By Jennifer Henderson

Cases of "Ozempic mouth" and "Ozempic teeth" have recently been described in the news, with most of the problems -- inflammation affecting the gums, tooth decay, and even bad breath -- linked to a dry mouth.

"All of the GLP-1 agonists that we use now cause changes in how everything is secreted in your GI tract," said Ann Marie Defnet, MD, who specializes in obesity medicine and bariatric surgery at Northwell Health's North Shore University Hospital and Long Island Jewish Medical Center in New York City. And this "definitely has an impact on saliva."

People taking GLP-1 drugs also tend to be a bit dehydrated because they are often not hungry or thirsty, she noted.

"I haven't seen too many horrible cases of periodontal disease, gingivitis, or anything like that, nor have I had any patients really complaining about dry mouth," she noted. "But definitely I have patients all the time that [say], 'Oh yeah, I can tell I'm dehydrated.'"

Defnet said she believes some of the serious oral health issues that have been reported are likely representative of "more of a later stage issue with patients who maybe just aren't staying hydrated in general."

"One of the big things I always counsel my patients on is they just have to remember to continue to drink water, even if they're not thirsty, even if they're not hungry," Defnet said. "That seems to help with all of these symptoms."

But often people taking GLP-1 drugs are not seeing a medical provider, she said, and if people are not receiving counseling, "the dehydration can add up, and that impacts the saliva more."

Changes in saliva and dehydration can also cause bad breath, Defnet said, but anyone who is in a ketotic state can have the smell of ketosis, often described as a fruity smell.

"That is mostly for people who are no longer eating any type of fat, which is not necessarily everyone on a GLP-1, but can be patients on a GLP-1," she said.

In addition, some 25% of people taking GLP-1 drugs experience GI issues, Defnet noted, and while these primarily include bloating, nausea, diarrhea, and constipation, some people have vomiting. This is "not a typical symptom, and you should speak to a medical provider about that side effect."

And vomiting can certainly affect the mouth, she added. "So, brushing teeth is important after vomiting just to get the acid off the mouth and off the teeth. But if you're vomiting so much that you're having periodontal disease ... you should speak to a medical provider and, most likely, should not be on a GLP-1."

"I think all of these sorts of symptoms, especially those in the mouth, are signs that you just need to take a little bit better care of yourself while taking these drugs," Defnet said. "They're definitely not completely benign. They have side effects. But if you are counseled well, and you keep up with your hydration and keep up with a balanced diet, that can really help alleviate a lot of the side effects."

And it's essential for physicians to be made aware of any and all medications patients are taking, Defnet added.

"Periodontal disease is definitely best diagnosed and treated by a dentist," she noted. Even if dentists aren't prescribing GLP-1 drugs, "they should know that you're on them because it does impact your saliva and obviously could be impacting your periodontal health."

"It is very important to be open and honest about all of the medications you're on because ... there are many other medications that affect oral health as well," she added.