Published March 2026

Suboxone Film vs Tablet: Why the Film Causes More Dental Damage

Not all buprenorphine products are the same. The lawsuits filed against Suboxone's manufacturers specifically target the sublingual film — not the tablet formulation. That's not a technicality. There's a real scientific reason for it, and understanding the difference matters if you're considering a claim.

Two Forms of the Same Medicine

Buprenorphine/naloxone — the active ingredients in Suboxone — come in two delivery formats approved by the FDA for opioid use disorder treatment. The first is a sublingual tablet, which dissolves under the tongue. The second is a sublingual film (the "Suboxone strip"), which also dissolves under the tongue but has a significantly different formulation and a significantly different pH.

The tablet formulation has a near-neutral pH. The film formulation has an acidic pH of approximately 3.4. On the pH scale, where 7 is neutral, 3.4 is quite acidic — similar to apple juice or a carbonated soft drink. The critical difference is that a single exposure to apple juice is brief. Suboxone film is designed to sit against oral tissues for 5 to 15 minutes, multiple times per day, every day, often for years.

The Chemistry of Enamel Erosion

Tooth enamel is primarily made of hydroxyapatite, a calcium phosphate mineral. Acid dissolves hydroxyapatite. This is not a controversial finding — it's basic chemistry, and it's why dentists have always warned about sugary drinks (which produce acid through bacterial fermentation) and acidic beverages.

What makes Suboxone film particularly problematic is the combination of factors: high acidity, prolonged contact time, repeated daily dosing, and the specific placement of the strip directly against tooth surfaces. The film sits in the sublingual space — the area under the tongue and against the back of the lower teeth — which is not a naturally acidic environment the way the stomach is.

Published research on buprenorphine oral products has documented pH levels at or below 4.0, which is the threshold at which enamel begins to demineralize. One study found that Suboxone film created sustained acidic conditions in the oral cavity for the entire dissolution period. For a patient dissolving strips four to eight times per day, that's potentially two or more hours of enamel erosion per day, 365 days a year.

Why This Matters for the Lawsuits

The legal cases being brought against Indivior PLC — the primary manufacturer of Suboxone film — focus specifically on the film product for exactly this reason. The allegation isn't that buprenorphine medication is inherently harmful. The allegation is that the specific film formulation chosen by the manufacturer creates foreseeable dental harm, and that the manufacturer knew or should have known this, and failed to warn patients and prescribers.

Indivior acquired the Suboxone film product from Reckitt Benckiser in a complex corporate transaction. Aquestive Therapeutics co-developed the film technology. Both entities are named in litigation. The claim is straightforward: a pharmaceutical company cannot put a product on the market with a pH of 3.4 that sits against people's teeth for hours every day, observe the accumulating adverse event reports of dental damage, and then claim they had no idea the product was harming people's mouths.

The Patent Controversy

There's a darker dimension to this story that has come out in the litigation. Around 2012, when Suboxone's core patent was about to expire and generic tablet competition was imminent, Indivior undertook an aggressive campaign to switch patients from the tablet to the film product. The film was still under patent protection. A switch from tablet to film meant continued market exclusivity and higher margins.

The company filed citizen petitions with the FDA raising safety concerns about generic tablets — concerns that critics argued were pretextual, designed to delay generic competition while Indivior retained market share. In 2019, Indivior was indicted on federal charges related to a fraudulent marketing scheme, and ultimately paid hundreds of millions in fines and restitution.

The relevance to dental injury claims: if the company knew about the acidic pH of the film, and if the company was actively steering patients toward the film for market reasons rather than clinical ones, then the failure to warn about dental damage looks less like an oversight and more like a deliberate choice.

What the Tablet Users Need to Know

If you used the Suboxone tablet — not the film — your situation is different. The tablet formulation's near-neutral pH means the mechanism of dental damage described in the film lawsuits does not apply. That doesn't mean the tablets are without side effects, but it does mean you would not be part of the current wave of dental injury litigation targeting the film product.

If you're not sure which formulation you used, your pharmacy records will show the specific product dispensed. "Suboxone film" or "Suboxone sublingual film" designates the strip product. "Suboxone sublingual tablet" designates the tablet. Generic buprenorphine/naloxone products may also specify film or tablet.

The Bottom Line

The distinction between Suboxone film and tablet isn't a footnote — it's central to the legal theory of the current litigation. The film's acidic pH, prolonged oral contact time, and the manufacturers' failure to warn about the foreseeable dental consequences of these properties form the core of the claims being filed.

If you used Suboxone sublingual film for six months or more and suffered significant dental damage — decay, fractures, tooth loss, expensive procedures — the connection between those two facts is exactly what these lawsuits are about.