Does Suboxone® cause tooth decay? Here’s how to protect your smile on buprenorphine-naloxone

While taking Suboxone® (buprenorphine-naloxone) as part of your Medication-Assisted Treatment (MAT) program, it’s natural to have questions about your overall health, including your dental health, especially if you’ve heard mixed things online.

Many people take Suboxone for years without dental issues. That said, it’s important to understand that buprenorphine (a key ingredient in Suboxone) is acidic. When dissolved in the mouth, as it must be for treatment, it can temporarily lower your mouth’s pH. Over time, and without supportive oral care, this acidic environment may make teeth more vulnerable. This doesn’t automatically mean damage is inevitable, though.

It’s also worth remembering that many people in recovery face oral health challenges due to a number of factors unrelated to Suboxone, including past substance use, nutrition changes, or access barriers to dental care. You’re likely already following advice like “rinse after your dose,” “brush your teeth,” and “go easy on the soda.” Let’s go beyond the basics and share some practical ways to protect your smile while continuing your recovery journey with more confidence.

Does Suboxone cause tooth decay?

Suboxone has not been proven to cause tooth decay. But certain factors related to how it’s taken may contribute to an environment in your mouth that can make decay more likely over time if extra care isn’t taken.

When a Suboxone film or tablet dissolves under your tongue or against your cheeks, it creates a temporary acidic environment. This acidity can soften tooth enamel (especially with daily, long-term use) and reduce your mouth’s natural ability to neutralize acid and restore lost minerals like calcium and phosphate. 

Even if you follow FDA guidance perfectly, such as rinsing with water after your medication dissolves and waiting a full hour before brushing, your mouth may still face some challenges. However, the FDA also notes that the “benefits for use outweigh these risks and oral care can help.” What this tells us is tooth decay isn’t inevitable. It just means your dental routine might need a few thoughtful upgrades.

Oral care recommendations while taking buprenophine-naloxone
These steps are widely recommended by dental professionals and the FDA:

• After your medication has completely dissolved, gently rinse your mouth with water and swallow.
  This helps neutralize acids and wash away residue. Some people choose to spit out excess saliva first for comfort; either approach is fine once absorption is complete.
• Wait at least one hour before brushing your teeth.
  Brushing too soon can damage enamel that has been temporarily softened by acidity.
• Ask your provider or dentist about fluoride support.
  Fluoride supplements, rinses, or prescription-strength toothpaste may help strengthen enamel.
• Schedule regular dental checkups and let your dentist know you’re taking buprenorphine.
  This allows them to tailor preventive care to your needs.

Three ways buprenorphine can affect your mouth 

Buprenorphine is a key ingredient in several medications used to treat opioid use disorder (OUD), including Suboxone, Zubsolv®, Subutex®, and any generic version of these medications. While buprenorphine itself isn’t proven to rot teeth, three related factors can create conditions that make your teeth more vulnerable. Understanding these can help you take proactive steps, putting you in a position of control.

1. Dry mouth (xerostomia)

Suboxone can reduce saliva flow for some patients, leading to what’s called “xerostomia,” or dry mouth. Saliva does more than keep your mouth moist. It’s your mouth’s natural clean-up crew that washes away food and bacteria, neutralizes acids, and helps rebuild enamel. When there’s less saliva, it means more acid, more bacteria, and less protection for your teeth.

2. Direct exposure from sublingual dosing

Because Suboxone is taken under the tongue, it sits close to your teeth and gums for several minutes. This prolonged exposure to acidic ingredients can temporarily affect the pH balance in that area, making it easier for bacteria to thrive. This means flossing, brushing, and rinsing your mouth thoughtfully matter more. An antibacterial liquid (like Listerine) can help rebalance your mouth’s pH. 

3. Acidic formulation

Suboxone films and tablets contain ingredients like citric acid to help them dissolve properly. These acids aren’t unique to this medication, but when combined with dry mouth or infrequent rinsing, they can contribute gradually to tooth enamel softening over time.

Does Suboxone contain sugar?

Suboxone does not contain traditional sugar like candy or soda. However, it does include inactive ingredients that can influence your mouth’s chemistry. Some formulations include:

• Citric acid: Helps the film dissolve, but can affect enamel with repeated, prolonged contact.  
• Acesulfame potassium & saccharin: These artificial sweeteners don’t feed cavity-causing bacteria, but may slightly alter mouth pH.  
• Sodium citrate: Can make the mouth more acidic and increase the risk of cavities, especially if saliva flow is low.
  

Why do some people have few or no dental issues with Suboxone?

The answer comes down to a combination or mix of habits, biology, support, and access to care. Taking great care of your teeth and gums is the best way to avoid dental issues when taking Suboxone. Many people protect their teeth simply through consistent oral care and building a good routine of brushing gently, flossing, rinsing, and seeing a dentist regularly. 

