Does Buprenorphine (Butrans) cause dental caries (tooth decay)?

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From the Guidelines

Butrans (buprenorphine transdermal patch) does not directly cause tooth decay, but it can increase the risk of tooth decay due to its side effect of dry mouth (xerostomia). Butrans is an opioid medication used for pain management that is delivered through a skin patch, so it doesn't come into direct contact with the teeth. However, like other opioids, Butrans can cause dry mouth, which reduces saliva production, an important factor in neutralizing acids and washing away food particles in the mouth. With reduced saliva, there is an increased risk of tooth decay and other dental problems over time.

If you're using Butrans and experiencing dry mouth, it's essential to maintain good oral hygiene by:

  • Brushing twice daily
  • Flossing regularly
  • Staying hydrated
  • Using alcohol-free mouthwashes or saliva substitutes to manage dry mouth symptoms Regular dental check-ups are crucial if you're on long-term opioid therapy like Butrans to monitor and prevent potential dental issues 1.

It's also important to note that while Butrans itself does not directly cause tooth decay, the overall health and well-being of the patient, including their oral health, should be considered when prescribing and managing opioid therapy. According to the most recent and highest quality study, maintaining good oral hygiene and regular dental check-ups are key to preventing tooth decay and other dental problems in patients using Butrans 1.

From the Research

Butrans and Tooth Decay

  • Butrans, a transmucosal buprenorphine product, has been linked to tooth decay and other dental problems 2, 3.
  • The US Food and Drug Administration has issued a warning about xerostomia and caries associated with the use of transmucosal buprenorphine products 2.
  • Buprenorphine can cause dry mouth, which increases the risk of tooth decay and other oral health issues 2, 4.

Mechanisms of Tooth Decay

  • Tooth decay is caused by the erosion of tooth enamel or cementum by acidic substances produced by bacteria found in dental plaque 5.
  • Dry mouth, which can be caused by buprenorphine, increases the risk of tooth decay by reducing saliva production and altering the oral environment 4.
  • Other factors, such as poor oral hygiene and certain dietary habits, can also contribute to tooth decay 5.

Prevention and Management

  • Patients taking buprenorphine should be instructed on how to prevent tooth decay, including rinsing with water, swallowing once the drug has been completely dissolved, and toothbrushing at least 1 hour after taking the drug 2.
  • Fluoride supplements and regular dental care can also help prevent tooth decay in patients taking buprenorphine 2, 3.
  • Other preventive measures, such as applying fluoride gel or using a fluoride mouthwash, can also be effective in preventing tooth decay 6.

References

Guideline

Guideline Directed Topic Overview

Dr.Oracle Medical Advisory Board & Editors, 2025

Research

Orally dissolving buprenorphine for opioid use disorder linked to caries.

Journal of the American Dental Association (1939), 2024

Research

New Dental Warning for Buprenorphine.

The American journal of nursing, 2022

Research

Caries prevention for patients with dry mouth.

Journal (Canadian Dental Association), 2011

Research

Drugs that promote dental caries.

Prescrire international, 2015

Research

[Xerostomia-related dental caries].

Nederlands tijdschrift voor tandheelkunde, 1992

Professional Medical Disclaimer

This information is intended for healthcare professionals. Any medical decision-making should rely on clinical judgment and independently verified information. The content provided herein does not replace professional discretion and should be considered supplementary to established clinical guidelines. Healthcare providers should verify all information against primary literature and current practice standards before application in patient care. Dr.Oracle assumes no liability for clinical decisions based on this content.

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