As obesity rates continue to rise across Canada, so does the demand for weight-loss medications. More than 63% of Canadian adults were classified as overweight or obese in 2018,1 a number that has likely increased in the intervening years, fueling a significant increase in prescriptions for these drugs. Originally designed to treat type 2 diabetes, semaglutide—marketed as Ozempic and Wegovy—has gained widespread use in recent years for its effectiveness in managing both high blood sugar and obesity. Semaglutides mimic a natural hormone in the body called glucagon-like peptide-1 (GLP-1) which lowers blood sugar by stimulating insulin release, slowing down digestion, and decreasing the liver’s production of sugar. Additionally, it can support weight loss by helping to control appetite and reduce food cravings. In late 2023, the FDA expanded treatment options by approving tirzepatide (trade name Mounjaro) for long-term weight management; although in Canada, it is currently only approved for use in the treatment of type 2 diabetes.2
Weight-loss medications can affect oral health and may signal underlying systemic conditions. If your patients are using these drugs, you might need to modify local anesthetic or pain management dosages, along with other aspects of their dental care.3 Regardless of the purpose or the trade names, here is what dental professionals need to know about the potential oral implications of these medications in clinical practice.
READ: Optimizing Dental Patient Medication Response For Better Treatment Outcomes
While not directly linked, semaglutide use may have several oral health implications. Side effects such as dry mouth, increased acid reflux, and nausea or vomiting can contribute to enamel erosion, tooth decay, gingival inflammation, and tooth sensitivity, collectively referred to as “Ozempic teeth”. Additionally, some patients report altered taste. It can cause or worsen halitosis by slowing digestion, which promotes bacterial growth in the mouth, and by reducing saliva production, which further contributes to this effect.
Of significant concern, semaglutides can delay gastric emptying, which may increase the risk of regurgitation and aspiration during dental procedures involving general anesthesia or deep sedation. There are various suggested guidelines. For patients on daily dosing, consider holding GLP-1 agonists on the day of the procedure/surgery, and for patients on weekly dosing, consider holding GLP-1 agonists a week prior to the procedure/surgery (American Society of Anesthesiologists).4 For patients taking GLP-1 receptor agonists for weight loss, consider holding the drug at least three half-lives (approximately 88% clearance of the drug) ahead of the planned procedure. For semaglutide, this would be three weeks (Canadian Journal of Anesthesia).5
Clinical practitioners must be aware of these and other newly reported side effects and warnings of the commonly prescribed semaglutides and incorporate appropriate precautionary and oral care management measures for the safety and long-term health of their patients. 
Oral Health welcomes this original article.
References
- https://www150.statcan.gc.ca/n1/pub/82-625-x/2019001/article/00005-eng.htm
- FDA approves new medication for chronic weight management. US Food and Drug Administration. November 8, 2023. Accessed February 15, 2024. https://www.fda.gov/news-events/press-announcements/fda-approves-new-medication-chronic-weight-management
- Maragliano-Muniz P, Viola T. Dental considerations for people taking Ozempic. DentistryIQ. September 21, 2023. Accessed February 16, 2024. https://www.dentistryiq.com/dentistry/pharmacology/video/14299247/dental-considerations-for-people-taking-ozempic
- https://www.asahq.org/about-asa/newsroom/news-releases/2023/06/american-society-of-anesthesiologists-consensus-based-guidance-on-preoperative
- Jones, P.M., Hobai, I.A. & Murphy, P.M. Anesthesia and glucagon-like peptide-1 receptor agonists: proceed with caution!. Can J Anesth/J Can Anesth 70, 1281–1286 (2023). https://doi.org/10.1007/s12630-023-02550-y.
About the author
Dr. Freedman is a founder and past president, American Academy of Cosmetic Dentistry, a co-founder, Canadian Academy for Esthetic Dentistry, Regent and Fellow, International Academy for Dental Facial Esthetics, and a Diplomate and Chair of the American Board of Aesthetic Dentistry. Adjunct Professor of Dental Medicine, Western University, Pomona, California. Author of 14 textbooks and > 1000 dental articles.
