What Every Dentist Needs to Know About GLP-1s

Dr. Leslie S.T. Fang breaks down what GLP-1 and GIP are, how they work, common side effects, and how to best manage dental patients who take them. 

It seems like GLP-1 medications can treat just about anything.

While they’re best known for promoting weight loss and helping diabetic patients manage blood sugar levels, studies have shown GLP-1 receptor agonists also can lower blood pressure, improve lipid disorders and fatty liver disease, and reduce the risk of heart disease, kidney disease and stroke.

As more patients turn to these medications, it’s critical for dentists to understand how they work and the side effects they cause, said Dr. Leslie S.T. Fang, co-author of “Ultimate Cheat Sheets: The Practical Guide for Dentists,” a chairside resource that keeps dentists up to date on FDA mandates, life-saving algorithms and new drugs. There’s been an “incredible wave” of GLP-1 drugs entering the marketplace, making them a dominant force that dentists simply can’t avoid. 

“There’s no question these medications are gaining acceptance,” Dr. Fang said, “so we had to make a Cheat Sheet so dentists know what they are, what they do, and what dental professionals are supposed to do with them.”

That’s exactly what you’ll learn during Dr. Fang’s session at the Wellness Dental Forum, slated for October 17-18. He’ll go over everything you need to know about these medications and how to manage dental patients on GLP-1 therapy. Here, we give you a sneak peek into that presentation. 

What They Are

GLP-1 receptor agonists, Dr. Fang said, come from something clinicians never paid much attention to: the gut hormones.

When food hits the GI tract, he said, it signals the pancreas to make insulin—long before blood sugar spikes. How? Incretins. L cells secrete glucagon-like peptide-1 (GLP-1) incretins while K cells secrete glucose-dependent insulinotropic peptide (GIP) incretins, which are also activated when food hits the GI tract. GLP-1 incretins then travel to the pancreas, signaling it to increase the production of insulin and reduce the production of glucagon. That means blood sugar never rises because there’s an adequate amount of insulin to handle whatever glucose is being absorbed through the food.

What’s interesting, Dr. Fang said, is GLP-1 also seems to have a direct effect on the brain, signaling it to stop eating. 

“It goes to the brain and says you’re full,” he said. “Don’t stuff yourself.”

And it doesn’t stop there. GLP-1 also impacts the peripheral tissue, making it more sensitive to insulin. That’s key because type 2 diabetes is often a disease of insulin resistance in the peripheral tissue, Dr. Fang explained. So, when GLP-1 is activated, not only does the body produce more insulin, that insulin actually does its job better.

GLP-1 also slows down the GI tract, giving food more time to absorb, Dr. Fang said. Finally, the incretin moves to the liver, where it reduces the fatty deposition that can cause inflammation, swelling and liver damage.

To harness these powerful benefits, GLP-1 receptor agonists were developed to attach to the L cells and fool them into thinking food is always there. What started out as a medication to manage type 2 diabetes, Ozempic®, was soon marketed as Wegovy® for weight loss (same active ingredient, semaglutide, but different dosing and FDA-approved indication).

We can’t forget about GIP, which comes from the K cells and works similarly to GLP-1. It travels the same path to manage blood sugar and promote weight loss. The difference is fat storage, with GIP having a more direct effect on fat metabolism to enable lipid storage and fat accumulation. In medication form, GIP is paired with a GLP-1 receptor agonist—and the combination produces net weight loss because the GLP-1 component’s appetite-suppressing and gastric-slowing effects outweigh GIP’s pro-lipogenic role. The most common option is tirzepatide, which comes as Zepbound® for weight loss and Mounjaro® for diabetes (again, the same active ingredient marketed under different brand names for different indications).

The Downside to GLP-1

While these medications offer so many benefits to patients, there’s “no free lunch,” Dr. Fang said. Both have side effects that patients must learn to manage, and that dentists must be aware of before scheduling procedures.

Because GLP-1 medications slow down the GI tract, Dr. Fang said, patients are likely to experience unpleasant side effects like constipation, nausea, GERD and abdominal pain.

