Good morning.

A surprising number of your dental patients are now on medications like Ozempic, Wegovy, Rybelsus, Mounjaro, or Zepbound.

And while most clinicians focus on weight loss and glucose control… there’s a high-stakes airway issue hiding in plain sight:

These medications slow gastric emptying and increase reflux, which may increase the risk of aspiration in patients with OSA, nasal congestion, and sleep-disordered breathing.

Meaning: a patient’s “new medication” may be quietly increasing:

• Nocturnal reflux

• Gasping / airway instability

• Micro-aspiration

• Airway inflammation (cough / asthma-like symptoms)

• And potentially sedation-related aspiration risk around induction and emergence

This week, we connect the dots in a way your dental team can use immediately: through screening questions, scripts, and a practical protocol.

In Today’s Edition:

-The airway-and-reflux physiology behind GLP-1 meds
-Why OSA + nasal obstruction may increase aspiration risk
-Dental implications: erosion, xerostomia, caries, candidiasis, airway instability
-Sedation checklist update (for anesthesiologist-run cases)
-Monday Morning Moves: implement tomorrow

(7-minute read👇)

Clinical Corner

GLP-1 Medications + OSA: A New Aspiration Risk Triangle

🔑 Key Takeaways

1) GLP-1/GIP meds commonly slow gastric emptying
This increases the chance that gastric contents remain in the stomach longer, especially overnight.

2) OSA amplifies reflux risk
OSA creates a large negative pressure during obstructive events. That mechanical “vacuum” effect increases the likelihood of reflux during sleep.

3) Nasal obstruction intensifies aspiration risk
Congested noses push patients toward mouth-breathing and gasping arousals; conditions perfect for micro-aspiration.

4) Micro-aspiration is a silent driver of airway inflammation
It may show up as a chronic cough, throat clearing, hoarseness, wheezing, or poorly controlled asthma, especially in OSA patients.

Why It Matters: Dentistry Is Now an Airway Safety Checkpoint

Here’s the “real world” scenario you’re likely already seeing:

A patient with undiagnosed (or undertreated) OSA starts semaglutide or tirzepatide.

They lose weight — great.

But they also develop:

• reflux/nausea

• dry mouth

• more mouth breathing at night

• cough, hoarseness, or “asthma”

• increased bruxism and arousals

They don’t connect it to the medication.
And their medical team often doesn’t connect it to airway mechanics.

But you can, because you’re already looking at:

• airway

• sleep symptoms

• enamel

• wear facets

• tongue scalloping

• xerostomia

• nasal breathing

Dental Implications (What You’ll See Clinically)

1) Erosion Risk

Reflux/vomiting patterns → enamel loss, hypersensitivity, failed bonding margins.

Clinical move: Add “reflux risk + GLP-1” to your erosion differential.

2) Xerostomia / Caries Risk

Patients may eat less but sip more acidic drinks, snack differently, and hydrate poorly.

Dry mouth → higher risk of:

• cervical caries

• candidiasis

• burning mouth

• tissue soreness

• denture irritation

3) Perio and Healing Considerations

Improved glycemic control may help reduce long-term periodontal inflammation.

But rapid weight loss, reduced protein intake, and dehydration can temporarily reduce the resilience of soft-tissue healing.

Sedation Implications (for anesthesiologist-managed cases)

Even when your anesthesiologist intubates and preserves spontaneous respiration, here’s the truth:

Intubation helps protect the airway during the procedure
It does not remove risk at:

• pre-induction

• emergence

• post-op vomiting

• or the patient’s sleep at home

High-risk sedation flags

Add these to your sedation intake:

• GLP-1/GIP medication name + last dose timing

• recent dose escalation (within the last 2–4 weeks)

• active nausea/bloating/reflux

• history of GERD

• moderate/severe OSA

• chronic nasal obstruction

• asthma/chronic cough

Then communicate with anesthesia.

You’re not “telling anesthesia what to do.”
You’re giving them the missing clinical variable.

📊 Research SpotlightClinical Script (Chairside)

The 20-second GLP-1 + Airway Check-in

If “yes,” → proceed to STOP-BANG or Epworth.

Add This to Your Medical History Form (Drop-in)

1. Are you on any GLP-1 or GIP/GLP-1 medication? (Ozempic / Wegovy / Rybelsus / Mounjaro / Zepbound)

2. Last dose date/time: ________

3. Any nausea, reflux, bloating, or vomiting? Y / N

4. Any new cough/wheeze/or hoarseness since starting? Y / N

5. Diagnosed with OSA? CPAP / oral appliance / untreated

6. Chronic nasal congestion? Y / N

Quick Tips to Share with Patients (Immediate prevention)

If reflux/vomiting is present:

• Do NOT brush immediately after vomiting.

• Rinse with water + baking soda.

• Wait 30 minutes before brushing.

• Consider high-fluoride toothpaste/varnish if there is an erosion risk.

If dry mouth is present:

• hydration + xylitol strategy

• Rx fluoride (high caries risk)

• screen for candidiasis

If airway symptoms present:

• Emphasize nasal breathing optimization

• Treat nasal congestion aggressively

• Reinforce OSA therapy compliance

📊 Research Spotlight (Pre-reviewed learning materials) Link

1) GLP-1 medications and delayed gastric emptying/aspiration concern
Key takeaway: These medications can increase residual gastric contents, which is important in planning sedation/GA risk.

2) OSA and nocturnal reflux mechanics
Key takeaway: Negative airway pressure during obstruction increases the likelihood of reflux.

3) Micro-aspiration → airway inflammation
Key takeaway: Small, repeated aspiration events can worsen cough-like or asthma-like symptoms.

Monday Morning Moves ✅

Implement this tomorrow (team huddle checklist)

1) Update your medical history form with 3 GLP-1 questions (name, last dose, GI symptoms)

2) Add one chairside script to hygiene appointments (20 seconds)

3) Create a “GLP-1 Airway Risk” flag in your sedation chart

• recent dose escalation

• nausea/reflux

• OSA severity

• nasal congestion

4) Provide a standardized handoff to anesthesia:

Coach Cathy’s Corner 💬

“But I’m Finally Losing Weight — Please Don’t Take This Away.”

This is not about fear.

It’s about fine-tuning the win.

We’re not telling patients to stop medications that may change their lives, but we do want them to be well-informed.

We’re teaching them to listen earlier to what their body is signaling:

• Reflux is not “normal.”

• Dry mouth isn’t “no big deal.”

• Coughing at night isn’t “just allergies.”

Small awareness → big protection.

Coach tip for your team:

Final Word

Dentistry has always been about prevention.

But now the scope is bigger:

If we identify reflux, OSA, and aspiration risk early, we’re not just protecting enamel; we're also protecting overall health.

We’re protecting lungs, airway stability, sedation safety, and long-term health.

As always, keep connecting the dots.

Until next week,
Dr. Michael & Cathy Bennett
More Than Teeth | A Mission for Generational Health

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