Halitosis, more commonly known as bad breath, affects approximately 35% of people worldwide and 80 million people in the United States.1 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.2
Other less popular drugs that fall under this category include:
- Dulaglutide (Trulicity)
- Exenatide extended-release (Bydureon BCise)
- Exenatide (Byetta)
- Liraglutide (Victoza, Saxenda)
What you need to know about Ozempic ... Ozempic and dentistry: Implications for today's clinicians
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.3 Many study participants reported these burps to be “sulfa burps” containing foul-smelling volatile sulfur compounds (VSCs).4 VSCs are the hallmark gases associated with bad breath.5
Read more about halitosis …
Halitosis: Etiology, diagnosis, and treatment
Bad breath: Is it coming from the gut?
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.6
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.7
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.8
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.
Editor’s note: This article originally appeared in Perio-Implant Advisory, a chairside resource for dentists and hygienists that focuses on periodontal- and implant-related issues. Read more articles and subscribe to the newsletter.
References
- Bad breath statistics. Bad Breath Institute. https://xbadbreath.com/bad-breath-info/statistics/
- Jastreboff AM, Arrone LJ, Ahmad NN, et al. Tirzepatide once weekly for the treatment of obesity. N Engl J Med. 2022;387(3):205-216. doi:10.1056/NEJMoa2206038
- Wilding JPH, Batterham RL, Calanna S, et al. Once-weekly semaglutide in adults with overweight or obesity. N Engl J Med. 2021;384(11):989-1002. doi:10.1056/NEJMoa2032183
- Gutman-Wei R. Beware the Ozempic burp. The Atlantic. May 2, 2023. https://www.theatlantic.com/health /archive/2023/05/ozempic-burping-smell-eggs-side-effect/673925/
- Schmidt NF, Missan SR, Tarbet WJ. The correlation between organoleptic mouth-odor ratings and levels of volatile sulfur compounds. Oral Surg Oral Med Oral Pathol. 1978;45(4):560-567. doi:1016/0030-4220(78)90037-3
- Wang L, Li P, Tang Z, Yan X, Feng B. Structural modulation of the gut microbiota and the relationship with body weight: compared evaluation of liraglutide and saxagliptin treatment. Sci Rep. 2016;6: 33251. doi:1038/srep33251
- Prescribing information for Ozempic. Novo Nordisk. Updated December 2017. https://www.accessdata.fda.gov/ drugsatfda_docs/label/2017/209637lbl.pdf
- Al-Zahrani MS, Zawawi KH, Austah ON, Al-Ghamdi HS. Self reported halitosis in relation to glycated hemoglobin level in diabetic patients. Open Dent J. 2011;5:154-157. doi:2174/1874210601105010154
Scott Froum, DDS, a graduate of the State University of New York, Stony Brook School of Dental Medicine, is a periodontist in private practice at 1110 2nd Avenue, Suite 305, New York City, New York. He is the editorial director of Perio-Implant Advisory and serves on the editorial advisory board of Dental Economics. Dr. Froum, a diplomate of both the American Academy of Periodontology and the American Academy of Osseointegration, is a volunteer professor in the postgraduate periodontal program at SUNY Stony Brook School of Dental Medicine. He is a PhD candidate in the field of functional and integrative nutrition. Contact him through his website at drscottfroum.com or (212) 751-8530.
