Wisdom Teeth Removal on a GLP-1: The Conversation to Have Before Surgery

If you take Ozempic, Wegovy, Mounjaro, Zepbound, or another GLP-1 based medication and need your wisdom teeth removed, there is a conversation worth having before the day of surgery.

The useful question is not simply whether you need to stop the medication.

A better starting point is what kind of anesthesia you are having, and whether your medication changes the plan.

That distinction matters because wisdom tooth removal is performed at very different levels of anesthesia. The American Association of Oral and Maxillofacial Surgeons describes options ranging from local anesthesia and minimal sedation through moderate intravenous sedation, deep sedation, and general anesthesia. Moderate sedation is specifically described as an option for removal of impacted wisdom teeth [4].

GLP-1 based medications matter here because they slow gastric emptying. That can leave food or liquid in the stomach longer than expected, which becomes relevant when sedation or anesthesia creates conditions in which stomach contents could be regurgitated and enter the lungs.

The point is not that these medications make wisdom tooth surgery unsafe. It is that your medication may change how your oral surgery and anesthesia team plans the procedure.

Why GLP-1 medications are now part of the anesthesia conversation

Current FDA-approved prescribing information for semaglutide and tirzepatide states that these medications delay gastric emptying. The labels for Ozempic, Mounjaro, and Zepbound each describe rare postmarketing reports of pulmonary aspiration in patients receiving GLP-1 receptor agonists during elective surgeries or procedures requiring general anesthesia or deep sedation. Some of those patients had residual gastric contents despite reported adherence to preoperative fasting recommendations [1] [2] [3].

Pulmonary aspiration occurs when material from the stomach enters the respiratory tract. It can be a serious anesthesia complication.

There is an important limit to what the FDA labeling says.

It does not state that everyone taking a GLP-1 will have retained food in the stomach. It does not provide a universal rule for how long to stop treatment before a procedure. All three labels state that available data are insufficient to determine whether modifying preoperative fasting recommendations or temporarily discontinuing the medication would reduce the incidence of retained gastric contents. What they instruct patients to do is tell their healthcare providers about the medication before any planned surgery or procedure [1] [2] [3].

That acknowledged uncertainty is precisely why the pre-op conversation matters.

The evidence for retained stomach contents is real

The concern rests on more than isolated case reports.

A 2024 cross-sectional study in JAMA Surgery examined 124 adults who had followed standard preoperative fasting instructions before an elective procedure under anesthesia. Gastric ultrasound found increased residual gastric contents in 35 of 62 patients taking a once-weekly GLP-1 receptor agonist, or 56 percent, compared with 12 of 62 patients not taking one, or 19 percent. After adjustment for confounders, GLP-1 use remained independently associated with increased residual gastric contents. The study examined once-weekly medications only, and most participants had taken their last dose within five days of the procedure [5].

A 2026 study in Anesthesia and Analgesia, drawing on patients at three hospitals, evaluated 316 adults who were taking GLP-1 receptor agonists and found high residual gastric contents in 113 of them, or 35.8 percent. Shorter medication withholding periods and shorter solid food fasting periods were associated with high residual gastric contents [6].

Both numbers need careful interpretation.

They are not aspiration rates.

A person can have retained gastric contents without aspirating. These studies show that GLP-1 use complicates the assumption of an empty stomach. They do not show that a third or a half of GLP-1 users aspirate during anesthesia.

It also matters that the 2026 study had no comparison group. All 316 participants were taking GLP-1 medications, so the figure describes how common retained contents were within that group rather than how much higher the rate was than it would otherwise have been [6].

That distinction matters because the evidence for retained gastric contents is substantially stronger than the evidence for an increase in clinically apparent aspiration.

A 2025 cohort study in JAMA Network Open examined 366,476 people undergoing one of fourteen common surgical procedures, using commercial claims data. After adjustment, researchers found no statistically significant increase in postoperative aspiration pneumonia among patients with a preoperative GLP-1 prescription. The adjusted odds ratio was 0.78, with a 95 percent confidence interval from 0.57 to 1.06 [7].

Two features of that study deserve attention. Only 5,931 patients, about 1.6 percent of the cohort, had a preoperative GLP-1 prescription, so the exposed group was far smaller than the headline number suggests. And the surgeries took place between 2020 and 2022, before the anesthesiology guidance that changed how these medications are handled [7].

