What Is Suboxone — and Why Does It Damage Teeth?
Suboxone sublingual film is a life-saving treatment for opioid use disorder. It's also destroying the teeth of patients who were never warned about the risk.
What Is Suboxone?
Suboxone is a prescription medication used to treat opioid use disorder (OUD). It contains two active ingredients:
- Buprenorphine — a partial opioid agonist that reduces cravings and withdrawal symptoms without producing the high of full opioids
- Naloxone — an opioid antagonist added to deter misuse (if injected, it triggers withdrawal)
Suboxone is available in two main forms: sublingual tablets and sublingual film (thin strips similar to breath strips). The film version is placed under the tongue, where it dissolves over 5-10 minutes and is absorbed directly into the bloodstream.
Suboxone is a critical medication. It helps people recover from opioid addiction and saves lives. This is not about the medication's therapeutic purpose — it's about a product defect that the manufacturer failed to adequately disclose.
Key Facts About Suboxone
- Manufacturer: Indivior PLC (formerly Reckitt Benckiser)
- Film manufacturer: Aquestive Therapeutics
- Approved for: Opioid use disorder treatment (maintenance therapy)
- Form at issue: Sublingual film (dissolving strips) — NOT the tablet form
- ~16 million Americans have been prescribed buprenorphine products
- FDA dental warning: June 2022 — class-wide warning for all buprenorphine oral dissolution medicines
How Does Suboxone Film Work?
When a patient places Suboxone film under the tongue, the film dissolves over approximately 5-10 minutes. During this dissolution, the film creates an acidic microenvironment in the mouth. Buprenorphine and naloxone are then absorbed through the mucous membranes under the tongue directly into the bloodstream — bypassing the digestive system for faster and more reliable absorption.
Patients are typically instructed to not eat, drink, or smoke while the film is dissolving, and to avoid rinsing the mouth immediately after. This means the acidic film residue remains in contact with the teeth for an extended period after each dose.
Depending on the prescription, patients may take one or two films per day, every day, for months or years.
Why Does Suboxone Film Damage Teeth?
The answer lies in chemistry: Suboxone sublingual film has a highly acidic pH of approximately 3.4.
For context:
- Pure water has a pH of 7.0 (neutral)
- Tooth enamel begins to dissolve at pH 5.5
- Orange juice has a pH of approximately 3.5
- Suboxone film has a pH of approximately 3.4
- Battery acid has a pH of approximately 1.0
Every time a patient places Suboxone film under their tongue, they are effectively bathing their teeth in an acid solution as acidic as orange juice — for 5-10 minutes at a time, once or twice a day, every day.
The Acid Erosion Mechanism
Here is what happens to teeth with repeated acid exposure:
- Acid softens enamel — the film's acidic pH begins dissolving the mineral content (calcium and phosphate) from tooth enamel
- Demineralization accumulates — with daily use, the enamel layer progressively thins and weakens
- Enamel erosion becomes visible — teeth appear chalky, yellow, or translucent at the edges; they become sensitive to temperature and sweets
- Dentin becomes exposed — as enamel wears away, the softer inner dentin layer is exposed; decay accelerates dramatically
- Cavities, fractures, and infection — bacteria colonize damaged areas, causing rapid decay; teeth become brittle and prone to cracking
- Tooth loss — without intervention, teeth deteriorate to the point of requiring extraction
Unlike normal tooth decay, Suboxone-related acid erosion can be severe and rapid, affecting multiple teeth simultaneously — especially the teeth nearest the dissolving film.
Why Didn't Patients Know About This Risk?
This is the central question of the litigation. Indivior and Aquestive Therapeutics developed Suboxone film and brought it to market. They conducted clinical trials. They collected adverse event data. The acidic pH of the film was a known property of the formulation.
Yet for years, no warning was included in the prescribing information about dental risks. Patients were not told. Dentists were not told. Prescribing physicians received no guidance to counsel patients about dental care while on Suboxone film.
The FDA only required a dental warning in June 2022 — years after the drug became the standard of care for opioid use disorder and was prescribed to millions of patients.
In the meantime, patients suffered. Many blamed themselves, assuming their dental problems were a consequence of their addiction history. This shame and self-blame led many to delay seeking dental care, exacerbating the damage.
Used Suboxone Film and Had Dental Problems?
If Suboxone damaged your teeth, you may have the right to seek compensation. A free case evaluation takes 2 minutes.
Check My Eligibility →Is Suboxone Film Still Being Prescribed?
Yes. Suboxone film is still available and widely prescribed. Following the June 2022 FDA warning, prescribers are now required to counsel patients about dental risks and recommend regular dental visits. The FDA also recommends patients rinse their mouth with water after each dose.
However, these precautions do not address the fact that millions of patients used Suboxone film for years before the warning existed — suffering dental damage they had no way to prevent because they were never told it was happening.
The Difference Between Film and Tablets
It's important to note that the dental injury litigation focuses specifically on Suboxone sublingual film — the dissolving strips — not Suboxone tablets (Subutex) or other buprenorphine formulations.
The film formulation's acidic properties appear to be particularly problematic. The tablet form has a different formulation and does not have the same acidic pH profile.
If you are unsure whether you used film or tablets, check your pharmacy records or speak with your prescribing physician.