In this episode, we sit down with Dr. John Comisi, DDS, interim chair of the Department of General Dentistry at the Dental College of Georgia at Augusta University, to explore the surprising connection between GLP-1 medications, sleep apnea, and your oral health. Jeffrey Snyder, Broadcast Retirement Network Well, Dr. Comisi, it’s so great to see you. Thanks for joining us on the program this morning. John C Comisi, DDS, Dental College of Georgia at Augusta University My pleasure. Jeffrey Snyder, Broadcast Retirement Network I’m really excited to talk about, you know, GLP-1, but also about oral and dental health. We’ll get into that in a minute, but I know that the paper and research that you worked on specifically looked at OCA or obstructive sleep apnea. Before we kind of get into the research, would you mind helping us understand exactly what O-S-A is? I think I said C, but I meant S. Yeah. John C Comisi, DDS, Dental College of Georgia at Augusta University O-S-A is? Basically, obstructive sleep apnea is something that prevents an individual from getting a good night’s sleep. The airway becomes obstructed because in simple terms, the tongue gets in the way, falls to the back of the throat, and as such, the airway gets clogged. Airway has two types of airways in an individual. Type that’s like a garden hose that has corrugated wire and it is always open, and the other types of airway like my own is a fire hose. Once the water comes out of the fire hose, it closes down and it prevents an individual from breathing properly, and that creates a lot of stress on the person and creates high blood pressure and cardiac issues and other problems too. So having an airway that isn’t functioning optimally is something that is very, very significant, and it’s a lifelong process. It starts at early age at birth and can go on through my age and older, in my senior years now, but it’s something that’s also familial. It translates the generations. It passes down from parents to children, et cetera, and so this is one of our biggest problems that we have, and most people don’t even know that they have it. 80% of the population worldwide is unaware that they may have an airway problem that affects their overall ability to sleep comfortably and restfully at night. Jeffrey Snyder, Broadcast Retirement Network So that begs the question, and I promise we’ll get to your research in a second, but how do I know whether or not I have this? I mean, I think I do personally. That’s probably TMI for you in the audience. You know, wake up, don’t sleep too well. I’m a mouth breather, or so my dentist tells me, but how would someone who maybe isn’t having symptoms that they know of, how would they be diagnosed with this? John C Comisi, DDS, Dental College of Georgia at Augusta University Well, the most important way to diagnose it is having a sleep study done, either an in-laboratory polysomnograph or a home sleep test, which are becoming much more prevalent and available. Many of our sleep physicians and regular physicians are actually providing those to patients who have the signs and symptoms associated with airway issues, such as snoring, such as, you know, maybe having high blood pressure, any kind of diabetes. All of these are medical problems that are associated with people who have obstructive sleep apnea. And what we teach in the schools is for our dental students to screen for this, because dentists can’t diagnose it. It’s a medical condition that has significant ramifications dentally and medically. Jeffrey Snyder, Broadcast Retirement Network And we’ll talk about that in a second. So GLP-1s are a type of drug that really has become very popular, mostly for weight loss. But the more I read about a doctor, it’s like a miracle drug. It’s used in so many different areas. And my understanding, based on your research and the research of the team, is that it may be used to treat sleep apnea. Is that correct? John C Comisi, DDS, Dental College of Georgia at Augusta University That is correct. The review that I wrote as a single authored paper that came to my mind as I was reading an article regarding the new GLP-1s, especially the new Lily Pill Fundale and what it may or may not be able to help force with. And as I looked into it and started going through the research papers and the data, started to realize that there’s a lot of things going on with it. It’s a miracle drug. And according to J.P. Morgan, if I get my stats right, roughly 25 million people in the U.S. will be using this by 2030, which is an outstanding, extraordinary number. But it does create benefit. The weight loss, the overall ability to feel healthier with it is a great thing. So GLP-1s have an incredible benefit. But unfortunately, as the review has indicated, there’s also potential problems with it that physicians and dentists need to be aware of this and patients need to be able to provide that information to their treating healthcare professionals that they’re on a GLP-1. So that this way they can look for the signs and symptoms associated with the side effects. And there’s always a side effect for every medication that we have available, unfortunately. Jeffrey Snyder, Broadcast Retirement Network Yeah, I mean, it’s just the real world. But I guess clinicians have to evaluate whether or not the drug is worth more in terms of its benefit versus those side effects that you were talking about. So what are some of the impacts to oral health? Because I’ve learned from talking to people like yourself doing the show and just my own dental practitioner that my oral health can oftentimes be indicative of my overall health. So how can taking the GLP-1 and for sleep apnea and overall affect my oral health and therefore my overall health? John C Comisi, DDS, Dental College of Georgia at Augusta University Sure, overall the GLP-1s can be extraordinarily beneficial in many, many ways. Number one, of course, reducing weight. And that in and of itself