The study does not prove that aspiration cannot occur. It shows why retained stomach contents and actual aspiration should not be treated as the same outcome.

A 2026 randomized trial added an important piece of evidence

Until recently, most of the evidence came from observational studies.

In March 2026, researchers published the OCULUS randomized clinical trial in JAMA Internal Medicine. Adults taking stable doses of GLP-1 or dual GIP and GLP-1 medications for at least one month were randomized either to continue treatment or to hold one dose before elective upper endoscopy. Procedures were performed under moderate sedation or monitored anesthesia care, and patients scheduled for general anesthesia were excluded [8].

At a preplanned interim analysis covering 60 patients, clinically significant residual gastric volume was found in 25.0 percent of those who continued treatment and 3.1 percent of those who held a dose. The trial was terminated early because the result crossed a prespecified stopping boundary. No aspiration events occurred [8].

This is meaningful randomized evidence that withholding a dose can reduce retained gastric volume in at least some procedural settings.

It is not a wisdom tooth trial.

The 60 patients in the analysis are a small group on which to build a general rule. Participants were undergoing upper endoscopy, not oral surgery. The trial was also far too small to determine whether withholding treatment reduces rare outcomes such as pulmonary aspiration [8].

So it would be wrong to turn this study into a rule that everyone having oral surgery must skip a dose.

Should you stop your medication before wisdom tooth surgery?

There is no single answer that applies to every patient, and professional recommendations are not uniform.

A 2024 multisociety clinical practice guidance document recommends shared decision making among the patient, the prescribing clinician, the procedural team, and the anesthesia team. It was approved by the American Gastroenterological Association, the American Society for Metabolic and Bariatric Surgery, the International Society of Perioperative Care of Patients with Obesity, and the Society of American Gastrointestinal and Endoscopic Surgeons, and the American Society of Anesthesiologists affirmed its value.

The document identifies factors that raise concern about delayed gastric emptying, including longer-acting agents, higher doses, the dose escalation phase rather than maintenance dosing, gastrointestinal symptoms, and other conditions that can slow gastric emptying. Patients with those risk factors can continue treatment but should follow a liquid diet for at least 24 hours before the procedure. Patients without elevated risk may continue therapy [9].

In 2025, the Society for Perioperative Assessment and Quality Improvement published a separate multidisciplinary consensus statement in the British Journal of Anaesthesia. It also recommends continuing GLP-1 receptor agonists in patients without significant gastrointestinal symptoms, but recommends fasting from solids for 24 hours before procedures requiring anesthesia, with shorter and separate intervals for clear liquids depending on their carbohydrate content [10].

These recommendations do not converge on one universal protocol.

The practical consequence is that one oral surgery practice may give instructions that differ from another. Follow the medication and fasting plan given by the clinicians responsible for your procedure rather than applying a generic rule found online.

Six things to tell your oral surgeon

The exact medication you take

Give the team the drug name, not simply a description like a weight loss injection.

Semaglutide products include Ozempic and Wegovy. Tirzepatide products include Mounjaro and Zepbound. Tirzepatide is technically a dual GIP and GLP-1 receptor agonist, so GLP-1 based medication is a useful broader description. All three labels specifically instruct patients to inform healthcare providers before planned procedures [1] [2] [3].

Your current dose

Higher doses are among the factors identified in the 2024 guidance as raising concern, because gastrointestinal effects may be more likely at the upper end of the approved range [9].

When you last took it

Give the date of your last tablet or injection.

Do not change the schedule on your own to create a longer gap before surgery. The timing gives the clinical team the information it needs to apply its own protocol.

Whether you recently started or increased your dose

The 2024 guidance specifically identifies the dose escalation phase, rather than steady maintenance dosing, as a period of greater concern [9]. If your surgery falls soon after starting treatment or moving up a dose, say so explicitly.

Any gastrointestinal symptoms

Report nausea, vomiting, abdominal pain, indigestion, constipation, or other significant gastrointestinal symptoms, which are among the factors used in perioperative risk assessment [9].

