While eating lunch in the small courtyard of our home just east of San Francisco, I was startled by having bitten down on something hard and jagged.
There is nothing hard and jagged in cheese and croissants. Nothing at all. From the tip of my tongue, after a few moments, I extracted what looked like a thin sliver flake from one of my teeth. Looking in the bathroom mirror I couldn’t see any tooth that looked chipped.
But that night, having dinner with my wife, it happened again. This time the sliver was more of a chip, almost a chunk of enamel, something that by its absence would leave evidence. Sure enough, in the mirror I could see that one of my side teeth looked strangely indented.
Thus began the odyssey of the derangement of my teeth by Suboxone.
I knew from the dentist I had seen 6 months before that my teeth were vulnerable to this kind of calving from dry mouth – a side effect of Suboxone and many other opioids.
Even though she had given me a prescription mouthwash and toothpaste, as well as a sugarless gum and mint that would stimulate saliva, my mouth inexorably dried. The drying exposed my teeth to a corrosive acidic environment that began to rob me of my teeth — a chip here, a chunk there.
Well might the chorus sing: See a dentist!
And the chorus would be right, but for one thing. I had no health insurance, let alone the usual paltry benefits from dental coverage. We were living off the dwindling savings of our investments and my monthly disability check. My wife was unemployed and our son was in his second year of college. Every dollar we had was already spoken for.
I began to resemble Uncle Festus from Hazard County, who probably lacked money for dental care as well. Needless to say, the black spots between what was left of my teeth embarrassed me to my core. Outings were limited to the essential only.
Looking at snaggletooth in the mirror, I’d tell myself the destruction wasn’t so bad, kind of like the ruins of the Coliseum in Rome. I thought I could just wait it out and the destruction would stop on its own.
I was in enamel denial.
Before taking Suboxone, I was on a low dose of OxyContin that provided moderate pain relief, while causing my first oral droughts. But the dryness was contained and, with the exception of regular cavities, was manageable.
But after a few years of relatively mild dryness, the pain relief from OxyContin began to wane and I asked my provider if I could increase the dose. After a fairly lengthy discussion I decided to try Suboxone.
My readiness to try Suboxone was partially based on my knowledge, confirmed by my provider, that Suboxone often had a salutary effect on depression. As those of us living with miserable pain can attest, depression can be just as stubborn and refractive of treatment as the pain itself.
In the following weeks I successfully transitioned to Suboxone. Within the first week of being on the new medicine, I felt a noticeable improvement in the “black dog” that hounded my heels since descending into the hollows of pain.
But to my dismay I also began to perspire, not just a happy glow, but dripping wet sweating that started in my face and quickly spread over my whole body, drenching me within seconds.
The sweats were so bad I’d wake up several nights a week with the sweat soaking through my t-shirt and through the sheets. During the day I carried with me a rather large floor fan that I would put on high the moment the sweats began to pour over me. During the day, I’d usually experience these sweat episodes 3 to 4 times per hour.
And I just hate sweating, always have.
Having found the taste and out of pocket expense of Suboxone onerous, my provider switched me to Subutex, still in the same class of medication. Including a reduction in pain, it also helped the depression slip away.
However, at my next appointment my provider explained that he got a bit of heat from a federal regulatory agency, which had recently conducted an audit of his opioid prescribing.
He was told that for patients like me, and they provided no information on what “patients like me” meant, I was to be on Suboxone, not Subutex. Not wanting to cause him any difficulties, I agreed to the switch.
Thus, my first step into the bewilderingly rapid derangement of my teeth.
With the switch back to Suboxone I felt as if Death Valley took up residence in my mouth.
After a few weeks back on Suboxone I could feel the black dog creep out from behind the stove to lie at my feet. I was quite aware that, had I still been on Subutex, the dog would be content behind the stove.
I was pissed.
Over two years ago, with my mouth looking more and more like Uncle Festus, I made an appointment with the dental school at the University of California San Francisco. I was assigned a student dentist who’d be supervised by a senior faculty dentist.
Diagnosis: Severe decay.
Estimated cost: thousands and thousands of dollars.
Emotional response: Outraged dismay and resignation.
I started on the restoration there and have continued it here at my new home in Chicago. The final costs will approach $15,000 for drilling, root canals, extractions, implants and bridges, and yes, just maybe, the kitchen sink.
Additionally, my new physician but me back on a much higher dose of OxyContin that is working beautifully.
Beyond what I’ve already written above about my delayed treatment is this: I felt intense guilt that my dental restoration was causing us, yet again, tremendous financial distress. I couldn’t bring myself to the realization that this work needed doing and that I needed to get off Suboxone.
Guilt and denial reigned over common sense.
This, I’m afraid, is a common reaction for many of us, a common and costly reaction.
Just know that wrongheaded denial is usually the first tool we grab in emergencies. It should be the last, but it’s usually the default position when the heat’s on.
Contact others with pain for advice. Your health depends on it.
Mark Maginn lives in Chicago where he is a poet, writer and social justice activist. Mark suffers from chronic pain and was a longtime volunteer with the American Pain Foundation. His blog “Left Eye Blind” can be found here.
National Pain Report welcomes other opinions.
The information in this column is not intended to be considered as professional medical advice, diagnosis or treatment. Only your doctor can do that! It is for informational purposes only and represent the author’s personal experiences and opinions alone. It does not inherently or expressly reflect the views, opinions and/or positions of National Pain Report or Microcast Media.