Living with Pain: Suboxone Destroyed My Teeth

Living with Pain: Suboxone Destroyed My Teeth

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.

Suboxone tablets.

Suboxone tablets.

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.

Resist it!

Contact others with pain for advice. Your health depends on it.

Mark Maginn

Mark Maginn

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

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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.

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Hello everyone, id been on 6 to 8 norco a day for approximately 10 years for neck and back pain from several car accidents. I finally got tired of being chastized and treated like a drug addict because my health department “doctors” ensured that i became one over those ten years so i had to make a change. I live in a rural area and unfortunately, actual doctors are so few and far between that we depend on the county health department. Dont get me wrong, they do what they can and im not personally attacking anyone, but…they are nurse practioners who have very little schooling/general knowledge where the areas of pain management and depression are concerned. Unless you need treatment for a cold, the flu or perhaps a referral to an actual doctor they cant do much other than charge you the 125$ office visit fee. After ten years of playing the pain pill game ie. Vicodin, norco, lortab, oxycodone, oxycontin, tramadol (lol) etc. I called the clinic one day to get my refill of norco sent to the pharmacy, i spoke to a nurse who i knew and still know, she let me know that the “doctor” wasnt in that day and he wouldnt b back until th following week, well, as we all know, a week without your narcotic meds just will not do lol especially if you plan on working or sleeping, or eating, or having control of your own bowels etc etc, so first i nicely asked her if he could be reached and if not, if shed call it in like shed done many times in the past for myself as well as other patients whom i also knew personally, she all but laughed and told me shed do “no such thing”….well as i, from experience, knew this was not the case i less politely asked her again and again was told no like i was a junkie on skid row, so, knowing and feeling the fear of what later that night, let alone the next week would be like i found some on my own. Clearly as it was much cheaper this way and a lot less embarrassing i no longer returned to my clinic. After the next 6 or so years of obtaining them on my own, again my “friend” would no longer be getting them, so again i was on my own. This turned out to be a godsend as my next “friend” was a recovering addict and on suboxone. I had heard of the drug before but never knew itd change my life. The friend asked me how many norcos id been on on a regular basis and she suggested i take one third of a siblingual 8mg strip. I did this and felt nauseaus but no withdrawal at all. The second day i only took about a fifth of a strip with no nausea and no withdrawal either. Ive been on 1/8 th a strip a day now since… Read more »

Jacob Hayden

Im going through same thing im disabled been on all meds possible dr decides to put me on suboxone its been 6years now and they dont touch my pain at all but dr wont switch me back to other pain meds that will work because off DEA bullcrap and my teeth are rotten out of my head for no reason im constantly brushing my teeth and drinking water and still teeth are rotting out from under expense crown work I had done 7 years ago and all and its to the point that its every one of my teeth I just went into serious pain had to go to dentist that I cant afford being on disability and have major decal and tooth rot its gonna cost tens of thousands to fix n im just at a loss on what to do I truly feel n believe that the pharmaceutical company should have to pay to fix all of us that are having these problems to get are teeth fixed it so damn embarrassing its unreal

Hello Mark, Wow…I’m in awe and speaking of dry mouth, mine is wide open still from reading this last post. I have a support group for Invisible diseases, Rsd/CRPS, RA, Lupus, MS and more…so I”m not “new” to the pain scene and I have too many things injured and pain wise to bore you all here with it. Let’s just say that I was hit by a man who ran a red light in 2002 and have been in pain, have had now my 11th surgery, and M.I. and a C.V.A. and more. I acquired RSD/CRPS II from my 7th surgery in 2007, but 1st foot surgery…I was given all kinds of PT and pain dr injections after the MVA but nothing gave me much relief. I tried the patches (fentanyl) and they made me ill..I tried Kadian (a slow release Morphine type) and it worked for 2 yrs..then suddenly it stopped. I tried the patches again and this time they took “the edge off) of my pain. Now I have gone far beyond what any “normal” pain may be…and I’m on some meds and I have dry mouth also from those and from R.A. and the brain injury I got from the MVA….it all affects my mouth…SO far I’m “lucky” if you want to call it that. The prescription rinses and toothpastes have been helping me except that this coming monday I’m having the screw of the implant put in tooth #14 because it rotted out under a crown and I had a flaming infection and didn’t know until it was too late. I have to pay extra and go to the big hospital and get gen anesthesia with 2 anesthesiologists (one to watch me and one to watch just my heart *i have long QT syndrome..and Oral surgeon is very nervous and just wants to concentrate on my mouth, not my heart…so Im nervous and scared and all the talk about rotting teeth…scares me as I’ve been on mine and more since the MVA in 2002! Eleven years and since 2005, I have gotten meds that are known for killing peoples teeth. I’m lucky as my Dentist says i hve really clean and good teeth..but still i’ve lost one and im sure its not over and I’m scared…and the whole new system scares me and I’m afraid of losing my team of drs who know and have helped me and are kind and helpful…I’ guess I’m rambling now…and just want to say “thank you” for being an advocate…I do my best at it as well….Suzanne

