Written by: Shannon Nanne, RDH ([email protected] | LinkedIn | Facebook}
According to the Centers for Disease Control and Prevention (CDC), approximately 72.4% of adults in the United States are overweight or obese. Of these, about 31.7% are classified as overweight, with a body mass index (BMI) between 25 and 29.9. Approximately 40.3% have obesity, defined as a BMI of 30.0 or higher, and nearly 9.7% are considered severely obese, with a BMI of 40.0 or greater.
As obesity rates continue to rise, medications known as GLP-1 receptor agonists have gained significant attention as a treatment option. GLP-1 (glucagon-like peptide-1) is a naturally occurring hormone produced in the gut and released after eating. It stimulates the release of insulin, which helps take glucose from the bloodstream and pushes it into the body’s cells, where it can be used for energy.
Beyond their effects on blood sugar regulation, GLP-1 medications act on receptors that are expressed in brain areas involved in appetite, impulse control, reward and addiction — potentially explaining their effectiveness in curbing appetite and addiction disorders. However, there are potential downsides to the medications, including an increased risk of gastrointestinal problems, nausea, vomiting, diarrhea, dental side effects and in rare cases, paralysis of the stomach (gastroparesis) can occur.
Since medication trends evolve daily, staying informed helps us protect patient health and strengthen your role as their trusted dental care provider. Creating a safe, private environment and focusing on a patient-centered approach allows dental professionals to effectively address sensitive topics, like GLP-1 medications and their potential physical, psychological, and emotional impacts on patients.
According to The President of American Society of Anesthesiologists, President Michael W. Champeau, M.D., “There is currently a lack of scientific data on how GLP-1 receptor agonists affect patients having surgery and interact with anesthesia, we’ve received anecdotal reports that the delay in stomach emptying could be associated with an increased risk of regurgitation and aspiration of food into the airways and lungs during general anesthesia and deep sedation.” This is why understanding our patient’s medical histories are extremely important.
These considerations make thorough patient screening critical. When discussing health history with your patients, you can start by asking these questions;
What medications are you taking? As we learned, your body naturally produces a hormone GLP-1, but pharmaceutical drugs are engineered to provide a much stronger and longer-lasting effect. Why are you taking this medication? Understanding whether the medication is being used for diabetes management, weight loss, or another medical condition helps dental professionals assess potential oral health side effects and coordinate care appropriately.
The oral cavity can be significantly affected while taking these medications. Dry mouth, nausea, vomiting, and acid reflux are all commonly reported side effects of GLP1s and other weight-loss medications. It is quite common to evaluate sudden onset of dental decay because patients neglect regular brushing and flossing while they are feeling unwell. Enamel Erosion will become prominent because of pH changes from nausea and vomiting.
Dry Mouth is another important concern. Saliva plays a critical role in protecting oral health, neutralizing acids, and washing away bacteria. When the amount of saliva is too little, tooth decay, gingivitis, or oral infections can develop in the mouth. While GLP-1s are not exclusively triggering the increased tooth decay, many of the associated oral health concerns appear to stem from their side effects – particularly dry mouth, nausea, vomiting, and acid reflux.
Increased stomach acid associated with acid reflux, heartburn, and vomiting can have a significant impact on oral health. When gastric acid repeatedly comes into contact with the teeth, it can contribute to enamel erosion and increase the risk of dental decay. Dental caries is a pH-mediated bacterial disease that affects the hard surfaces of the teeth, making the oral environment a critical factor in maintaining tooth integrity.
Under normal conditions, healthy saliva has an average resting pH between 6.4 and 7.2, which helps protect teeth by neutralizing acids and supporting remineralization. However, enamel begins to demineralize when the pH drops between 5.0 and 5.5, while exposed root surfaces can begin to break down at a pH of approximately 6.0. Patients experiencing vomiting and reflux due to medications likely have acidic saliva at times.
