Oral Health Outcomes with GLP1 Receptor Agonists Compared with Other Metabolic Interventions

Semaglutide and tirzepatide are increasingly used for obesity and diabetes, producing substantial changes in appetite, dietary intake, body weight, glycemic control, and gastrointestinal physiology that could plausibly influence oral health. Reports of xerostomia and dental complications have emerged, but population-scale risk of new-onset oral disease remains unclear. Using de-identified electronic health records from a federated system of 29 million patients, we evaluated 15 oral and dental conditions over a 12-month follow-up period in 184,582 semaglutide or tirzepatide users after excluding patients with substantial pre-existing oral-health burden. GLP-1 receptor agonist users were propensity-score matched to patients initiating other anti-diabetic therapies (42,093 pairs) and undergoing bariatric surgery (15,793 pairs) and comparisons were performed based on structured diagnosis codes and natural language processing-derived phenotypes from clinical notes. During follow-up, 8.69% of GLP-1 users developed at least one newly documented oral-health condition, with dry mouth most frequent (5.29%). Compared with matched users of other anti-diabetic therapies, GLP-1 users had lower incidence of any oral-health condition (RR 0.74, 95% CI 0.71–0.77), dental caries (RR 0.47, 0.40–0.56), and periodontitis (RR 0.50, 0.40–0.61). Dental plaque/calculus was the only condition with higher incidence (RR 1.27, 1.02–1.56). Similar trends were observed versus bariatric surgery (any oral-health condition: RR 0.80, 0.75–0.86). Dry-mouth incidence increased with greater treatment-associated weight loss (P<0.001). Overall, semaglutide or tirzepatide initiation was not associated with broadly increased oral-health risk, although dry mouth may represent a weight-loss-associated phenotype warranting further study.