Mark Maginn

Melissa, for me the optimal dose right now is 180 mgs daily. I suppose I could use 240 but the 180 is doing a “good enough” job right now.


I realize you may not be a physician…but do you know the Oxycotin dose “limit” a physician can prescribe?
I’m curious as to what a “much higher dose of OxyContin that is working beautifully” would consist of????

I too, have that dog nipping at my heels…and suffer from the dry mouth…I have found if I eat ANYTHING sweet after 6 PM the dry mouth is worse than normal. I don’t know if anyone else has had this observation-and I’m not a diabetic.

Thank you-Melisa H.


Opioid rotation is a fairly common and acceptable practice when a patient has reached a point where the medicine is no longer working as well. There is quite a bit of literature supporting this practice and at the time, at least for me, it made sense to try rotating out of the Oxy that was no longer as effective. In retrospect, particularly after my current physician upped my dose of Oxycontin with such salutary effects, after having gone back to it months before, I would have opted for the greater dose of OxyContin But at the time, again, I’m speaking only for myself, the rotation made sense. I was aware that my physician in CA felt he was taking something of a risk in treating pain patients and my gratitude stepped ahead of a more closely examined decision. Part of my reason for writing about this was to warn other pain patients to look more closely, and even skeptically, at suggestions to alter treatment. Looking back on that decision to rotate to Suboxone a few years ago from the vantage point where I find myself now, I probably would have asked to increase the OxyContin & found some other way to deal with my providers anxiety about governmental scrutiny. It still amazingly pisses me off that we pain patients are the only patients who have to deal with extra-medical concerns when seeking treatment for the disease of pain.

Janice Reynolds

Sticking with buprenorphine for the sake of not going to a higher dose of OxyContin (which is working) would be foolish-what would be the rational?
Other medications cause dry mouth and it is seldom taken seriously. I used amitriptyline for many years; it decreases the dose of opioids I need, plus I take oxybutynin ER (for stress incontinence) and the dryness got so bad I would wake up because my lips were stuck tight to my teeth! I switched to nortriptyline for the TCA and while the dryness is still there it is improved. As an Oncology nurse I was very aware of the care dry mouth needs and fortunately could afford regular dentil care; but this is a subject everyone should be aware of and I thank Mark for sharing his story.

Tracy Jones

I am not sure what you have but my mom has sjrogrens and one of the symptoms is dry mouth so she kept telling her doctor how dry her mouth was and how her tougue was red and inflamed to the point she would have to make sure that no spice wwas hot or she couldn’t eat it she was always asking us if something was hot after she took a bite her mouth was on fire we would try it no problem we did this for over 8 years she had complained of exhauston for probably 10 or more years and they just told her she was depressed and give her all kinds of medicine finally I demanded her to be sent for testing for sjrogrens was told even if she has it nothing to help her well wrong anyway she had her saliva glands
cut open and she has no saliva at all so this year she had her teeth crumble out of her mouth she would call me about every 2-3 days and say I just lost another one so I know medicine causes dry mouth but if it is like you have no saliva please demand testing


What about Buprenophine Patches,where the suboxone is delivered into the body in a timely fashion intradermally.I have degenerative disc disease and after 3 epidurals,I have been on just the patch.No dry mouth.