@andyberkowskimd of ReLACS Health evaluates the concerns of buprenorphine and its relationship to dental disease in this week's informational video.

Buprenorphine is an opioid (narcotic) medication most commonly used for opioid use disorder (OUD) and secondarily, chronic pain. However, it is now increasingly prescribed by specialists for the treatment of moderate to severe restless legs syndrome (RLS) in which opioids have been used for a few centuries and are considered a consensus second-line therapy. For an introduction to buprenorphine for RLS, watch here:
https://youtu.be/nCoKMINDiwk

In 2022, the FDA released a communication on concerns of dental problems arising from forms of buprenorphine that are dissolved in the mouth. To read the FDA's communication about dental problems with forms of buprenorphine that dissolve in the mouth, click here:
https://www.fda.gov/safety/med....ical-product-safety-

The notice includes brand names of buprenorphine-naloxone like Suboxone® and Zubsolv® and other dissolving buprenorphine tablets or films that are placed under the tongue or cheek such as Subutex® and Belbuca®. Here is a video on the forms of buprenorphine used for RLS:
https://youtu.be/ZS-qrzu0z0A

A pharmacy database study from the Journal of the American Medical Association (JAMA) in late 2022 looked into the frequency of dental problems with buprenorphine-naloxone compared to other treatments for OUD such as oral naltrexone and transdermal buprenorphine (through a patch on the skin) and found a 1.7X and 1.4X risk of dental problems respectively. However, the absolute risk was only 1% more than the control groups with an annual risk of about 2%. You can read the study here:
https://www.ncbi.nlm.nih.gov/p....mc/articles/PMC98562

Buprenorphine has tremendous advantages over other opioids with a unique chemical effect leading to minimal risk of causing breathing problems that could lead to death, which is the most feared risk of regular opioids and why taking too strong a dose of opioids may lead to impairment, coma, and even death. Buprenorphine also does not typically cause an individual to "get high" (euphoria) making the risk of drug abuse with long-term use greatly reduced. This is why forms of buprenorphine like Suboxone® are now commonly used for opioid use disorder, to help people with opioid dependence and avoid the risk of an opioid poisoning. It is also why RLS clinicians are reaching for the buprenorphine prescription over other opioids like methadone and oxycodone for RLS.

@andyberkowskimd and colleagues published this conference abstract at SLEEP 2023 on buprenorphine effectiveness in severe RLS:
https://academic.oup.com/sleep..../article/46/Suppleme

Per the FDA and other sources, after the medication dissolves for 5-10 minutes, one can rinse out the mouth with water to improve the acidity and dryness that may occur from the medication, which could be the reason for increase in dental cavities, infection, and tooth loss. Those on a form of buprenorphine by mouth should brush their teeth regularly, but NOT immediately after taking the medication because the medication can soften the enamel and make the teeth vulnerable to wear and tear from brushing. A person should see their dentist regularly and make them aware of the reports of dental problems with buprenorphine so they can be monitored more closely.

The most important thing with any treatment is to weigh all of the risks and benefits of treatment when making a medical decision with the guidance of a licensed medical professional.

You may read A ReLACSing Blog #21 to learn why doctors have become so unwilling to prescribe opioids including for RLS (and it is not because of dental problems):
https://www.relacshealth.com/b....log/why-are-doctors-

These videos are for general medical information, but those who live in or near Arizona, Michigan, Ohio, or Florida can hire @andyberkowskimd of ReLACS Health for consultation regarding treatment of RLS as well as any sleep disorder that requires a little more time and expertise. Go to https://www.relacshealth.com/ for more information.

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