Understanding How Suboxone Causes Tooth Decay

Suboxone is a medication widely prescribed by doctors for its effectiveness in treating opioid addiction. Its benefit to people suffering from opioid dependence and addiction is undeniable; however, it has a hidden danger that most people don’t know about.

The medication is a combination of buprenorphine, a partial opioid agonist, with naloxone, an opioid antagonist. These two medications, particularly buprenorphine, are technically opiates themselves. However, they help to reduce opioid dependency without the “high” feeling associated with traditional opiates.

Despite its beneficial role in addiction treatment, using Suboxone can inadvertently cause dental health problems.

This article explores the underlying factors contributing to this side effect, such as acidity, dry mouth, sweeteners, prolonged contact with teeth, harmful bacteria, and the implications of long-term use.

Serious Harm Caused by Suboxone Film Strips

Studies and reports have shown the use of Suboxone to cause serious tooth decay and dental problems. What the medication’s warning guide calls “Dental Adverse Events”.

By the maker’s admission, multiple cases of these serious side effects have been reported in individuals without any prior history of dental problems.

These dental injuries include:

  • Severe dental caries (i.e., cavities)
  • Tooth fracture
  • Tooth decay
  • Tooth loss
  • Dental abscesses/infection
  • Rampant caries (i.e., many cavities)
  • Tooth erosion
  • Fillings falling out
  • Total tooth loss (i.e., all of a person’s teeth falling out)

How Suboxone Causes Tooth Decay

Suboxone has been found to cause tooth decay in medical studies, patient reports, and from the manufacturer.

This information is backed by long-term medical studies from journals like JAMA, patient adverse event reports (aka complaints to the FDA), and the medication’s own warning guide.

Acidity in Suboxone-Related Tooth Decay

A substance’s acidity is measured by its pH level, and substances with low pH levels can erode tooth enamel—for example, orange juice, coffee, and soda.

Suboxone, especially when administered sublingually, can create an acidic environment in the mouth. This exposure to acid can demineralize the enamel on one’s teeth, weakening them and making them more susceptible to decay.

Suboxone has a 3.4 pH when dissolved in water. This pH level is approximately the pH of fruits like grapefruits and pineapples (pH: 3.00–4.00) and sodas like Red Bull Energy Drink, Sprite, and Mountain Dew (pH: 3.3).

This acidic solution created by dissolved Suboxone in the mouth can wear away your tooth enamel, allowing your teeth to succumb to bacteria and decay.

Dry Mouth (Xerostomia) from Suboxone

Saliva plays a vital role in good oral health by neutralizing acids, washing away food particles, and aiding in remineralizing one’s tooth enamel.

Suboxone can reduce saliva production by quite a lot, leading to dry mouth (aka Xerostomia), which increases the risk of tooth decay.

Sweeteners in Suboxone Formula

Suboxone’s formula contains sweeteners to make it more palatable. This is especially important since a person has to put it in their mouth for 30 minutes instead of quickly swallowing it.

These sweet additives may make the medication more palatable, but they can also provide food to the oral bacteria that produce acid in the mouth and lead to tooth decay.

Prolonged Contact with the Teeth

Suboxone films are administered sublingually, which means the medication is placed under the tongue or in the cheek area. This administration method causes the medication to be in direct contact with the teeth and oral tissues for an extended period, roughly 30 minutes, according to the medication’s instructions.

This prolonged exposure can increase the risk of dental issues since the other negative effects, like acid, dry mouth, and feeding bacteria, worsen the longer the medicine is present.

Streptococcus Mutans Bacteria Caused by Suboxone

Streptococcus mutans is a type of bacteria closely associated with tooth decay. It thrives in acidic environments and feeds on sugars, producing acids that erode tooth enamel.

As we mentioned, conditions like dry mouth, low acidity, and sweeteners can promote the growth of these harmful bacteria. Since these bacteria are known to cause tooth decay, this presents a real problem.

The Impact of Long-Term Suboxone Use on Dental Health

Suboxone plays a critical role in helping people to recover from opioid addiction. One of the ways it does that, besides pharmaceutically, is by having the patient stay on a low dose of Suboxone for an extended period to reduce the risk of relapse.

This long-term use of Suboxone is beneficial to people who suffer from addiction or dependence on other drugs since relapse is so common. The relapse rate for opioid addiction is as high as 91%, and it takes an average of 5.35 recovery attempts before a person can get clean.

However, its long-term use also exposes patients to more opportunities for any of these potentially harmful effects to take a toll on their teeth.

FDA Forced Suboxone to Warn Patients of “Dental Adverse Events”

The FDA has always required drug manufacturers to include warnings about possible side effects on their medications. It’s one of their main jobs to help keep Americans safe.

In January 2022, the FDA required Indivior, the manufacturer of Suboxone, to add a warning label to Suboxone because of the risk of dental problems. Considering the medication was approved by the FDA in 2002, there was a 20-year gap between the release of the medication and the warning that it can cause severe tooth decay, including total tooth loss, meaning losing all of one’s teeth.

This late warning is one of the main reasons that Suboxone users who have severe dental health problems are turning to legal options.

Here is the excerpt from the FDA’s Medication Guide for Suboxone Sublingual Films]:

“Dental Adverse Events – Cases of dental caries, some severe (i.e., tooth fracture, tooth loss), have been reported following the use of transmucosal buprenorphine‐containing products. Reported events include cavities, tooth decay, dental abscesses/infection, rampant caries, tooth erosion, fillings falling out, and, in some cases, total tooth loss. Treatment for these events included tooth extraction, root canal, dental surgery, as well as other restorative procedures (i.e., fillings, crowns, implants, dentures). Multiple cases were reported in individuals without any prior history of dental problems…”

Lawsuits Over Suboxone’s Potential to Cause Tooth Decay

Suboxone tooth decay has become a controversial issue, leading to a series of lawsuits filed by patients who have experienced severe dental problems that they attribute to their medication.

These lawsuits argue that the manufacturers of Suboxone failed to adequately warn users about the potential risks of tooth decay and other dental issues associated with the drug.

Plaintiffs claim that they have been suffering from many different serious dental injuries and never knew it was because of their Suboxone films. These patients have alleged that they’ve suffered from severe tooth decay, gum disease, infections, tooth loss, and a host of other issues as a direct result of taking Suboxone.

According to the Suboxone lawsuit plaintiffs, these injuries have led to costly dental treatments, expensive prosthetics, painful surgeries, and, in some cases, long-term health consequences. It is precisely these damages that they are seeking compensation for, as well as punitive damages due to Indivior’s serious negligence in failing to warn patients about these possible side effects.

The large amount lawsuits filed against Suboxone has led to the cases being consolidated into a single federal case to streamline pretrial matters, known as multi-district litigation or MDL. This is a sign that the Courts are taking the lawsuits seriously and expect a lot more to be filed.


Suboxone is a valuable tool in the fight against opioid addiction. It has saved countless lives, helped people to recover and rebuild, and given people a much-needed safety net against opiate addiction relapse. But, these benefits have a few downsides, including potentially significant damage to one’s teeth.

Understanding the reasons behind these effects—acidity, dry mouth, sweeteners, prolonged contact, bacteria, and long-term use—allows individuals to weigh the pros and cons before deciding on using Suboxone as a course of treatment and enables healthcare providers to provide information that patients can use to mitigate risks.

If you are undergoing Suboxone treatment, consider scheduling a dental check-up to assess your oral health and discuss any concerns with your dentist. Proactive care can make a big difference in preventing tooth decay. If you fear that Suboxone is the cause of your dental problems, you should speak to a qualified personal injury lawyer.