There is an important lesson here from the randomized trial. Feeling fine does not prove that your stomach is empty. None of the patients with clinically significant residual gastric volume in the OCULUS trial reported nausea, vomiting, or other upper gastrointestinal symptoms on the day of the procedure. The investigators concluded that symptom-based screening alone may be insufficient [8].

Symptoms matter. Their absence does not rule out retained gastric contents.

Why you take the medication

Tell the team whether the medication is prescribed for diabetes, weight management, or another indication.

Withholding treatment carries different consequences for different patients, and the 2024 guidance specifically calls for balancing the metabolic need for treatment against perioperative risk [9].

Ask what kind of anesthesia you are having

This may be the single most useful question in the conversation.

The AAOMS distinguishes between local anesthesia, minimal sedation, moderate intravenous sedation, deep sedation, and general anesthesia, and describes moderate sedation as an option for impacted wisdom tooth removal [4]. The specific pulmonary aspiration language in the FDA labeling names deep sedation and general anesthesia [1] [2] [3].

That does not make GLP-1 use irrelevant at lighter levels of sedation. The 2026 randomized trial was conducted under moderate sedation or monitored anesthesia care and still found substantially more retained gastric volume among patients who continued their medication. That study was not conducted in oral surgery, so the size of the effect should not be assumed to carry over to wisdom tooth extraction [8].

Questions worth asking:

• What level of sedation or anesthesia am I having?
• Do you want me to continue or hold my medication?
• Does a recent dose increase change your recommendation?
• Are my fasting instructions different because I take this medication?
• What should I do if I develop significant nausea or vomiting before surgery?
• Who do I contact if your instructions differ from those of my prescribing clinician?

Do not build your own fasting plan

There is no good reason to improvise.

The 2024 JAMA Surgery study found increased gastric contents in more than half of GLP-1 users despite guideline-recommended fasting [5]. The 2025 consensus statement recommends substantially longer solid food fasting than conventional protocols, while the 2024 multisociety guidance takes a more individualized approach to diet modification [9] [10]. These are not interchangeable.

The randomized trial adds one more finding worth understanding correctly. Among the subgroup undergoing both upper endoscopy and colonoscopy, who had consumed a clear liquid diet the previous day, no patients in either the continue group or the hold group had clinically significant residual gastric volume [8]. That is an interesting signal. It is also a subgroup analysis in a trial of 60 people, and it was not designed to establish a clear liquid diet as equivalent to withholding medication.

So it is not a do-it-yourself workaround either. Follow the instructions written for your procedure.

Do not change your medication schedule on your own

Current evidence does not support a universal instruction to either always continue or always stop treatment.

The randomized trial provides evidence that holding a dose can reduce retained gastric volume in one specific procedural population [8]. Current professional guidance emphasizes that interrupting treatment has metabolic consequences and should be weighed against why the drug was prescribed [9] [10].

If your oral surgeon or anesthesia provider wants the medication withheld, and particularly if you take it for diabetes, make sure that decision is coordinated with the clinician who prescribes it.

Your pre-op checklist

Before wisdom tooth surgery involving sedation or anesthesia, confirm that the surgical team knows:

• your exact medication
• your current dose
• when you took your last dose
• whether you recently started treatment
• whether your dose recently increased
• whether you have gastrointestinal symptoms
• why you take the medication
• what level of sedation or anesthesia is planned
• whether the team wants you to continue or hold the medication
• exactly when you should stop eating and drinking

Oral surgery education has moved in the same direction. A continuing education webinar released by AAOMS in March 2025 covers identifying patients with a high-risk stomach, building a perioperative plan of care for patients taking GLP-1 receptor agonists, setting fasting recommendations, and recognizing and managing perioperative regurgitation and aspiration [11].

The bottom line

Taking a GLP-1 based medication does not mean you cannot have your wisdom teeth removed.

There is convincing evidence that these medications are associated with retained gastric contents around procedures. There is much weaker evidence that this translates into a higher rate of clinically apparent pulmonary aspiration. Current FDA labeling reports rare aspiration cases and states plainly that available data remain insufficient to establish the best withholding or fasting strategy [1] [2] [3].

Professional bodies differ in how they manage that uncertainty, and the first randomized trial, published in 2026, shows that holding a dose reduces residual gastric volume in one procedural setting without establishing a universal rule for oral surgery [8] [9] [10].

