Generations of Smiles | Issue 20

Oral Health Means Better Health At Every Age and Every Stage

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We're Turning 5!

At around age 5, baby teeth begin to wiggle out to make room for something more powerful. Well, “Generations of Smiles” turns five this year, and like a kindergartner’s smile, I feel we’re maturing into something bigger and stronger – thanks to an increasing appreciation1 of the Mouth-Body Connection® among doctors, dentists and their patients.

Issue 9: February 2023 Heart to Heart on Oral Health

Premiere issue: Feb 2021 Celebrating American Heart Month

2021

2022 Issue 8: November 2022 Dentists, Doctors and Diabetes The Data Is In

2023

From our first issue in 2021, we have explored the Mouth-Body Connection2 as it relates to brain health, heart disease, diabetes and more. We have learned how oral bacteria affects systemic health and how partnering with a dentist who keeps up with the latest advances in oral bacteria screening can meaningfully impact healthy aging and whole-body wellness.

In this, our fifth-anniversary issue, we take you behind the scenes of Montel Williams’ interview with Zulema Valdivia, DDS, and Christopher Tolmie, DDS, who discuss the two-way connection between diabetes and periodontal disease. We deliver insights into topics like "Ozempic teeth"—the reported increased risk of periodontal disease associated with certain weight-loss drugs. And we also offer some inspiring stories from dentists who are doing surprising and important work to improve oral health around the world.

It is hard to believe that we have been highlighting the Mouth-Body Connection for five years. In that time, researchers have taken a closer look at the connection between oral bacteria and everything from dementia3 to cancer4. Each year, we deliver more insights, more stories and more ways to take control of your whole health. As I look to the next five years, I’m all smiles.

Until next time,

Dr. Carolyn Ghazal, DDS

Issue 18: May 2025 The Future of Brain& Oral Health: What’s Next in Preventive Care?

2024

Issue 15: August 2024 Oral Health For Her: Adolescence to Adulthood

2025

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Keep smiling!

It's good for the soul.

Contents Protect Your Smile While Managing Diabetes: A Guide to the Ozempic Phenomenon How Ozempic and diabetes meds can affect your smile—and how to protect it.

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What I’ve Learned from Volunteering in Guatemala Volunteers bring medical-dental care and hope to Xenacoj, Guatemala.

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Montel Williams Spotlights Dentistry’s Starring Role in Diabetes Care The Balancing Act helps bring home the oral health and diabetes connection.

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FROM THE PATIENT FILES: The Two-way Street of Diabetes and Gum Disease Learn how a hygienist helped improve a patient’s oral health and diabetes management.

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Protect Your Smile While Managing Diabetes:

A Guide to the

Ozempic Phenomenon

By Christopher K. Tolmie, DDS, MBA

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hey’re medications that have taken the world of weight loss by storm, with names like Ozempic, Wegovy and Rybelsus. Much of the popularity of these semaglutides today stems from word-of-mouth and celebrities crediting their smaller waistlines to the medications. Two of these GLP-1 agonists – Ozempic and Rybelsus – were approved by the Food and Drug Administration specifically to treat type 2 diabetes, while Wegovy was approved for weight loss. However, studies show that weight loss is an effect of all three medications. With the rise of these medications also come reports of side effects, including what’s been dubbed “Ozempic teeth.”

If you have diabetes or are prediabetic and are taking semaglutides or considering them, here’s what you need to know about maintaining the health of your mouth and managing diabetes.

How do GLP-1 medications help people with Type 2 diabetes?

They lower blood sugar by helping your body release insulin when you eat, reducing glucagon — a hormone that your pancreas makes that helps regulate your blood sugar, slowing stomach emptying, and curbing appetite — a powerful combo for the ability for your body to process and use energy efficiently.1

Does dose matter?

Yes. Gastrointestinal side effects are more common during dose increases and at higher doses, including nausea, vomiting, diarrhea, and constipation. Long-term, repeated acid and dryness in the mouth can thin the tooth enamel, leading to sensitivity, cavities, cracks, and yellowing, and chronically irritated gums can progress to gum disease, bone loss, and even loose or lost teeth. Inflammation in the mouth can make blood sugar harder to control. A gradual increase in medication dosage aims to reduce this.2,3

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How can GLP-1s affect the mouth?

