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Suboxone and Dental Hygiene 

Suboxone is a medication that is used in the treatment of opioid use disorder (OUD)

Dental x-ray

What is Suboxone (Mosel, 2024)?

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  • Suboxone is a medication that is often used for the treatment of opioid use disorder (OUD)

  • This medication manages withdrawal symptoms and reduces substance cravings by blocking the brain’s opioid receptors with an opioid antagonist (causing our brain’s receptors to be unresponsive to the opioid)

  • Suboxone is used to stabilize withdrawal symptoms during the substance detoxification process and is used as a maintenance treatment in the promotion of OUD recovery

  • Suboxone is a combination of two drugs given in the form of dissolvable tablets or dissolvable film that goes either under your tongue or in the cheek of the mouth:

    • Buprenorphine – a partial opioid antagonist

    • Naloxone – an opioid antagonist

 

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Why does Suboxone cause tooth decay (Hill, 2024)?

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  • Suboxone is typically taken 1-3 times per day meaning your teeth are exposed to this medication multiple times a day

  • The main culprit of tooth decay from suboxone is the high amount of acidity in the medication

    • As the Suboxone dissolves, the mouth’s acidity levels rise

    • Suboxone has an acidic level of 3.4 pH, which is acidic enough to wear away at tooth enamel

      • This allows bacteria in the tooth, leading to tooth decay

  • Other problems that can lead to tooth decay include:

    • Dryness – many individuals using Suboxone have low levels of saliva

      • When there is not enough fluid to coat your teeth, food sticks and bacteria grows, making teeth susceptible to tooth decay

    • Poor habits – some people who use Suboxone may also drink sugary beverages, smoke, have poor dental hygiene habits, or limited access to dental care

      • All these factors contribute to tooth decay and dental disease

 

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How can tooth decay be prevented while taking Suboxone (Drew, 2024)?

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  • There are various ways that tooth decay can be prevented when taking Suboxone

  • Various ways to prevent tooth decay include:

    • Follow the proper technique for taking Suboxone

      • Ask your provider about the proper way to take your Suboxone

      • If you take multiple strips in each dose, consider taking both at once to reduce the duration of acid exposure on your teeth

      • Place the strip under your tongue and do your best to avoid the strip coming in to contact with your teeth (e.g., do not suck on the strip like candy, let it dissolve on its own)

    • Rinse after your suboxone dose

      • Once the strips are fully dissolved, take a large sip of water and rinse your mouth out

      • Make sure to swish water around to rid of any remaining medication residue

    • Wait to brush your teeth

      • The acid in Suboxone softens tooth enamel making toothpaste and brushing too abrasive for the tooth

      • Wait 1 hour before brushing your teeth to allow the enamel to harden

    • Use an enamel-strengthening toothpaste

      • Brushing your teeth with toothpaste that strengthens your enamel will minimize any enamel damage caused by the medication

      • Some brands that carry enamel-strengthening toothpaste include:

        • Sensodyne Pronamel

        • Regenerate Advanced Toothpaste

        • Made By Dentists Enamel Rebuilding Professional Toothpaste

    • Talk to your dentist

      • The American Dental Association recommends that individuals notify their dental provider when a care team prescribes Suboxone

        • It would be beneficial to sign a release of information so your dental and psychiatric provider can coordinate care

      • Go in for regular checkups and notify your dental provider if you notice any oral health problems

      • Don’t stop taking Suboxone without consulting with your care team. Both your mental health and dental providers can work together to address dental concerns without putting your OUD treatment at risk

      • If a dental procedure is required while taking Suboxone, work with your mental health and dental providers to develop a plan for the treatment of pain after the procedure

        • Post-procedure pain options the teams may consider are:

          • Using NSAIDs (ibuprofen) or non-opioid analgesics (Tylenol) to treat pain

          • Carefully introduce a short-acting opioid for extra pain relief while maintaining the current dose of suboxone

          • Increasing the Suboxone dose for a specific period after the procedure

          • Oral pain treatment planning will depend on various factors such as the type of dental procedure, recovery time, and pain severity

 

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Misconceptions about Suboxone and tooth decay (Drew, 2024)

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  • A misconception is that all Suboxone patients will experience dental problems

    • Over 2 million Americans use Suboxone each year and nearly half report no dental pain or other oral health concerns

  • Many individuals mistakenly believe that the risks of using Suboxone outweigh the benefits however, the benefits of taking Suboxone if you suffer from OUD can be much greater than the risks

 

 

 

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Crisis Resources:

  • NAMI HelpLine

  • NAMI Crisis Text Line

    • Text NAMI to 741-741

  • COPE (Hennepin County)

    • Adult: 612-596-1223

    • Child: 612-348-2233

  • Ramsey County

    • Adult: 651-266-7900

    • Child: 651-266-7878

  • Text Connect (Crisis counseling via text)

    • Text “HOME” to 741741

 

 

 

References

 

Drew, D. (2024). Suboxone and oral health. Ophelia Health. https://ophelia.com/blog/suboxone-and-oral-health

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Hill, E. (2024). Does suboxone rot your teeth? Can you prevent tooth decay? Bicycle Health.

https://www.bicyclehealth.com/suboxone-faq/suboxone-affect-my-teeth

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Mosel, K. (2024). Suboxone: Uses, side effects & addiction. American Addiction Centers.

https://americanaddictioncenters.org/suboxone

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