That said, there are also hidden factors outside your control that can affect oral health, including the makeup of your DNA. Studies have shown that the genes responsible for the strength of tooth enamel are linked to the amount of dental erosion and cavities a person has. So, it is possible that basic dental care may not be enough for some people.

In other words, two people can take the same dose and have very different outcomes. This isn’t because one person is “doing recovery wrong,” but because biology and routine can work together in complex ways. That’s why personalized prevention matters. If you have any concerns about your dental health while taking part in MAT, talk to your QuickMD provider. They can help you develop a dental routine that supports your needs or recommend a dentist in your area who can help. 

6 ways to support good dental health while on Suboxone

Suboxone is a life-changing medication for people with OUD, helping them take control of their health. Rather than worrying about worst-case scenarios, focusing on practical prevention can make a big difference. These six strategies can help balance your mouth’s pH, boost natural protection, and strengthen your teeth so you can stay focused on your sobriety.

1. Keep your saliva flowing

Saliva dissolves your Suboxone dose so it can enter your cells quickly, but saliva is also essential for good oral health because it keeps the mouth at the right humidity and maintains its pH level (acid/base balance). Since buprenorphine can reduce saliva production, replacing that moisture is key. Try these safe, effective options:

• Chew more gum. Chewing gum (the sugar-free kind, of course) has several benefits: It increases saliva production (which remineralizes your teeth), reduces the kind of bacteria linked to cavities, and clears food off your teeth. Not to mention it keeps your breath fresh. Be sure to avoid gum sweetened with sugar or ingredients ending in “-ose,” such as glucose and fructose. Instead, look for xylitol chewing gum. (As a bonus, xylitol itself stimulates the salivary glands.) Chewing gum can also help to ease acid reflux, but for some people, gum flavored with peppermint can make acid reflux worse.

• Try artificial saliva. Artificial saliva comes in many different forms, including spray, oral rinse or mouthwash, gel, lozenges, and melts. These products mimic natural saliva and help restore moisture and pH balance. Some options, such as Biotene, are available over the counter. Other products, such as Salivamax, require a prescription.
• Look into saliva stimulants. More than just adding moisture to the mouth, saliva stimulants cause your saliva glands to produce more of their own saliva. Saliva stimulants may prevent dental erosion for patients with dry mouth, reduced saliva flow, or impaired saliva composition.

2. Quit or cut back on tobacco and marijuana

Anything that adds excess acid to your mouth is fighting against your saliva to restore balance. Tobacco use increases gum disease and risk of tooth decay, while marijuana is linked to dry mouth and gingivitis. Reducing or stopping helps your saliva do its job and helps protect your teeth. For those who use tobacco regularly, nicotine replacement therapy (including patches, gum, lozenges, inhalers, nasal sprays, and medications) can help fend off cravings. And you don’t have to do it alone. Counseling sessions can help manage the stress and emotions linked to using substances. 

3. Address your heartburn

About 1 in 5 Americans deal with chronic acid reflux (GERD), which sends stomach acid into the mouth and softens enamel from the inside out. If you often have a sour taste, chest burn, or frequent throat clearing, talk to your provider. Untreated acid reflux can undermine even the best dental care. 

4. Ask your dentist about in-office solutions

Tell your dentist as soon as you begin Suboxone and ask them what extra steps you can take to protect your teeth. They can help you come up with a helpful routine for preventive care, including: 

• Regular, in-office fluoride treatments to harden enamel, strengthen your teeth, and prevent decay. 
• Prescription-strength fluoride rinses or gels for home use. 
• Dental sealants or varnishes that create a protective surface barrier that helps preserve teeth. 
  

Don’t think of these as “last resort” options. They’re smart, proactive tools, and many insurers cover them. 

5. Add protective minerals to your teeth at home

Your daily routine can do more than clean. With the right products, you can actively rebuild minerals and balance pH. 

• Use fluoride toothpaste. Read the label on your toothpaste to make sure it contains fluoride. Look for “sodium fluoride,” “sodium monofluorophosphate,” or “stannous fluoride.”
• Upgrade to a remineralizing formula. For even more protection, try a remineralizing toothpaste like Sensodyne Pronamel or Colgate PreviDent 5000.  These options contain higher fluoride levels and pH balancing ingredients. You can also ask your dentist about prescription-strength fluoride toothpastes, which contain about five times as much fluoride as over-the-counter toothpaste.
• Avoid brushing immediately after dosing. Just like you’d wait 15-30 minutes after taking Suboxone before drinking or swishing liquid in your mouth, you’ll want to wait a little while longer before brushing. Wait at least 60 minutes before brushing your teeth to protect softened enamel.
• Stay hydrated. One of the best things you can do to counteract dry mouth and tooth decay is to stay hydrated by drinking plenty of water. Try for 8 cups of water or more every day. 
• Look for fluoride in your water. Tap water in most cities and towns contains fluoride, which means there’s more fluoride in your saliva. Most bottled water, on the other hand, contains little to no fluoride. If you dislike the taste of tap water, consider investing in a carbon or charcoal filter (such as a pitcher you store in the fridge or a filter that screws onto your kitchen faucet). Filters can give your water a better taste without removing the fluoride. You can also try adding some flavor to your water that won’t add sugar, such as brewing herbal tea or adding mint leaves or fruit.