When a patient’s appetite is suppressed and gastrointestinal symptoms occur, this means a patient is taking in less fluids, is more dehydrated and has lower saliva flow. Sometimes, a patient may experience delayed gastric emptying – when the stomach takes longer to empty – which leads to acid reflux or vomiting.

The acid softens enamel, accelerates erosion, and intensifies gum disease.4

Why does this matter more with diabetes?

Remember to hydrate, screen early, treat proactively, track progress— and protect your smile while you manage your blood sugar levels.

Diabetes and gum disease run both ways: Diabetes raises the risk for gum disease, and inflamed gums can worsen blood sugar control.

Most analyses of studies show a modest improvement in average A1c – a measurement of blood sugar levels – after deep cleaning, though not every study agrees. 5,6

What do you tell your dentist if you’re on a GLP-1?

Tell your dentist about any daily symptoms of dry mouth, reflux, or vomiting, nutrition/hydration habits, and your latest A1c. Include the specific drug/brand, the current dose and gradual dosage increase, and the start date.

You can get whole-body insights during a routine checkup in our offices.

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Dr. Christopher K. Tolmie, DDS, MBA is a multi-practice owner in South Florida, focusing on comprehensive oral health through his Mouth-Body Connection® philosophy. He holds dual doctorates in dental surgery (University of Maryland) School of Dental Surgery and osteopathic medicine (Philadelphia College of Osteopathic Medicine), along with an MBA from the University of Miami.

What can you do to maintain or improve your oral health and prevent gum disease while taking semaglutides?

Rinse with water:

After any reflux or vomiting, swish with water (or a small pinch of baking soda in water). Wait about 30 minutes before brushing so you don’t scrub softened enamel.

Keep saliva flowing: Sip water often; chew sugar-free (xylitol) gum; avoid constant sipping of acidic drinks (soda, energy drinks, citrus waters).

Take an in-office saliva screening (OralFitnessCheck®, aMMP-8):

This detects active inflammation and breakdown of gums surrounding your teeth—no needles.7, 8

If high risk, take the MyPerioPath® saliva test:

This measures which harmful bacteria are present so your care can be personalized.9

Treat what’s discovered:

Your dentist can go below the gums to target infection and inflammation with deep cleaning, laser treatments, and irrigation — the use of pressurized water to reduce bacteria.10, 11

Re-screen:

Repeat the saliva screening in 8-12 weeks if your score is elevated; otherwise, an annual screening is recommended.

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GUATEMALA What I’ve Learned from Volunteering in

By Vicky Dyck

Twice a year, an integrated team of medical and dental volunteers from PDS Health travels to the impoverished village of Xenacoj, Guatemala to serve nearly 150 people who face significant barriers to care. These volunteers started making the biannual treks to change lives – only to find that the lives they changed were their own.

My husband and I have been part of the team providing medical and dental services to the community at the PDS Health Foundation Clínica Dental in Xenacoj, and recently began sponsoring the travel cost of volunteer medical assistants who bring medical expertise, medication and hope to this 10,000-person village.

During these missions, I learned about caring for people with very limited access to dental and health care and the challenges they face, saw examples of the importance of the Mouth-Body Connection®, and experienced the impact that people can have on one another:

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On what surprised me the most during my first visit to Clínica Dental in Xenacoj:

Very quickly, we identified that diabetes in that community was rampant. We ended up going to local pharmacies throughout Guatemala, and bought everything off the shelves. There is no clean water, so it’s cheaper for them to drink soda than water. You see babies sipping on soda all day, so their teeth are affected, the levels of diabetes are affected.

People sometimes travel three hours to get to the clinic, so when we’re there, we make sure to see everyone.

We give vaccines when we are able and address oral health to help people who are unable to chew, for example. We see them about everything. We ask the questions that you’d get at your annual physical, but then there are different questions: Do you have access to food?

