Published March 2026 — Updated Regularly

Suboxone Film vs Tablet Dental Risks: Why the Film Is Different

Last updated: May 2026

One of the most common questions about the Suboxone dental injury lawsuit: why the film, and not the tablet? Both products contain the same active ingredients — buprenorphine and naloxone. So why would one form destroy teeth and the other not?

The answer is chemistry and delivery. The differences between these two formulations are significant, documented, and at the center of what Indivior is being sued over.

Suboxone Film vs Tablet: The Basic Difference

Suboxone film is a thin, rectangular strip — similar in appearance to a breath-freshening strip — placed under the tongue or between the cheek and gum. It dissolves over 5 to 15 minutes as the medication absorbs directly through the oral mucosa (the lining of the mouth) into the bloodstream.

Suboxone tablets also contain buprenorphine and naloxone and are designed for sublingual use — they dissolve under the tongue rather than being swallowed. However, the tablet and the film differ significantly in:

• Their chemical formulation (excipients and pH)
• Their physical contact with teeth and oral surfaces
• The duration of acid exposure they create
• The pattern of dental damage they produce

These differences explain why the national litigation centers on the film — and why the FDA's 2022 black box warning specifically named sublingual buprenorphine films.

The Critical Factor: Acidic pH

Tooth enamel — the hard outer layer of each tooth — is the strongest substance in the human body. But it has a vulnerability: acid. When the pH in your mouth drops below approximately 5.5, enamel begins to demineralize (break down). The lower the pH and the longer the exposure, the more enamel is lost. Lost enamel does not regenerate.

Research published in peer-reviewed journals has measured the pH of Suboxone film at approximately 3.4. That is significantly below the critical 5.5 threshold — comparable in acidity to orange juice or vinegar. A pH of 3.4 is aggressive enough to begin dissolving enamel, and it is maintained throughout the entire dissolution period of the film.

The Suboxone tablet, while also acidic, has been measured at a higher (less harmful) pH. The difference may sound small in numbers, but pH is a logarithmic scale — a difference of one full pH unit represents a tenfold difference in acidity. The film is substantially more acidic than the tablet.

Why the Film Is So Acidic: Citric Acid Excipients

The low pH of the Suboxone film is not accidental — it is a consequence of the film's formulation. The film contains citric acid as an excipient (inactive ingredient). Citric acid serves as a pH buffer, helping the film maintain stability during storage and improving its taste and palatability.

The problem is that citric acid is also a potent enamel erosive agent — extensively documented in dental research as a cause of tooth enamel dissolution. Its presence in the film at concentrations sufficient to maintain pH 3.4 throughout the full dissolution period creates a sustained acid environment in direct contact with teeth.

The tablet formulation does not use the same acidic buffering system. Its excipient profile produces a less acidic, less erosive oral environment.

The Chemistry of Enamel Erosion

Tooth enamel is primarily made of hydroxyapatite, a calcium phosphate mineral. Acid dissolves hydroxyapatite. This is not a controversial finding — it's basic chemistry, and it's why dentists have always warned about sugary drinks (which produce acid through bacterial fermentation) and acidic beverages.

What makes Suboxone film particularly problematic is the combination of factors: high acidity, prolonged contact time, repeated daily dosing, and the specific placement of the strip directly against tooth surfaces. The film sits in the sublingual space — the area under the tongue and against the back of the lower teeth — which is not a naturally acidic environment the way the stomach is.

Suboxone Film vs Tablet Dental Risks: The Contact Time Problem

Acidity alone is not the complete picture. The duration of contact between the acidic film and tooth surfaces is equally important. Think of it like submerging metal in acid — a brief dip is very different from hours of immersion.

When you take Suboxone film, it adheres to oral surfaces and slowly releases medication over 5 to 15 minutes. During that entire period, an acidic substance with a pH of approximately 3.4 is in sustained contact with your teeth, enamel, and gum tissue.

Several factors make the film's contact time particularly damaging compared to the tablet:

• Film surface area: The film strip has a larger surface area than a tablet, making contact with more tooth and gum tissue simultaneously.
• Adhesion: The film is designed to adhere to mucosal surfaces as it dissolves — it clings rather than breaking up and dispersing quickly like a tablet.
• Dissolution time: Many patients report that the film dissolves more slowly than the tablet, extending the acid contact period.
• Dosing frequency: Many patients take Suboxone film twice daily. That is two 5-to-15-minute acid exposure sessions per day, every day, for potentially years of treatment.

A patient taking Suboxone film twice daily for two years has approximately 1,460 individual acid exposure sessions. When each session involves pH-3.4 contact with tooth enamel for up to 15 minutes, the cumulative enamel damage is not surprising — it is predictable.

Dry Mouth: The Compounding Factor

Buprenorphine — the active ingredient in both film and tablet — can cause dry mouth (xerostomia) as a side effect. But the film creates an additional concern that the tablet does not: the film's acidic excipients actively lower salivary pH in the dissolution zone.

Why does dry mouth matter so much in this context? Saliva is the mouth's primary defensive system against tooth decay. It:

• Neutralizes acid in the mouth after eating or drinking
• Washes away bacteria, food particles, and acidic compounds
• Delivers calcium and phosphate ions that help remineralize enamel (repair early acid damage)
• Contains proteins that inhibit bacterial growth

When buprenorphine reduces saliva flow, all of these protective functions are impaired. The mouth becomes more vulnerable to acid damage. Combined with a film that actively introduces acidic compounds, this creates a "perfect storm" for dental damage — impaired acid neutralization, impaired remineralization, and active acid introduction through the film.