6. Adjust your diet

If you’re doing everything right, but still having dental issues, another strategy for strengthening your teeth is to take a look at your diet. Small, consistent adjustments can make a big difference.

Eat less sugar and processed foods

Most people know that lots of soda, candy, and other junk food can ruin your teeth. But sometimes, added sugar is hidden in foods we don’t instantly think of as “sugary.” Check your food labels for “added sugar” and also check the ingredients list to see if any of the following are listed as one of the first few: 

• Corn sweetener
• Maltose
• Fructose
• Sucrose
• Glucose 
• Dextrin 
• Syrup (including high fructose corn syrup)
• Cane juice
• Fruit juice
  

Besides items with added sugar, there are other foods that can impact your oral health, like: 

• Alcoholic beverages
• Breakfast cereals
• Bread
• Chips
• Other foods that contain processed carbohydrates
  

Over the centuries, the human diet has shifted toward eating more carbohydrates,  making our mouth bacteria less diverse. Today, our mouths contain Streptococci (particularly Streptococci mutans) bacteria, which are known to cause cavities. These bacteria in your mouth use carbohydrates for food, so when you cut back on sources of simple carbohydrates, you can reduce your risk of cavities.

Eat more foods with fiber and minerals

What you eat plays a bigger role in dental health than you might think, especially when you’re in recovery and your body is adjusting. Certain foods don’t just nourish your body. They actively support your teeth by boosting saliva, neutralizing acids, and replenishing the minerals your enamel needs to stay strong. Think of your diet as part of your daily oral care routine, right alongside brushing and rinsing.

Here are some foods and minerals to incorporate into your diet to help create a healthier mouth:

• Fiber. Whole fruits and vegetables with lots of fiber can help keep your teeth clean, plus they get your saliva flowing. Many fruits and vegetables also contain vitamins A and C, which are excellent for healthy teeth and gums.
• Fluoride-rich foods. The recommended daily intake of fluoride for adults 19 and older is 3mg for women and 4mg for men. But most Americans aren’t getting that much. To get more fluoride via the foods you eat, you can try spinach, grapes, and black tea.
• Foods high in calcium and phosphorus. These important minerals help keep teeth strong and reduce the harm done by bacteria. Cheese, milk, yogurt, leafy greens, and almonds are high in calcium. Protein-rich foods like fish and eggs are good sources of phosphorus. If you are not getting enough of these minerals from your diet, a calcium supplement with phosphorus could help.
• Green and black tea. Tea contains natural compounds called polyphenols that kill or weaken bacteria, which means less acid attacking your teeth. (Plus, if you use tap water to brew your tea, it can also be a source of fluoride.)

Recognizing tooth decay: Early warning signs to watch for

Recovery already takes strength and focus. Your dental health is just one more part of caring for yourself along the way. Catching changes early can make all the difference. It can often help you avoid more complicated treatment down the line.  Watch for these warning signs.

Visual and physical signs of enamel damage and cavity formation

Those little sensations you’re experiencing matter. That twinge you feel with hot or sweet foods might be a sign that your teeth are under stress. It’s your teeth signaling that something has changed. Increased sensitivity means your tooth enamel is getting thinner, making your nerves more vulnerable. 

White spots appearing on your teeth aren’t just cosmetic. They’re early warning signs of mineral loss. Dark spots or tiny holes are more serious signals that need professional attention. If something feels rough when you run your tongue across your teeth, it might be your body’s way of saying it’s time for a check-in. 

Secondary symptoms of dental decay: Pain, bad breath, and gum issues

Bad breath that won’t go away is a sign of bacterial changes happening in your mouth. Those bleeding gums or pain when you bite down are your body communicating that something needs attention. You might also notice your teeth feeling a bit more sensitive or prone to minor chips. 

These signals offer a helpful cue to check in with your dentist. Don’t let them scare you. They’re part of routine dental health awareness, not a sign that something is wrong.

We’re here to support your recovery journey

You’re not in this alone. Here at QuickMD, you have an entire team behind you, ready to listen to your concerns with zero judgment and meet you wherever you are in your recovery.