Long-Term Opioid Therapy Linked to Increased Risk of Infection-Related Dental Complications: Study
USA: Researchers have found in a recent study that long-term opioid therapy (LTOT) is associated with a modestly increased risk of dental infections. The association, reported in PLOS One, suggests that patients receiving prolonged opioid treatment may benefit from closer dental monitoring and preventive oral healthcare strategies.
The study, led by Anne C. Black of the VA Connecticut Healthcare System and Yale School of Medicine, examined whether extended opioid use is linked to infection-related dental problems. Interest in this question has grown following a U.S. Food and Drug Administration warning that transmucosal buprenorphine—a partial opioid agonist used for opioid use disorder and chronic pain—may contribute to dental disease. The new findings raise the possibility that similar risks could extend to other commonly prescribed opioid analgesics.
Investigators conducted a large retrospective matched cohort study using national data from the U.S. Department of Veterans Affairs (VA) between October 2010 and September 2019. Patients prescribed LTOT were matched in a 1:2 ratio with individuals not receiving LTOT based on age, sex, geographic service region, and VA dental coverage status. The primary outcome was a composite infection-related dental outcome (CIDO), which included diagnoses such as oral infections and other dental conditions linked to infection.
The study led to the following findings:
- The study cohort comprised over 2.17 million patients, including nearly 788,000 individuals (36%) who received long-term opioid therapy.
- During the study period, 28% of participants developed a composite infection-related dental outcome (CIDO).
- Both unadjusted and adjusted Cox regression analyses showed that LTOT exposure was associated with an increased risk of infection-related dental outcomes.
- The unadjusted hazard ratio for CIDO among LTOT users was 1.24.
- After adjusting for potential confounders, LTOT remained significantly associated with CIDO, with an adjusted hazard ratio of 1.08.
Additional sensitivity analyses largely confirmed these findings. However, among patients with comprehensive VA dental coverage, infection-related dental outcomes were more common overall, and LTOT was not significantly associated with additional risk in this subgroup. The authors noted that these patients may already represent a population particularly vulnerable to dental disease due to service-related or disabling conditions.
The researchers emphasized that this is the first large-scale study to demonstrate a link between long-term opioid exposure and dental disease. While the increased risk appears modest, the findings may have implications for clinical practice. Enhanced oral health surveillance, patient education about dental hygiene, and proactive dental referrals could be considered when initiating or maintaining LTOT.
The authors also acknowledged several limitations, including potential residual confounding, reliance on electronic health record data, and limited generalizability beyond the VA population. However, the results highlight the importance of integrating oral health considerations into opioid prescribing decisions and underscore the need for further research comparing the dental risks of different opioid therapies, including buprenorphine.
Reference:
Black, A. C., Gordon, K. S., Dziura, J. D., Barry, D. T., Crystal, S., Edelman, E. J., Gibson, G., Hamilton, M., Jurasic, M., Li, Y., Marshall, D. L., Skanderson, M., Suda, K., & Becker, W. C. (2026). The association between long-term opioid therapy and composite infection-related dental outcomes. PLOS ONE, 21(2), e0341361. https://doi.org/10.1371/journal.pone.0341361
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