How buprenorphine law changes may affect dentistry

Legislative changes related to the prescribing of the opioid use disorder drug buprenorphine, which can cause dental problems, has more taking it, and dentists should be prepared. The commentary was published on February 2 in the Journal of the American Dental Association.

Dentists can not only aid in identifying the early signs of oral health complications linked to buprenorphine use, but they can better help these patients by communicating with them and members of their healthcare team, the authors wrote.

“Providing dental care professionals with education on substance use disorder and medication management can help further refine expertise in treating this population,” wrote the authors, led by Leslie Siegel, PharmD, RPh, of the Mayo Clinic Center for Palliative Care in Rochester, MN.

In 2023, the Mainstreaming Addiction Treatment Act expanded access to treatment by allowing any clinician with a U.S. Drug Enforcement Administration license to prescribe buprenorphine for opioid use disorder with no special waiver requirement or maximum number of patients who can be treated by a single provider. That same year, more than 15 million buprenorphine prescriptions were dispensed in the U.S.

Since the drug’s approval in 2002 by the U.S. Food and Drug Administration (FDA) as a medication taken sublingually to treat opioid use disorder, reports of dental problems, including oral infections and tooth decay and loss, have surfaced. The dental issues prompted the FDA to issue a warning about the potential side effects in 2022 and led an Ohio man to file a lawsuit in 2023 against Suboxone drug manufacturers, claiming its use led to his permanent tooth decay.

It’s been suggested in the literature that buprenorphine may cause dental problems because it is acidic and the pH of the drug promotes tooth decay. Another proposed cause is that the drug’s prolonged contact in the mouth may change the microbial profile of a tooth’s surface.

Since buprenorphine remains a key treatment for opioid use disorder, medical providers, including dentists, should try to ease risks by encouraging patients to rinse 30 minutes after taking the drug, recommending high-fluoride products, and promoting regular dental care, the authors wrote.

Dentists may want to work with prescribers to identify those patients who have ongoing dental problems and may benefit from switching to a long-acting injectable form of buprenorphine. Furthermore, clinicians should register with their state prescription drug monitoring program and review reports for patients before prescribing controlled substances. In some, not all, states, review of these reports is a legal requirement, they wrote.

For patients with substance use disorder who are undergoing extensive dental procedures, dentists should have open, direct conversations with them about pain management before any treatment, the authors wrote.…Read more by Melissa Busch