Are you in a safe environment? Do you fear for your life?

On the value of integrating medical and dental care in the clinic: PDS Health has always promoted the Mouth-Body Connection for holistic health. It’s who we are here in the United States. And so, it was natural that we would bring integrated care to Guatemala. When you are there, you can really see how significant the connection is. You see poor oral care affecting diabetes, for example, and vice versa. The fact that we can actually help people from a wholehealth perspective in Guatemala is incredible. The medical team took the bottom floor of the clinic, and the dental team took the top floor, and people file in one by one. We stay until we’ve seen everyone, and we provide them with the best care and support we can.

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On providing more beyond medical and dental care:

We provide supplies like food and, of course, toothbrushes, toothpaste and water. The husband of one of our dentist partners, Dr. Miran Ho, owns a bunk bed company. So, we have been driving to the back of this village and hiking up mountains, carrying donated bunk beds, which we then go and assemble for kids living in corrugated metal homes.

On the impact of connections on the people who live in the village:

There are many stories, but one that stands out is of a young woman who came to us who was suicidal.

We see a lot of depression, in addition to diabetes and malnutrition, in the village. Her situation shook us, and Dr. Ho took her under her care. Today, this woman is in nursing school and focused on her future.

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On lessons from this volunteer experience about health care in our own country:

Most people know to go to the dentist twice a year. But if you ask people how often they see their primary care doctor, they’ll tell you that they go when they’re sick. So, we don’t have healthcare, we have sick care. That’s what I love about our mission. We are committed to making the change from sick care to true healthcare through the integration of dental and systemic health. We see it when we are in Guatemala, and we see it in our own practices here in the U.S. I feel truly blessed to be a part of it.

Vicky Dyck is the Vice President of Medical Operations for PDS Health.

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M O N T E L

W I L L I A M S

S P O T L I G H T S

Dentistry's Starring Role in

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lashing his signature smile, television host Montel Williams gives oral health a much-deserved close-up. His Lifetime program “The Balancing Act’s” six-part series, “Beyond Dentistry: The Importance of the Mouth-Body Connection®” recently focused on the link between oral care and diabetes.

Guests Christopher Tolmie, DDS, and Zulema Valdivia, DDS, surprised Williams with the fact that diabetes and periodontal disease often go hand-in-hand – and gave viewers advice about how to manage, or even prevent, both.

“Both are chronic inflammatory diseases, so by treating periodontal disease, we’re going to help blood sugar levels,” Dr. Valdivia said. “By treating diabetes and controlling it, we’re going to be able to control periodontal disease.”

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The episode highlighted Smile Generation’s Connected Care, the program that connects doctors and dentists in the mission of improving overall health and quality of life.

Williams emphasized the important role dentists play in that effort, particularly when it comes to diabetes.

Dentists, for example, can perform saliva screening to uncover inflammation-causing bacteria that might affect both blood sugar and gum disease. Smile Generation dentists also offer HBA1C testing, which reveals three-months’ worth of information about a person’s blood sugar control. This helps dentists plan procedures and gives people insight into areas of their health that might need improvement.

“And this is where Smile Generation’s Connected Care really shines right?”

Williams said.

“Exactly,” Dr. Tolmie said.

“We’re truly a force for good helping our patients achieve a better quality of life.”

You can view "Beyond Dentistry: The Importance of the Mouth-Body Connection" to learn more.

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Don’t Forget to

Download the App Easily schedule appointments, communicate with your team, check in for your appointment and review your dental history all on the app.

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FROM THE PATIENT FILES

PATIENT PROFILE: A woman in her early 40s, visiting South Bay Modern Dentistry in Chula Vista, Calif. for routine cleaning and maintenance of gum health.

Registered dental hygienist Hannah Joseph reviewed the patient’s medical history and learned that her patient has diabetes but had stopped taking her prescribed medication, Metformin, due to stomach issues. Her patient shared that she’s currently trying to manage her blood sugar through diet alone.

