Dental problems reported with buprenorphine
By Dr Many Ayer Oct 24
Buprenorphine is a novel opioid increasingly being used in Australia for pain management and treatment of opioid dependence. Dentists should be aware that severe dry mouth and consequent dental problems are being reported with the buprenorphine products dissolved in the mouth. These formulations are tablets and films that are dissolved under the tongue or against the inside of the cheek. Non-oral products containing buprenorphine can also cause dry mouth, but to a lesser extent. These products include transdermal patches, depot injections and intravenous infusions.
The FDA has been warning since 2022 ((1) that the dental problems associated with buprenorphine include tooth decay, cavities, oral infections, and loss of teeth, can be serious which have been reported even in patients using buprenorphine with no prior history of dental issues.
Dentists may see more patients on buprenorphine now that the depot injection has become available to treat opioid dependence and pharmacists are now authorised to administer these injections, as part of their credentialing to administer medicines by injection. (2)
Therefore, patients using buprenorphine products in the mouth should take extra steps to help lessen the impact on their oral health. These patients should schedule a dental visit soon after starting this medicine and inform the dentist that they are taking buprenorphine, and schedule regular dental checkups while taking this medicine.
In addition, the patient’s oral health history needs to be taken prior to prescribing treatment with a transmucosal buprenorphine medicine. Dentists treating someone taking a transmucosal buprenorphine product should perform a baseline dental evaluation and caries risk assessment, establish a dental caries preventive plan, and encourage regular dental checkups.
