Halitosis, more commonly known as bad breath, affects approximately 35% of people worldwide and 80 million people in the United States. While many people are aware of the unpleasant consequences of this condition, few know that it can be caused by a variety of underlying medications, including using a GLP-1 (glucagon-like peptide-1) agonist drug like Ozempic.
What kind of drug is Ozempic?
Ozempic, the brand name for semaglutide, is a GLP-1 receptor agonist used to treat type 2 diabetes and, more recently, obesity. The drug is administered through an injection once a week or as a once-daily pill (Rybelsus). Another similar drug that has gained popularity is tirzepatide (Mounjaro), which is a combination GLP-1 and GIP (glucose-dependent insulinotropic polypeptide) receptor agonist. These drugs, originally approved for type 2 diabetes, lower A1c, slow digestion to increase satiety, increase fat utilization, and have led to dramatic weight loss results of around 12%–17% of body weight after 48 weeks of use.
Other less popular drugs that fall under this category include:
· Dulaglutide (Trulicity)
· Exenatide extended-release (Bydureon BCise)
· Exenatide (Byetta)
· Liraglutide (Victoza, Saxenda)
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While Ozempic has proven effective in controlling blood sugar levels and weight reduction, recent research suggests that it can also have a negative impact on breath. For example, in one trial, 10% of patients taking semaglutide reported burping or eructation as a side effect compared to 1% reporting burping with the placebo. Many study participants reported these burps to be “sulfa burps” containing foul-smelling volatile sulfur compounds (VSCs). VSCs are the hallmark gases associated with bad breath.
Ozempic and the mechanism of bad breath
The exact mechanism of how Ozempic causes bad breath is unclear; however, one theory suggests that the drug could be contributing to gut dysbiosis. Gut dysbiosis is an imbalance of bacteria in the intestines that can lead to a variety of digestive problems and oral health issues such as bad breath.
One animal study found that a GLP-1 receptor agonist (liraglutide) decreased microbial diversity when given to mice and led to gut imbalance. The study concluded that because this class of drugs slows digestion, they can lead to a proliferation of gut bacteria that are known to produce VSCs.
In addition, pH balance, nutrient composition, gastric emptying time (gastroparesis), and gut transit time are all affected by drugs like Ozempic and can lead to an alteration of gut microbial homeostasis.
Conclusion
There is evidence to suggest that Ozempic may be a contributing factor to bad breath. However, more research needs to be done to better understand the exact relationship between these classes of drugs and halitosis. It is also important to note that bad breath can be caused by a variety of factors that may be coincidental with taking Ozempic. For example, studies have shown that patients with an elevated HbA1c (high blood sugar) have an increased incidence of bad breath.
If you or your patients are taking drugs like Ozempic or Mounjaro and experiencing halitosis, a dental professional can help determine the exact cause of the problem.
Until Next time: Stay Safe, Stay Healthy and be Careful out in the World.
James A Vito, D.M.D.