GLP-1 Medications, Sleep Apnea, and Oral Health: A Connection Many Doctors May Miss

In this conversation, we speak with Dr. John Comisi, DDS, interim chair of the Department of General Dentistry at the Dental College of Georgia at Augusta University, about the unexpected relationship between GLP-1 medications, sleep apnea, and oral health.

Jeffrey Snyder, Broadcast Retirement Network

Dr. Comisi, it’s a pleasure to have you with us this morning. Thanks for being here.

John C Comisi, DDS, Dental College of Georgia at Augusta University

My pleasure.

Jeffrey Snyder, Broadcast Retirement Network

I’m looking forward to discussing GLP-1s and oral health. We’ll get to that in a moment, but I know your research focused on obstructive sleep apnea, or OSA. Before we talk about the study itself, could you explain what OSA is?

I said C, but I meant S.

John C Comisi, DDS, Dental College of Georgia at Augusta University

Obstructive sleep apnea is a condition that keeps a person from getting restorative sleep. In simple terms, the airway becomes blocked because the tongue falls back toward the throat and restricts breathing.

There are different airway types in the body. One is more like a garden hose with corrugated wire that stays open, and another is more like a fire hose that collapses once the water stops flowing. When that happens, breathing becomes difficult, and that can lead to stress, high blood pressure, heart problems, and other complications.

An airway that does not function well is a serious issue. It can begin early in life and continue into older adulthood, and it often runs in families.

It can be passed from parents to children, and it is one of our biggest health problems. Many people do not even realize they have it. Worldwide, an estimated 80% of people may be unaware that an airway problem is affecting how well they sleep at night.

Jeffrey Snyder, Broadcast Retirement Network

That raises an important question. We’ll get to your research in a second, but how would someone know if they have it? I think I may have some of those signs myself, though that might be a little more information than the audience needed.

I don’t sleep very well, and I’m a mouth breather, or so my dentist says. But how would someone who may not notice symptoms be diagnosed?

John C Comisi, DDS, Dental College of Georgia at Augusta University

The most important diagnostic tool is a sleep study, either an in-lab polysomnogram or a home sleep test, which are now much more common and accessible. Many sleep physicians and general physicians order them for patients who show signs and symptoms tied to airway issues, such as snoring, high blood pressure, or diabetes.

In dental education, we teach students to screen for these issues, because dentists cannot diagnose them. It is a medical condition, but one that has major dental and medical implications.

Jeffrey Snyder, Broadcast Retirement Network

We’ll come back to that. GLP-1s have become widely known, mostly for weight loss, but the more I read, the more they seem like miracle drugs.

They are being used in so many areas. Based on your research and your team’s work, is it true that they may also help treat sleep apnea?

John C Comisi, DDS, Dental College of Georgia at Augusta University

Yes, that is correct. My review came about as I was reading about the newer GLP-1 medications, especially the latest Lilly pill and what it may or may not help with. As I dug into the studies and the data, it became clear that there is a lot going on with these drugs.

They really are remarkable. According to JPMorgan, if I have the numbers right, about 25 million people in the United States could be using them by 2030, which is an extraordinary figure. They do offer real benefits.

Weight loss and feeling healthier overall are significant advantages. GLP-1s have tremendous potential. But the review also shows there may be problems that physicians and dentists need to understand, and patients need to tell their healthcare providers if they are taking a GLP-1 so clinicians can watch for related signs and side effects.

Every medication has potential side effects, unfortunately.

Jeffrey Snyder, Broadcast Retirement Network

That’s just the reality of medicine. Clinicians have to weigh the benefits against the side effects. So what are some of the oral health effects?

From speaking with experts and from my own dentist, I’ve learned that oral health can reflect overall health. How can GLP-1s, sleep apnea, and related issues affect the mouth and, in turn, overall health?

John C Comisi, DDS, Dental College of Georgia at Augusta University

Overall, GLP-1s can be very beneficial in many ways. First and foremost, they can help reduce weight, and weight is one factor in obstructive sleep apnea.

The more weight we carry, the more likely fat can build up around the airway, which can narrow it. One major benefit of GLP-1s is that they can help reduce that risk. There are many positive opportunities with these medications.

I am not saying not to use them. The point is to understand where possible problems may arise so they can be identified early before they become more serious. Dry mouth is one of the main concerns.

This tends to happen more with semaglutides such as Mounjaro than with Zepbound-type medications, though both can contribute to dryness. Dry mouth can affect oral health and make a person more vulnerable to cavities and gum disease.

Some meta-analyses have shown a connection between OSA and these issues. If dry mouth is present, disease becomes more likely unless it is identified and managed properly. The earlier a patient tells a healthcare provider, especially a dentist, that they are taking the medication, the better the chance of catching problems early.

Gastrointestinal reflux can also occur with some of these medications. Nausea may lead to a higher acid level in the mouth, which can contribute to tooth decay. If someone feels nauseated after taking the medication, rinsing the mouth afterward can help reduce acidity and lower the risk of dental problems.

Jeffrey Snyder, Broadcast Retirement Network

When I go to the dentist, I often don’t connect the dots between my primary care doctor and my dental health, and that’s my own fault. I think a lot of people do the same thing.

It seems like best practice is for patients to tell their dentist what medications they are taking, even if the dentist doesn’t ask. That way there is a full record, and dentists are trained medical professionals who look for signs of cancer and other conditions in and around the mouth.

They’re often the first to spot signs of disease. So the responsibility is on the patient, but I imagine, as you said, it’s also on the dentist to ask the right questions.

John C Comisi, DDS, Dental College of Georgia at Augusta University

That’s right. Whenever a patient comes in, whether it was in my private practice or in my students’ appointments, one of the first questions should be: Are you taking any new medications? Are you doing anything differently?

That could be as simple as a new vitamin or an allergy tablet, or as complex as starting a new GLP-1. The more we know, the better chance we have to help patients stay healthy.

People often ask why dentists care about medical conditions. The answer is that dentistry is really a subset of medicine.

Because of that, it needs the same information a primary care doctor would have. Anything your primary care physician, cardiologist, endocrinologist, or rheumatologist knows should also be shared with the dental team so they can intercept anything unusual before it becomes harmful.

Jeffrey Snyder, Broadcast Retirement Network

You mentioned that the paper was self-authored, and that stood out to me. Do you think organizations such as the American Dental Association would be interested in elevating this issue and working with groups like the American Medical Association so practitioners share information more effectively?

That seems to follow the logic of your research.

John C Comisi, DDS, Dental College of Georgia at Augusta University

The review highlights many of the gaps in our current knowledge. There is still a great deal we do not know. The paper is really a call to action for more research, more clinical trials, and more investigative work to determine how much is actually happening.

At this point, much of it is still speculation. The data and studies I reviewed suggest we simply do not know enough yet. Every new medication comes with both benefits and challenges.

The key question is how it affects patients. I can’t speak for the ADA or AMA, but it makes sense that medical and dental providers should be aware of the issue.

If something unusual is happening with a patient’s health, we should be able to trace it back and see whether anything can be done to improve their wellbeing. That is the purpose of this kind of review: to identify what we know and, just as importantly, what we still do not know.

Jeffrey Snyder, Broadcast Retirement Network

It starts with an idea and someone willing to take the first step. You’ve done that, and hopefully it will lead those associations to take a closer look.

Maybe it will even spark additional research. Dr. John Comisi, it’s been a pleasure speaking with you. Thank you for joining us.

We hope to have you back on the program again soon.

John C Comisi, DDS, Dental College of Georgia at Augusta University

The pleasure is mine. I’d be happy to return anytime.

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