Together, these factors compromise the mouth’s natural protective mechanisms, increasing susceptibility to enamel erosion, tooth sensitivity, and the progressive loss of tooth structure. For patients taking GLP-1 medications who experience acid reflux, nausea, or vomiting, dental professionals should be vigilant in assessing signs of erosion and implementing preventive strategies to protect long-term oral health.
Severity of dry mouth symptoms may range from mild oral discomfort to significant oral disease that can compromise the patient’s health, dietary intake, and quality of life.
The goals of treating xerostomia include identifying the possible cause(s), relieving discomfort, and preventing complications (e.g., dental caries and periodontal infections).
Xerostomia may be alleviated by use of saliva substitutes, alcohol free mouthwashes, SLS-free toothpastes and other interventions such as lozenges and gum. Under normal circumstances, the mouth is protected by a delicately balanced bio-system of enzymes and lubricants in saliva, allowing beneficial bacteria to flourish and inhibit the growth of pathogenic bacteria. Recommending beneficial products for your patients can make all the difference.
For over 33 years, I’ve dedicated myself to becoming a salivary expert. I have tried everything from gels, sprays, lozenges, gum, Salivary Pacemakers -implantable and removable, pilocarpines, and cevimelines. The best treatment for dry mouth is to eliminate putting something in your mouth that can injure your tissue. Reading the ingredients of your mouthwash and toothpaste is the best treatment you can offer.
You want to avoid SLS, which is a foaming agent and can dry the mouth more and has been associated with apthous ulcers. I would avoid any alcoholic mouthwash completely and look for one that includes enzymes that occurs in your mouth naturally.
Try to replenish your saliva naturally with products that include enzymes like
- Lysozyme that splits the cell wall of bacteria and helps prevent infection.
- Lactoferrin is an iron-binding protein that reduces inflammation.
- Amylase breaks down starch in the mouth and starts the digestion process.
- Serralysin promotes healing and reduces swelling.
- Papain, an enzyme derived from papaya can improve saliva flow and reduce thirst.
Other natural care remedies include Spilanthes flower is known for its soothing, tingling effects. I would look for products that include natural sweeteners like xylitol as it helps prevent cavities and increases the pH of the oral cavity.
When I was a speaker at Hinman in 2025, I found a Dry Mouth Rinse called TheraBreath Dry Mouth Oral Rinse. It has all of these 6 enzymes and proteins and helps stimulate salivary flow.
It’s one of the only rinses on the market that contains these 6 specific enzymes and is a great option for any patient suffering from dry mouth. It is easy for patients to find this over the counter and can be a good solution for patients who experience dry mouth due to GLP-1 medications.
REFERENCES
- Cleveland Clinic – Saliva and Oral Health
- PMC10537525 – Lactoferrin and oral immune support
- PMC7585045 – Serralysin biofilm activity
- MDPI Dentistry Journal 13(3):132 – Papain enzyme research
LINKS
- https://www.asahq.org/about-asa/newsroom/news-releases/2023/06/patients-taking-popular-medications-for-diabetes-and-weight-loss-should-stop-before-elective-surgery
- https://www.niddk.nih.gov/health-information/health-statistics/overweight-obesity
- https://www.ada.org/resources/ada-library/oral-health-topics/xerostomia
ABOUT THE AUTHOR
Shannon M. Nanne, RDH has strengthened partnerships with dentists, dental hygiene schools and other professional partners for over 32 years. With extensive experience in dental education, Shannon started her career in executive oral care upon her graduation from the University of Pittsburgh’s School of Dental Medicine in 1994. Since then, Shannon has authored scholarly pieces in many industrious outlets including RDH Magazine, Dentistry IQ, Dimensions of Dental Hygiene and was the first dental hygienist to be published in Dentistry Today.
With her global experience as an international speaker, she has served as a key opinion leader for several corporations and associations, notably holding an executive board position with the Cleveland Dental Hygiene Association for over 16 years. Named the Executive Director of the Global Oral Cancer Forum in 2016, Shannon helped further the changes required for a substantial impact on the incidence, morbidity and mortality of oral cancer worldwide.