“They almost killed the drug because everybody on the drug says, ‘you know what, I have no appetite and I’m always feeling a little bit bloated and full, a little bit of nausea,” Dr. Fang said. “Well, that’s a GI side effect of the drug. That’s the way that it works.”

And patients are willing to deal with these side effects because GLP-1/GIP is so effective at regulating blood sugar and helping them lose weight. Obese patients are finally shedding unwanted pounds, with 10% weight loss expected, Dr. Fang said, and as much as 15% to 20% “not unheard of.” 

Dr. Fang also makes it very clear to patients that, along with fat loss, they also expect to lose bone, muscle and collagen. And that muscle loss can become a big problem if patients don’t develop a plan to counteract it.

“I tell every patient on these meds that they will lose muscular strength,” he said, “and to make sure they do weight bearing exercises or wear weighted vests.”

Because of the collagen loss, they’ll also notice they seem to be aging faster, Dr. Fang said. They’ll start to see age lines, a drooping mouth, wrinkles and more creases in their forehead when they look in the mirror.

The other issue, Dr. Fang said, is there is no exit strategy.

“It’s a designer drug; it is not inexpensive. And we know the minute they stop using the drug, patients tend to regain a significant portion of the weight,” Dr. Fang said. Published data support this: the STEP-1 extension trial found that participants regained roughly two-thirds of their lost weight within a year of stopping semaglutide, underscoring why a structured weaning and maintenance plan matters from the start.

Dr. Fang has, however, been able to successfully wean patients off these medications as they get close to their target weight, and prepares them for that from the start. When it’s time to start weaning, Dr. Fang gives patients the lowest dose possible and then spaces out the intervals. Patients start microdosing on their own, and find they only need to purchase a small supply of the medication to “turn off their appetite” when cravings start to come back.

Managing Dental Patients

These medications aren’t going away, and it’s critical for dentists to understand their nuances. Dr. Fang has developed a Cheat Sheet so dentists know exactly how to handle patients taking these medications.

“With this Cheat Sheet, dentists understand the side effects of the drugs,” Dr. Fang said, “and are able to develop a dental management program that will be helpful for their patients’ health and welfare.”

To start, Dr. Fang recommends that patients consider holding GLP-1/GIP medications for seven days before any dental procedure involving deep sedation or general anesthesia—or any minor surgery—to reduce the risk of pulmonary aspiration. Any decision to hold these medications should be made in coordination with the patient’s prescribing physician, particularly for diabetic patients where temporary discontinuation may affect glycemic control.

GLP-1 patients should always be scheduled for the first appointment of the morning, Dr. Fang said, with no food or medication—including morning insulin and hypoglycemic agent for diabetic patients—after midnight. That, of course, isn’t your typical protocol for diabetic patients, but it reduces the risk of aspiration. 

“Limit the procedure to no longer than three hours,” Dr. Fang said, “and afterward make sure patients can resume oral intake, and when they do they can take their hypoglycemic agent or insulin at the original dose.”

Dr. Fang describes that as the Sunday protocol. Many patients sleep in on Sunday, and may take their medicine a few hours late. Like a lazy Sunday morning, this GLP-1 protocol basically delays the patient’s day by about three hours. Patients can resume all medications, including GLP-1 and GIP receptor agonists, after the procedure.

Safer Patient Care

Dentists must understand how to manage patients and the various medications they take. Dr. Fang’s Ultimate Cheat Sheet bridges the gap between medical and dental, keeping dentists updated on everything they need to know about common medical conditions and the drugs that treat them. It’s continuously updated, and now includes important information about GLP-1/GIP.

“Understanding what is happening with a patient is something that you always need,” Dr. Fang said. “And once you understand it, everything actually makes sense. Why you do what you do is predicated upon the understanding of how the drug works and what the side effects are. And now you can one up every one of your colleagues, including your medical colleagues, because you have information they don’t have. But, most importantly, you’re going to be delivering safer care for your patients.”

To learn more about GLP-1/GIP and how these medications affect the dental patient, be sure to attend Dr. Fang’s presentation at the Wellness Dental Forum in October.

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