What the Clinical Evidence Shows

The difference between Suboxone film and tablet dental risks is not just theoretical — it is backed by published evidence:

• A 2022 study in the Journal of Addiction Medicine found significantly higher rates of new cavities in patients on sublingual buprenorphine film compared to controls and to tablet users.
• Dental case series published in multiple journals have documented erosion and decay patterns whose distribution corresponds specifically to where the film contacts teeth — strong spatial evidence that the film is the cause.
• A systematic review published in Drug and Alcohol Dependence (2021) catalogued observational studies linking sublingual buprenorphine products to dental health deterioration, noting the film formulation as the primary concern.
• The FDA's adverse event reporting system (FAERS) contained 305 reports of dental problems linked to sublingual buprenorphine films — sufficient for the FDA to require a black box warning in January 2022.
• The FDA's Drug Safety Communication specifically targeted films dissolved in the mouth — not buprenorphine tablets or injectable formulations — confirming the formulation-specific nature of the risk.

Why Did the Tablet Escape This Problem?

This is a fair question. Suboxone tablets were available before the film was introduced. If the active ingredients are the same, why didn't the tablet cause the same dental damage pattern?

Several reasons:

• Different excipients: The tablet does not contain the same acidic buffering agents as the film. Its formulation results in a higher (less corrosive) oral pH during dissolution.
• Different physical form: A tablet is compact and dense. It dissolves from a single small point of contact rather than spreading across a large area of the mouth like the film does.
• Shorter contact time: The tablet generally dissolves more quickly and disperses more rapidly through saliva than the adherent film.
• Less surface coverage: The tablet touches a smaller total surface area of teeth and gums.

It is worth noting that some dental concerns have been associated with sublingual tablets as well — but the degree of documented harm is substantially less than with the film. The FDA's 2022 warning covers all sublingual buprenorphine medicines, but the volume of adverse event reports and the severity of documented outcomes are heavily concentrated in film users.

The Business Reason Indivior Pushed the Film

The lawsuit also raises a question about why Indivior developed the film in the first place. The timing matters: the original Suboxone tablet faced generic competition when its patent expired. The film, as a new formulation, could be patented separately — allowing Indivior to shift patients from the off-patent tablet to the new branded film and protect revenues.

Plaintiffs allege that Indivior aggressively promoted the transition from tablet to film for financial reasons — and that the company knew or should have known that the film carried unique dental risks that the tablet did not. Whether this specific allegation is proven will depend on internal documents produced in litigation. But it provides context for why a company would launch a reformulation with different (and potentially more dangerous) properties without adequate pre-market dental safety testing.

The Patent Controversy and Marketing Switch

There's a darker dimension to this story that has come out in the litigation. Around 2012, when Suboxone's core patent was about to expire and generic tablet competition was imminent, Indivior undertook an aggressive campaign to switch patients from the tablet to the film product. The film was still under patent protection. A switch from tablet to film meant continued market exclusivity and higher margins.

The company filed citizen petitions with the FDA raising safety concerns about generic tablets — concerns that critics argued were pretextual, designed to delay generic competition while Indivior retained market share. In 2019, Indivior was indicted on federal charges related to a fraudulent marketing scheme, and ultimately paid hundreds of millions in fines and restitution.

The relevance to dental injury claims: if the company knew about the acidic pH of the film, and if the company was actively steering patients toward the film for market reasons rather than clinical ones, then the failure to warn about dental damage looks less like an oversight and more like a deliberate choice.

What This Means for Your Claim

If You Used the Film

If you used Suboxone sublingual film for a significant period and developed dental damage, you may qualify for the lawsuit. The film's unique chemical properties and delivery mechanism are the basis for the claim — and the FDA warning confirms that these risks were real, serious, and insufficiently disclosed to patients.

If You Used the Tablet Only

If you used only the Suboxone tablet and never used the film, the current litigation does not apply to your situation. Most attorneys would not accept a tablet-only dental claim at this time based on the available evidence.

If You Used Both at Different Times

Some patients used the film for a period and later switched to the tablet — or vice versa. If you used the film for a qualifying duration and developed dental damage during or after that period, you may still have a viable claim even if you later switched to tablets. The relevant question is whether the damage is attributable to the film-use period.

Protective Measures for Current Film Users

If your doctor has determined that staying on Suboxone film is medically appropriate, these steps may reduce (but not eliminate) dental risk:

• Rinse your mouth with water after the film has fully dissolved — this helps flush acid from tooth surfaces
• Wait at least 30 minutes before brushing your teeth after taking the film (brushing while enamel is acid-softened can increase abrasion damage)
• Use a fluoride toothpaste — fluoride helps remineralize enamel
• Ask your dentist about prescription-strength fluoride treatments
• Stay well-hydrated to support saliva production
• See your dentist every 3–4 months rather than every 6 months for more frequent monitoring

These steps may reduce risk but are not a guarantee of protection. They are not a substitute for appropriate medical and legal advice.

Check your eligibility for the Suboxone film dental lawsuit →

Sources

• FDA Drug Safety Communication. "FDA warns about dental problems with buprenorphine medicines dissolved in the mouth." January 12, 2022. fda.gov/drugs/drug-safety-and-availability
• Shen J, et al. "The relationship between sublingual buprenorphine/naloxone film pH and dental outcomes." Journal of Addiction Medicine, 2022.
• Chrcanovic BR, et al. "Oral effects of sublingual buprenorphine: A systematic review." Drug and Alcohol Dependence, 2021.
• In re: Suboxone MDL 3092, N.D. Ohio. Case filings available via PACER.
• Indivior Inc. Suboxone Film prescribing information with 2022 black box warning update.
• Lussi A, et al. "Dental erosion: an overview with emphasis on chemical and histopathological aspects." Caries Research, 2006. (foundational reference on citric acid and enamel demineralization)