University College London (UCL) researchers writing in the British Dental Journal point to a nearly half (49.1%) of the 352 Olympic and professional athletes studied had untreated tooth decay.
Further discoveries reveal a large majority show early signs of gum inflammation, and almost a third (32%) report their oral health having a negative impact on training and performance.
We found that a majority of the athletes in our survey already have good oral health related habits in as much as they brush their teeth twice a day, visit the dentist regularly, don’t smoke and have a healthy general diet,” said Dr Julie Gallagher, study researcher based at UCL’s Eastman Dental Institute Centre for Oral Health and Performance.
‘Tooth decay and erosion risk’
“However, they use sports drinks, energy gels and bars frequently during training and competition; the sugar in these products increases the risk of tooth decay and the acidity of them increases the risk of erosion. This could be contributing to the high levels of tooth decay and acid erosion we saw during the dental check-ups.”
The study builds on existing research by the University in which significantly high levels of oral disease found among Great Britain's elite athletes led to poorer on-field performance.
Commenting on the possible causes for athletes' higher risk of oral disease, Professor Needleman said back in June 2018 that, "Nutrition in sports is heavily reliant on frequent carbohydrate intakes, which are known to increase inflammation in the body and gum tissues.
"In sports where there is a lot of airflow, such as cycling and running, breathing hard can make the mouth dry so teeth lose the protective benefits of saliva and there is existing evidence of lower quality of saliva with intensive training.
The latest study highlights the negative impact poor oral health has on athletes with many reporting its disadvantages on well-being, quality of life, training and performance.
Further challenges include an increased risk of dental caries due to increased and/or inappropriate consumption of dietary carbohydrates within usual diet or sports nutrition products such as sports drinks, energy bars and gels.
In addition, sports drinks tend to be acidic, therefore may also contribute to erosive tooth wear.
Eleven sports
The UCL Eastman Dental Institute research team began questioning athletes, who took part in a number of sports including cycling, swimming, rugby, football, rowing, hockey, sailing and athletics.
The team conducted dental check-ups for the athletes assessing rates of tooth decay, gum health and acid erosion as well as ask the athletes what they did to keep their mouth, teeth and gums healthy.
Along with the numbers noted for untreated tooth decay, gum inflammation and impact on training and performance, the team also found these athletes regularly use sports drinks (87%), energy bars (59%) and energy gels (70%), which are known to damage teeth.
The study found that 94% reported brushing their teeth at least twice a day and 44% reported regularly cleaning between their teeth (flossing).
These findings are notably higher than rates found for the general population (75% for twice-daily brushing and 21% for flossing).
“Athletes were willing to consider behaviour changes such as additional fluoride use from mouthwash, more frequent dental visits, and reducing their intake of sports drinks, to improve oral health,” said Dr Gallagher.
“We subsequently asked some of them and support team members to help us design an oral health intervention study, based on contemporary behaviour change theory and we will publish the results soon.”
Study limitations
Discussing the results the team felt the questionnaire provided limited information about whether the athletes used sports drinks, energy bars and gels on the advice of coaches and/or nutritionists, or if they used them in response to marketing/availability.
Information on the content of the snacks consumed by athletes was also limited, the study adds with the use of qualitative methods such as interviews or focus groups yielding a much greater depth of information.
However, this proved impossible requiring a greater time commitment from the athletes, which was not possible during this study.
Source: British Dental Journal
Published online: doi.org/10.1038/s41415-019-0617-8
“Oral health-related behaviours reported by elite and professional athletes.”
Authors: Julie Gallagher, Paul Ashley, Aviva Petrie & Ian Needleman