Many Rx Opioids – Not Just Suboxone – Raise Risk of Dental Disease

By Pat Anson

Suboxone isn’t the only opioid medication linked with dental decay and disease.

A large study led by VA Connecticut researchers found that patients on long-term opioid therapy with pain medications such as morphine and oxycodone have a significantly higher risk of infection-related dental disease.

The observational study included data from over 2 million U.S. veterans, 36% of whom were on long-term opioid therapy (LTOT). Those taking opioid pain medication for at least 90 days had a 24% higher chance of tooth decay, infections or tooth loss. 

Suboxone, which contains the partial opioid agonist buprenorphine, was excluded from the study, along with the opioid methadone. Both medications are used to treat opioid use disorder (OUD). 

The FDA warned in 2002 that buprenorphine tablets and film, when dissolved in the mouth, were linked to serious dental problems, including tooth decay, cavities, oral infections, and loss of teeth. Methadone has also been associated with dental problems because it induces dry mouth (xerostomia), which reduces saliva needed to wash away bacteria and plaque.  

The new study is believed to be the first linking dental disease to opioids taken long-term for pain relief.

“To our knowledge, this is the first study to demonstrate the association between LTOT exposure and dental disease. This finding is important in light of recent warnings of buprenorphine risks that may influence decision-making in the context of chronic pain and/or OUD,” researchers reported in the journal PLOS One.

In their analysis, VA researchers compared veterans who took 12 opioids (hydrocodone, oxycodone, morphine, fentanyl, hydromorphone, dihydrocodeine, meperidine, pentazocine, propoxyphene, levorphanol, tramadol, or tapentadol) to veterans who had no exposure to LTOT in the prior year.

Researchers think the higher rate of dental disease for those on LTOT stems from immune suppression and reduced saliva flow, which raises the risk of bacterial infections that lead to dental disease and cavities. 

The findings suggest that all patients on LTOT – whether for pain relief or OUD treatment – should be cautioned about the risks of dental problems.

“Concern over these risks may present a barrier to buprenorphine initiation in patients prescribed LTOT for whom such treatment is indicated. However, full opioid agonists themselves may pose oral health risks due to immunosuppression and well-documented effects on saliva flow causing xerostomia; both create opportunity for oral disease development,” researchers concluded.

Doctors who have patients on LTOT are advised to monitor their oral health and to have discussions with patients about dental risks before starting them on opioids.

There are simple steps patients on long-term opioids can take to reduce their risk of dental disease. Patients on buprenorphine or methadone are often advised to drink more water to combat dry mouth, and to brush and floss regularly to help prevent dental infections. 

Poor Oral Health Linked to Fibromyalgia and Migraines

By Crystal Lindell

Poor oral health is significantly associated with body pain, headaches, and abdominal distress in women, according to a new study published in Frontiers in Pain Research. The research highlights the importance of dental hygiene and its role in fibromyalgia and other chronic pain conditions. 

Australian researchers looked at the oral health of 158 women by using the World Health Organization's oral health questionnaire. Over two thirds of the women (67%) had fibromyalgia, a chronic pain condition that causes fatigue, body pain and sleep disturbances. 

Researchers also evaluated saliva samples from the women to look for four oral microbe species that have previously been associated with migraines.

They found that poor oral health scores, higher pain scores, and high microbe levels were significantly associated with each other. That suggests a potential role for the microbes as a cause of the pain experienced by the women. 

“This is the first study to investigate oral health, oral microbiota and pain commonly experienced in women with fibromyalgia, with our study showing a clear and significant association between poor oral health and pain,” said lead investigator Joanna Harnett, PhD, an Associate Professor at the University of Sydney. 

Women with the poorest oral health were more likely to suffer from higher pain scores. Sixty percent experienced moderate to severe body pain, and 49 percent were more likely to experience migraine headaches. Poor oral health was also a significant predictor of frequent and chronic migraine.

Researchers say it’s entirely plausible that poor oral health leads to gum disease and oral dysbiosis, an imbalance of microorganisms that can spread throughout the body. The bacteria then trigger more pain signalling, thus increasing widespread body pain. 

“Our findings are particularly important to fibromyalgia, which, despite being a common rheumatological condition, is often underrecognized,” added first author Sharon Erdrich, a Doctorate Student and Research Assistant at the University of Sydney.

The research is especially interesting because dental health is often cordoned off from the rest of healthcare, at least in the United States. Dental insurance is usually completely separate from regular health insurance, and most doctors will not evaluate your teeth during an appointment. 

Dental care is still often viewed as a cosmetic issue, despite the fact that dental pain is some of the worst pain imaginable. Studies like these show why trying to separate teeth off from the rest of healthcare is a failing strategy.