OBSERVATIONS: During the visit, Hannah noticed that her patient’s gum health had deteriorated since her last appointment, which led to a conversation about the strong connection between diabetes and gum disease. Hannah explained that when diabetes isn't well-controlled, it can raise sugar levels in saliva, which encourages harmful bacteria and plaque to build up. This can cause more gum inflammation, slower healing, and faster progression of gum disease. She also explained how active gum infections can increase inflammation throughout the body, making it harder to manage blood sugar levels and increasing insulin resistance.

RECOMMENDATIONS: Hannah customized the oral hygiene routine to her patient, emphasizing how good daily care, along with regular dental visits, can reduce inflammation and help support better blood sugar control.

She also encouraged her patient to speak with her doctor about alternative medications for managing her diabetes.

OUTCOME: Hannah’s patient was very receptive and appreciated the education and guidance. She has since followed up with her doctor and made adjustments to the treatment plan to better manage her diabetes.

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Healthie Happi Generations of Smiles A Smile Generation Magazine

LET'S DO THIS AGAIN! Smile Generation exists to connect you with trusted dentists in your area and to offer education on the critical link between oral and overall health. We’d love to know what you think of our magazine.

DROP US A NOTE!

Sources We’re Turning 5!

1. Some bacteria in the mouth may play a role in memory loss and dementia: https://www.medicalnewstoday.com/articles/some-bacteria-mouthmicrobiome-may-play-role-memory-loss-dementia 2. Can periodontal disease affect conception? A literature review: https://pmc.ncbi.nlm.nih.gov/articles/PMC8812457/#sec12 3. Pathogenic Mechanisms That May Link Periodontal Disease and Type 2 Diabetes Mellitus–The Role of Oxidative Stress: https://pmc.ncbi.nlm.nih. gov/articles/PMC8812457/#sec12 4. Global Research Trends in the Links between Periodontal Disease and Cancer: A Bibliometric Analysis: https://pmc.ncbi.nlm.nih.gov/articles/ PMC11435047/#sec5-pathogens-13-00789

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Protect Your Smile While Managing Diabetes: A Guide to the Ozempic Phenomenon® 1. Zheng Z, et al. Signal Transduct Target Ther. 2024 — GLP-1RA mechanisms. doi.org/10.1038/s41392-024-01931-z. Nature 2. FDA. Ozempic® (semaglutide) Prescribing Information (2025). accessdata.fda.gov/drugsatfda_docs/label/2025/209637s025lbl.pdf.

FDA Access Data 3. Ismaiel A, et al. Int J Obes. 2025 — Dose-response meta-analysis of GI AEs with GLP-1 RAs. doi.org/10.1038/s41366-025-01859-6. Nature 4. Columbia Univ. “Brushing immediately after meals? You may want to wait.” (2022). cuimc.columbia.edu/go/teeth-wait. cuimc.columbia.edu 5. Simpson TC, et al. Cochrane Review (2022 update) — Periodontal therapy and HbA1c. doi.org/10.1002/14651858.CD004714.pub4.

Cochrane Library+1 6. Engebretson SP, et al. JAMA. 2013 — RCT: periodontal therapy did not change HbA1c at 6 mo. doi.org/10.1001/jama.2013.282431. JAMA Network 7. Wei S, et al. J Clin Periodontol. 2024 — aMMP-8 POCT accuracy (systematic review). doi.org/10.1111/jcpe.14000. Wiley Online Library 8. Lähteenmäki H, et al. 2023 — aMMP-8 POCT: diagnostic/monitoring overview (expert review). pubmed.ncbi.nlm.nih.gov/37522314. PubMed 9. Ito T, et al. ISRN Dent. 2014 — PCR quantification of periodontal pathogens (salivary testing). pmc.ncbi.nlm.nih.gov/4232322. PMC 10. Lalli AK, et al. Cureus. 2024 — Diode laser + SRP in T2D (RCT). pmc. ncbi.nlm.nih.gov/10941804. PMC 11. Arnett MC, et al. J Periodontol. 2023 — SRP ± minocycline microspheres; clinical & microbial outcomes. doi.org/10.1002/JPER.23-0002. aap. onlinelibrary.wiley.com

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