Shortages in the UK for Ozempic, a brand name for semaglutide, have been reported for long over a year. It is an effective treatment for type 2 diabetes, amidst a group of drugs called glucagon-like peptide-1 (GLP-1) receptor agonists. These also cause weight loss, making them a treatment option for chronic weight management in people living with type 2 diabetes and who are overweight or obese.
Recently, GLP-1 receptor agonists have gained popularity – Ozempic in particular – and quickly become household names as weight loss aids for individuals, no matter their diabetic status. An increased demand developed, creating the aforementioned shortage which was expected to last until at least mid-2024. At the time of writing, it is yet to subside.
Patients who use Ozempic must be treated with individualised care that recognises the potential oral health issues resulting from its use and side effects.
Breathtaking effects
As of now, there is not sufficient evidence to suggest that semaglutide solutions such as Ozempic or Wegovy have a direct connection to oral health. However, common side effects and impacts can have knock-on effects and must still be considered.
Ozempic is used to lower blood sugar levels and does so by increasing the amount of insulin that the body produces. It also slows the movement of food through the stomach and limits the amount of sugar that is released into the bloodstream. With food movement slowed, patients feel full for longer periods and can limit their diet, causing weight loss.
This function has potential links to oral malodours, with the term ‘Ozempic breath’ gaining traction. One animal study has found that the use of GLP-1 receptor agonists slowed digestion, which led to the creation of gut bacteria that produces volatile sulphur compound (VSCs). These play a significant role in malodorous gas production. Dental professionals may be able to help by recommending or providing oral hygiene adjuncts that mask and eliminate the odour, such as an effective mouthwash.
However, halitosis is multi-causal and could be linked to poor oral hygiene. Clinicians should ensure this is not the case and direct patients to keep regular and effective oral hygiene routines. Interdental cleaning is particularly essential, as studies have found that interdental plaque contains a uniquely diverse microbial community which harbours high levels of VSC-producing bacteria.
Understanding side effects
Patients who take Ozempic may be prone to common side effects and must understand the risk these present to the quality of their oral health.
One study observing semaglutide use in overweight or obese patients saw a nausea prevalence of 44.10 per cent, vomiting of 24.58 per cent and gastroesophageal reflux disease (GERD) of 6.28 per cent. These were each at least double the occurrence within a placebo group.
Vomiting and its effect on oral health have largely been studied in the context of eating disorders. Whilst the circumstances are different, the effect remains the same. Dental caries risk increases due to cariogenic food content consumed before vomiting, and the risk for dental erosion increases as acidic content from the stomach reaches the oral cavity. If patients brush their teeth immediately after vomiting, they are further prone to dental erosion.
The impact of GERD is similarly devastating. Dental erosion is the most common dental manifestation of this condition, with prominently observed impacts on the buccal, occlusal and lingual surfaces of the dentition. Hyposalivation is also often seen in obese individuals with GERD, which is important to note as Ozempic users may be taking the medication for weight loss. Patients with dry mouth are at a heightened risk of dental caries development.
Keep an oral hygiene routine
Whilst Ozempic or other semaglutide solutions may not directly cause oral health issues, it’s clear that their side effects can impact many patients. People must be advised to maintain a high-quality oral hygiene routine to minimise the development of caries, dental erosion and oral malodours.
This includes twice-daily brushing with an effective toothpaste, and cleansing of the interdental spaces, where bacteria or acidic content may be left undisturbed. A solution like the Waterpik Cordless Advanced water flosser can access the interproximal and subgingival spaces – areas toothbrushes cannot reach as easily. The Cordless Advanced water flosser is 50 per cent more effective for protecting gum health than dental floss and removes up to 99.9 per cent of plaque after a three second application at treated areas.
Ozempic is one of the most in-demand drugs today. When a patient discloses its use, clinicians should look out for any oral health impacts and ensure patients can maintain the health of their dentition. This is possible with close support and a brilliant oral hygiene routine.
References available on request.
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