complaint is not that Suboxone causes damage to teeth, but that the company did not warn doctors or patients about that potential damage. Most medications have the possibility of side effects, but it is ethically and legally important that the dangers be explained so that people can make informed choices about their health. At this time, these lawsuits have not been settled.
Is using Suboxone worth the potential risk of dental damage?
In our opinion, yes. Medication-assisted treatment including buprenorphine/naloxone reduces the risk of overdose and increases the likelihood of long-term recovery from opioid use disorder. Maintaining your treatment is important, despite the possible risk of dental issues.
If you’re caught up in fear about your teeth, it can help to recognize that, along with major impacts to physical, mental, and emotional health, opioid use on its own also brings risks to dental health. For example, opioid use often causes dry mouth, which increases tooth decay and fungal infections in the mouth. Some opioids are associated with an increase in tooth-grinding (bruxism), which can crack and damage tooth enamel. And untreated opioid use disorder is also associated with a decrease in personal care, so people in active opioid use disorder may be less diligent about oral care while also avoiding going to the dentist. The FDA says, “For those suffering from addiction to opioids, the benefits of using buprenorphine medicines clearly outweigh the risks and should be considered in conjunction with counseling and other behavioral therapies.”
