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Sublingual Buprenorphine-Naloxone Exposure & Dental Disease

Adverse dental outcomes were significantly more common among 21,404 users of sublingual buprenorphine/naloxone than in those using transdermal buprenorphine (n = 5,385) and oral naltrexone (n = 6,616), a study shows. “Sublingual buprenorphine/naloxone is acidic in nature,” the authors write. “Patients are instructed to hold the tablet under the tongue for 5 to 10 minutes to maximize absorption. Thus, prolonged acidic exposure of the drug in the mouth might lead to tooth damage. ”

Patient-level prescription and diagnostic data in the PharMetrics system showed the following based on a primary outcome of time from the first prescription to the first occurrence of a dental event: “The incidence of any dental adverse event was 21.6 per 1000 person-years with sublingual buprenorphine/naloxone, 12.2 per 1000 person-years with transdermal buprenorphine, and 10.9 per 1000 person-years with oral naltrexone. The adjusted HRs were 1.42 (95% CI, 1.17-1.73) for sublingual buprenorphine/naloxone vs transdermal buprenorphine and 1.67 (95% CI, 1.41-1.98) for sublingual buprenorphine/naloxone vs oral naltrexone. The incidence of dental caries or tooth loss was 8.2 per 1000 person-years with sublingual buprenorphine/naloxone, 3.5 per 1000 person-years with transdermal buprenorphine, and 3.8 per 1000 person-years with oral naltrexone. For dental caries or tooth loss, the HRs were 1.57 (95% CI, 1.11-2.23) for sublingual buprenorphine/naloxone vs transdermal buprenorphine and 1.71 (95% CI, 1.29-2.27) for sublingual buprenorphine/naloxone vs oral naltrexone. Results were generally similar for the different sensitivity analyses.”

Source: JAMA