That makes the practical advice straightforward. Tell your oral surgery team exactly what you take, your dose, when you last took it, whether the dose recently changed, and whether you have gastrointestinal symptoms. Ask what anesthesia you are having. Then follow the medication and fasting instructions created for your procedure.

One caveat deserves emphasis. Everything described here is perioperative evidence drawn from endoscopy, general surgery, and mixed procedural populations. None of it comes from a wisdom tooth trial. Until oral surgery specific evidence exists, individualized planning is more defensible than any universal rule about stopping or continuing.

Primary sources

1. Novo Nordisk. OZEMPIC (semaglutide) injection, for subcutaneous use. FDA-approved prescribing information, revised May 2026. Warnings and Precautions section 5.10, Pulmonary Aspiration During General Anesthesia or Deep Sedation, and Clinical Pharmacology section 12.2.
2. Eli Lilly and Company. MOUNJARO (tirzepatide) injection, for subcutaneous use. FDA-approved prescribing information. Warnings and Precautions, Pulmonary Aspiration During General Anesthesia or Deep Sedation.
3. Eli Lilly and Company. ZEPBOUND (tirzepatide) injection, for subcutaneous use. FDA-approved prescribing information. Warnings and Precautions section 5.10, Pulmonary Aspiration During General Anesthesia or Deep Sedation.
4. American Association of Oral and Maxillofacial Surgeons. Types of Anesthesia. Patient information page, myoms.org.
5. Sen S, Potnuru PP, Hernandez N, Goehl C, Praestholm C, Sridhar S, Nwokolo OO. Glucagon-Like Peptide-1 Receptor Agonist Use and Residual Gastric Content Before Anesthesia. JAMA Surgery. 2024;159(6):660-667. DOI 10.1001/jamasurg.2024.0111.
6. Pai SL, Nimma SR, Beam WB, et al; Mayo Anesthesia Gastric Imaging Collaborative. Assessment of Gastric Content Using Gastric Ultrasound in Patients on Glucagon-Like Peptide-1 Receptor Agonists Before Anesthesia. Anesthesia and Analgesia. 2026;142(4):640-649. DOI 10.1213/ANE.0000000000007764. Published online October 1, 2025.
7. Chen YH, Zink T, Chen YW, Nin DZ, Talmo CT, Hollenbeck BL, Grant AR, Niu R, Chang DC, Smith EL. Postoperative Aspiration Pneumonia Among Adults Using GLP-1 Receptor Agonists. JAMA Network Open. 2025;8(3):e250081. DOI 10.1001/jamanetworkopen.2025.0081.
8. Ahmad AI, Garg S, Jacobs J, et al. Holding vs Continuing GLP-1/GIP Agonists Before Upper Endoscopy: The OCULUS Randomized Clinical Trial. JAMA Internal Medicine. 2026;186(5):578-584. DOI 10.1001/jamainternmed.2026.0027. Published online March 16, 2026. Two corrections to this article have since been published by the journal.
9. Kindel TL, Wang AY, Wadhwa A, Schulman AR, Sharaiha RZ, Kroh M, Ghanem OM, Levy S, Joshi GP, LaMasters TL. Multisociety Clinical Practice Guidance for the Safe Use of Glucagon-like Peptide-1 Receptor Agonists in the Perioperative Period. Clinical Gastroenterology and Hepatology. Published online October 29, 2024. DOI 10.1016/j.cgh.2024.10.003. Published concurrently in Surgery for Obesity and Related Diseases and Surgical Endoscopy.
10. Oprea AD, Ostapenko LJ, Sweitzer B, et al. Perioperative management of patients taking glucagon-like peptide 1 receptor agonists: Society for Perioperative Assessment and Quality Improvement (SPAQI) multidisciplinary consensus statement. British Journal of Anaesthesia. 2025;135(1):48-78. DOI 10.1016/j.bja.2025.04.001.
11. American Association of Oral and Maxillofacial Surgeons. Revisiting NPO Status for Office-Based Anesthesia: Updates for OMSs. Continuing education webinar, AAOMS CE Online. Original release date March 13, 2025.

This article is for general educational purposes and is not medical, dental, or anesthesia advice. Do not start, stop, or change any prescribed medication because of information in this article. Medication and fasting decisions before a procedure should be made with the clinicians responsible for your care.