Buprenorphine

Oral health effects

• Xerostomia (dry mouth)

  Opioids reduce salivary flow; chronic use raises caries risk, compounded by sugary drinks and neglected hygiene.

  Clinical management: Hydration, salivary substitutes, high-fluoride caries prevention; screen for substance-use considerations.

• Rampant caries with sublingual films/tablets

  Sublingual buprenorphine prolongs intraoral acid exposure and is associated with marked dry mouth and rapid caries; the FDA has warned about dental problems.

  Clinical management: After the dose dissolves, have the patient rinse with water (wait ~1 hour before brushing); aggressive caries prevention; non-judgmental care.

• Oral numbness, tongue pain and mucosal redness at the dissolution site

  With sublingual/buccal use, oral hypoesthesia (numbness; the most common local reaction, >1%), glossodynia and oral mucosal erythema are reported; postmarketing reports include stomatitis, glossitis, and blistering/ulceration of the mouth or tongue.

  Clinical management: Examine the floor of mouth, ventral tongue and buccal mucosa at each visit; manage sore areas symptomatically, advise rotating placement sites as directed, and refer persistent ulceration or blistering back to the prescriber. Do not advise stopping the medication.

• Dizziness or fainting on standing (orthostatic hypotension)

  Like other opioids, buprenorphine/naloxone may produce orthostatic hypotension in ambulatory patients (label Warnings).

  Clinical management: Raise the chair slowly at the end of treatment, let the patient sit upright for a minute or two before standing, and assist them out of the chair; take extra care in older patients and those also on antihypertensives, sedatives or other CNS depressants.