What Dentists Need to Know About Kratom

Once a little-known herbal stimulant, kratom has rapidly emerged as a controversial substance in the United States. Marketed as a “natural” remedy for pain, anxiety, and even opioid withdrawal, its accessibility and unregulated status have fueled a surge in use. But behind the perception of safety lie serious side effects.
Kratom is derived from the leaves of a tropical tree (Mitragyna speciosa) native to Southeast Asia. While currently available over the counter and generally unregulated, problems related to its use are sparking change. Recently, the Florida Attorney General outlawed one of kratom’s components 7-hydroxymitragynine, also known as 7-OH. Other states have banned its use while some are proposing increased regulation.

Historically, kratom was delivered by chewing the plant’s leaves and became popular because of its energy and pain-relief properties. It is now available in multiple forms: powder made from dried, ground leaves; premeasured capsules; tincture; extract form; and tea bags or gummies.

According to US Drug Enforcement Administration data, approximately 2 million Americans older than 12 have used the drug in the past year.¹ Individuals use the drug for pain control, to reduce anxiety, and, in some cases, to reduce opioid withdrawal symptoms.² The drug is especially popular among individuals with a history of opioid abuse. Kratom is used by those of all socioeconomic statuses and is slightly more popular among men than women. Likely, the global market for this drug is increasing exponentially.

Low doses of kratom can indeed increase energy and alertness, while higher amounts have been shown to have opioid-like effects resulting in relaxation, relief of pain, and euphoria. Adverse effects include drowsiness, sweating, loss of appetite, tachycardia, and hypertension. Long-term use has been associated with anorexia, insomnia, frequent urination, hallucinations, and psychosis.

Some patients also use the drug for relief of dental pain. The negative oral side effects include xerostomia with an attendant increase in dental caries. The decay problem is exacerbated because many users mix the drug with high sugar drinks. Other negative effects include a reported increase in parafunctional habits. Addiction to the drug can also lead to reduced attention to personal hygiene including self-delivered oral care.³ The drug effects start within minutes of ingestion and are dose dependent; effects can last for hours.

Because of the availability and increased usage, dentists should be aware of the possible effects on therapy. This drug can interact with other central nervous system depressants, such as benzodiazepines and opioids, leading to potentially dangerous levels of sedation and respiratory depression. A combination of opioids and benzodiazepines can cause death. The drug also has the potential to increase liver toxicity when combined with acetaminophen. Given the increased popularity and availability of kratom, dentists need to become aware of its use by patients and its potential problems.

References

1. United States Drug Enforcement Administration. Drug Fact Sheet: Kratom. Available at dea.gov/factsheets/kratom. Accessed September 5, 2025.
2. National Center for Complementary and Integrative Health. Kratom. Available at nccih.nih.gov/health/kratom. Accessed September 5, 2025.
3. National Institute on Drug Abuse. Kratom. Available at nida.nih.gov/research-topics/kratom. Accessed September 5, 2025.

From Decisions in Dentistry. October/November 2025;11(5):5.