is a component of a lot of obstructive sleep apnea components. The heavier we are, the more likely we are to build up and a lot of fat around the airway system and that closes down the airway. The benefits of the GLP-1 is that it helps to reduce that. And there’s so many fabulous opportunities with the GLP-1s. I’m not saying that don’t use them, basically just understand where the problems could be. And if we can identify the problems ahead of time before it becomes, it becomes a better situation. The dry mouth factor is one of the big things that can occur. More so with the semi-glutides like Mongero than with the Zep-Mound type of medications. Those are not quite as much, but there’s still some. Both of those medications can contribute to dry mouth which can then affect the overall health of the mouth and make the person more prevalent to cavities and gum disease, et cetera. As some of the meta-analyses have shown that OSA is associated with this. So if we have a dry mouth, then we have more potential for disease if it isn’t identified and if it isn’t managed appropriately. So the earlier that a person informs their healthcare provider, especially their dentist that they’re on it, they can keep an eye out for potential problems. Also we have gastrointestinal reflux that can occur with some of this. So people get a little nauseated and that becomes a problem and that can contribute to some of the oral disease cavity formation that can occur. So if you are nauseated by taking the medications, rinsing your mouth after you’ve had that nauseous feeling will help to reduce some of the acidity in the mouth which causes the dental disease problems that we see as well. Jeffrey Snyder, Broadcast Retirement Network My experience in, oftentimes when I go to the dentist, I don’t connect the dots between what, and this is my own fault. I think a lot of people are like this. I don’t connect the dots between my PCP, my primary care physician and what’s going on on that side of the equation with my dental health as you were mentioning. I would imagine it’s a best practice as patients to, if the dentist doesn’t ask, we should be telling them, hey, I’m on this medication, that medication, this so that you have a running list because you’re medically trained. Meaning dentists are medically trained to do the work that they’re doing. They’re looking for things like cancer and other things around the mouth. They’re oftentimes the early indicators of disease. So it’s on the patient, but I would imagine, as you said earlier, it’s on the dentist as well, to the practitioner to ask questions to. John C Comisi, DDS, Dental College of Georgia at Augusta University That’s correct. Again, every time a patient comes in, when I was in private practice and every time that my students have a patient coming in, one of the first questions, are you on any new medications? Are you taking anything different? And that can be as simple as a new vitamin or an allergy pill. And as complex as taking a new GLP-1. So it helps us as healthcare providers give you as a patient optimum opportunity to stay healthier. Because the more that we know, which is why we take a blood pressure all the time. People ask, why are dentists concerned with my medical condition? Because dentistry is, if you think about it, really a subset of medicine. And as such, it needs to have the same information that your primary care physician does. So anything that your primary care physician provides to you, your cardiologist provides to you, your endocrinologist and your rheumatologist, we need to know that. So that this way we can intercept any unusual activity before it becomes detrimental. Jeffrey Snyder, Broadcast Retirement Network So you mentioned it’s a self-authored paper. Obviously I picked up on it. Do you think that you’ll work with the American, and I don’t want to put carp before the horse, but I would imagine group industry association groups like the American Dental Association would have an interest in trying to elevate this and also working with their peers at the American Medical Association to make sure that practitioners are informing each other, right? I mean, that would seem the logic of what you wrote. John C Comisi, DDS, Dental College of Georgia at Augusta University Well, the review basically exposes many of the gaps in our knowledge right now. And there’s a lot that we do not know. And the call to action from the paper is that we need to be doing more research, more clinical trials, more investigative work to determine how much is really occurring. Right now we’re just speculating. The data that has been raised via the review and the papers that I looked at indicate that we don’t know enough about this yet. Every new medication that comes on the market, there are potential benefits and challenges. And how is it affecting our patients? That’s the most critical thing. So I can’t speak for the organizations, the AMA and the ADA, but it would make sense that our medical providers, our dental providers, all of our healthcare providers are aware of this issue. And if anything unusual is occurring in the individual’s wellbeing, that tracing it back and seeing if there’s anything that can be done to help that person be healthier and better. That’s the whole purpose of these kinds of reviews is seeing where the knowledge is and unfortunately where it isn’t. Jeffrey Snyder, Broadcast Retirement Network Well, look, it starts with an idea and someone taking the initiative. You’ve done that. And hopefully it will bubble up to those associations to consider further. Hopefully maybe you will lead some research out of it. Dr. John Camisi, it’s great to see you. Thanks for joining us. And we look forward to having you back on the program again very soon. John C Comisi, DDS, Dental College of Georgia at Augusta University My honor and pleasure. I’d be happy to do so at any other time.
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