Yes, Suboxone can damage your teeth. The FDA issued a safety warning confirming that buprenorphine medicines dissolved in the mouth, including Suboxone films and tablets, are linked to serious dental problems such as tooth decay, cavities, oral infections, and tooth loss. These problems have been reported even in patients with no prior history of dental issues. Since buprenorphine was first approved, the FDA identified 305 cases of dental problems tied to these medications, with 131 classified as serious.
What Kind of Dental Damage Happens
The dental problems linked to Suboxone go beyond ordinary cavities. Reported issues include rampant tooth decay, dental abscesses and infections, erosion of tooth enamel, fillings falling out, and in some cases, complete tooth loss. The word “rampant” matters here: it describes decay that spreads rapidly across multiple teeth at once, sometimes affecting teeth that are normally resistant to cavities, like the lower front teeth.
What makes this particularly concerning is that these problems can develop in people who previously had healthy teeth. This isn’t simply a continuation of dental neglect from before treatment. The medication itself appears to play a direct role, largely because of how it’s taken.
Why Dissolving the Film Causes Problems
Suboxone is designed to dissolve under the tongue or against the inside of the cheek, where it sits in direct contact with your teeth and gums for several minutes. This delivery method creates two issues that work together to erode dental health.
First, buprenorphine is acidic. Each time the film or tablet dissolves, it temporarily lowers the pH in your mouth, creating conditions that soften and wear down tooth enamel. Over weeks and months of daily use, this repeated acid exposure adds up. Second, buprenorphine reduces saliva production. Saliva is your mouth’s primary defense against decay: it washes away food particles, neutralizes acids, and delivers minerals that repair early enamel damage. When saliva flow drops, your teeth lose that protection around the clock, not just during the minutes the medication is dissolving.
The combination of direct acid exposure and chronic dry mouth creates a perfect environment for aggressive tooth decay. People who take Suboxone twice a day face even more acid exposure than those on a once-daily dose.
How to Protect Your Teeth While Taking Suboxone
The dental risks are real, but they can be managed. The American Dental Association recommends a specific routine for anyone on sublingual buprenorphine:
- Rinse with water after each dose. Once the medication has fully dissolved, take a large sip of water, gently swish it around your mouth, and swallow. This helps wash away residual acidity and raise your mouth’s pH back toward normal.
- Wait at least one hour before brushing. This is counterintuitive, but brushing immediately after taking Suboxone can actually make things worse. Your enamel is temporarily softened by the acid, and scrubbing it with a toothbrush during that window can physically wear it away. Give your saliva time to remineralize the surface first.
- Use a prescription fluoride product. Over-the-counter toothpaste may not be enough. Ask your dentist about a high-concentration fluoride toothpaste or rinse to strengthen enamel against ongoing acid exposure.
- Schedule more frequent dental visits. Rather than seeing the dentist every six months, people on Suboxone benefit from visits every three to four months. This allows your dentist to catch early decay before it becomes severe and to monitor for dry mouth.
Staying hydrated throughout the day also helps counteract reduced saliva production. Sugar-free gum or lozenges containing xylitol can stimulate saliva flow between doses.
Injectable Alternatives Skip the Mouth Entirely
The FDA warning specifically targets buprenorphine medicines that dissolve in the mouth. Long-acting injectable forms of buprenorphine bypass oral contact altogether, delivering the medication through a monthly injection under the skin. Because the drug never touches your teeth or gums, the direct acid exposure and localized drying effect don’t apply. If dental damage is a significant concern for you, this is worth discussing with your prescriber as an alternative delivery method.
Don’t Stop Taking Suboxone Because of Dental Risk
This is the most important point dental professionals emphasize: the risk of dental problems does not outweigh the benefits of treating opioid use disorder. Untreated opioid dependence carries risks that are far more dangerous than cavities, including overdose and death. The American Dental Association explicitly states that dentists should make sure patients continue following their buprenorphine treatment plan rather than encouraging them to stop because of potential decay.
The goal is to manage both at the same time. With consistent preventive care, the severity of dental damage can be significantly reduced. Many people take Suboxone for years without catastrophic tooth loss, particularly when they follow the rinse-and-wait routine and keep up with regular dental appointments.
The Lawsuits Over Failure to Warn
Nearly 1,900 lawsuits have been filed against Indivior (the manufacturer of Suboxone) and its development partner Aquestive Therapeutics, alleging that the companies knew about the risk of severe dental damage and failed to warn patients or prescribers. These cases have been consolidated into a single federal proceeding in Ohio, with the first trial projected for March 2028.
The core claim in every case is the same: the manufacturers were aware that buprenorphine’s acidity caused harmful damage to teeth when used as prescribed, and they chose not to disclose that risk. Before the FDA’s 2022 warning, Suboxone’s labeling did not mention dental decay as a potential side effect. For many patients, the damage had already been done by the time the warning was issued.