If your patients are taking GLP-1s, you’ve explained the common side effects, such as gastrointestinal (GI) issues and muscle-loss implications.  However, GLP-1 receptor agonists, often prescribed for type 2 diabetes and sometimes for weight management, can affect the entire body — including the oral cavity, said Anita Aminoshariae, DDS, MS, professor in the Department of Endodontics and director of predoctoral endodontics at the Case Western Reserve University School of Dental Medicine in Cleveland.  “Oral health should be part of the conversation at the time of prescription,” she said.

Why Oral Health Matters

GLP-1s can cause changes in hydration, nutrition, and GI function that directly affect the mouth.  Aminoshariae said these effects may increase the risk for:

Dry mouth.  Reduced salivary flow due to dehydration and appetite suppression alters pH, increases plaque, and raises the risk for decay and gum disease.

Gum inflammation and plaque accumulation.  An altered oral microbiome can lead to gingivitis and periodontal risk.

Tooth decay and sensitivity.  Acid exposure from vomiting and reduced buffering capacity.  They can also weaken enamel and increase dentinal sensitivity, said Aminoshariae.

Erosion in the enamel.  Vomiting, GI upset, and delayed gastric emptying can affect enamel.

Bad breath.  Dry mouth and microbial imbalance may cause halitosis.

As with all medications, primary care physicians and/or members of the patient care team should discuss potential side effects of GLP-1s.

Is Altered Taste a Side Effect?

There is not an agreed-upon reason for what causes this, said Jiwon Lim, DMD, MPH, assistant professor in dentistry, Division of Dentistry in the Department of Plastic Surgery, Oral & Maxillofacial Health, UVA Dentistry in Charlottesville, Virginia.

“GLP-1 agonists mimic GLP-1s, and there are known GLP-1 receptors in the taste buds in the mouth, so this may be the connection; however, the true cause of why taste changes happen is unknown,” Lim said.  “There have been reports of metallic tastes and reduced sensitivity to some tastes.”

Furthermore, some users of GLP-1 drugs may experience “Ozempic tongue” — a persistent bitter, sour, or metallic taste in the mouth, said Tricia Quartey, DMD, who works in private practice in Brooklyn, New York, and is also a spokesperson for the American Dental Association Consumer Advisor.

“While there isn’t yet a definitive reason for this, dry mouth may be a possibility, as some medications reduce saliva production.  In addition to causing bad breath and intensifying bitter or sour flavors, dry mouth also increases your risk for tooth decay, as saliva washes away food and neutralizes acids produced by plaque,” said Quartey.  “There are ways to help with dry mouth, including chewing sugar-free gum to increase saliva flow, using oral rinses or artificial saliva to add moisture, drinking plenty of water, and brushing twice daily with a fluoride toothpaste.”

What Can a Patient Do in the Short-Term to Manage Symptoms?

Keeping good overall oral hygiene is key.  Lim, with UVA, has provided these directives to patients to better manage symptoms:

• For xerostomia and halitosis caused by xerostomia, over-the-counter topical products like mouth rinses, lozenges, sprays, or gels geared towards alleviating dry mouth can be helpful.  Under careful consideration of a physician, medications like pilocarpine and cevimeline can be considered.
• Overall hydration should be maintained.
• Balanced nutrition is also important in overall dental and oral health.  To mitigate acid erosion of enamel, you can rinse the mouth with water (or another acid-neutralizing liquid like milk or sodium bicarbonate rinse) or a fluoridated mouth rinse after.

In addition, Aminoshariae, with Case Western, suggested patients chew xylitol gum or lozenges to stimulate saliva, brush twice a day, floss daily, and monitor nutrition, especially calcium, vitamin D, and protein intake.

Is a Certain Type of Product Recommended?

The American Dental Association recommends using a soft-bristled brush twice a day with a toothpaste containing fluoride for 2 minutes and using an interdental cleaner (like floss) daily.  Studies have shown that a manual toothbrush can be just as effective as an electric toothbrush with proper technique, Lim clarified.  “Folks with limited dexterity or with dental appliances (like braces) may find an electric toothbrush easier to use,” said Lim.

For more complicated issues, seeking an oral medicine specialist may be appropriate, and this specialist can identify major problems before they escalate.  “Importantly, we strengthen the transdisciplinary care that treats the patient as a whole, not in parts,” Lim said.