Listen for Dental Problems With Buccal or Sublingual Buprenorphine

A new FDA warning will spur questions about the risk of dental problems with buccal or sublingual buprenorphine (Suboxone, etc).

Labels will now caution about cavities, tooth loss, and other oral health issues. These can happen even in patients withOUT a history of dental problems.

It may be because these products create an acidic environment in the mouth...which can wear away tooth enamel and lead to decay within weeks or years.

So far, there are about 300 cases reported...in the over 2 million patients on buprenorphine in the US.

But DON'T expect that patients will stop buccal or sublingual buprenorphine. Its benefits for opioid use disorder (OUD) or chronic pain outweigh this RARE risk.

Plus stopping buprenorphine can lead to withdrawal, relapse, or overdose in OUD...or loss of pain control in patients using it for chronic pain.

Ensure patients getting buccal or sublingual buprenorphine receive pharmacist counseling...and a MedGuide...to learn about strategies to reduce the risk of dental problems.

For example, patients should allow the med to dissolve completely in the mouth...take a large sip of water...then swish and swallow. This might help dilute the acid.

But patients shouldn't brush their teeth right after a dose...this can accelerate enamel loss. Instead, they should wait at least 1 hour after using the med before brushing.

Don't be surprised to hear your pharmacist advise patients to see a dentist when starting buprenorphine and at least twice a year.

Consider asking if patients have a dentist...and have a list of local offices or clinics handy, if needed.

Listen for patients on buprenorphine complaining of tooth pain, sensitivity, or other adverse events. Notify the pharmacist...and help report the situation to FDA's MedWatch.

Learn more about the role of buprenorphine in our FAQ, Management of Opioid Use Disorder.

Key References

  • https://www.fda.gov/drugs/drug-safety-and-availability/fda-warns-about-dental-problems-buprenorphine-medicines-dissolved-mouth-treat-opioid-use-disorder (2-25-22)
  • Prim Care Companion CNS Disord. 2013;15(5):PCC.13l01533
  • https://www.mouthhealthy.org/en/az-topics/e/dietary-acids-and-your-teeth (2-25-22)
Pharmacy Technician's Letter. March 2022, No. 380304



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