Oral Health and Elite Athletes by Deborah Lyle

In general, exercise offers a number of benefits to individuals including antioxidant and anti-inflammatory effects which can help protect against several systemic diseases.¹ However, among elite sportsmen and women, research has shown that many suffer from a high number of caries, dental erosion and periodontal disease.²

Since the first report from the 1968 Olympic Games, research has consistently demonstrated poor oral health among elite athletes from various sports. A study of 300 competitors attending a dental clinic at the London 2012 Olympic Games revealed 55 percent had caries, 45 percent dental erosion and 76 percent gingivitis. Furthermore, 30 percent reported an impact of oral health on their quality of life and almost 20 percent on their training or performance.³ In a more recent study into professional UK footballers, researchers once again found that oral health was poor. Figures showed that 37 percent had active caries, 53 percent dental erosion and 5 percent moderate-severe irreversible periodontal disease.⁴

It is believed there are many challenges to oral health that athletes face, including oral dehydration, exercise-induced immune suppression, nutritional, lack of awareness, negative health behaviours and lack of prioritisation.²

Oral dehydration
Several sporting activities reduce salivary flow or amount, which impairs the protective properties of saliva. These include the re-mineralisation effects, as well as non-specific and specific antimicrobial activity, which is also important in protecting against periodontal disease.

The diminished flow reduces the capacity to clear and neutralise dietary acids in the mouth, contributing to erosive lesions in some individuals.⁵

Exercise-induced immune suppression
Prolonged bouts of strenuous exercise are also known to induce an overproduction of reactive species, which can result in oxidative damage to macromolecules and tissues.⁶

This results in a temporary depression of various aspects of immune function (for example, neutrophil respiratory burst, lymphocyte proliferation, monocyte antigen presentation) and if intense training is prolonged it can result in longer lasting immune dysfunction.⁷

Nutritional intake
Training and performance are often supported by carbohydrate-containing sports drinks or gels which are a major determinant of poor oral health. Sports drinks generally contain high levels of sugars and acids, which can contribute to an increase in dental caries and erosion but also to general health problems, such as diabetes and heart disease.8 Furthermore, the pro-inflammatory effects of a high carbohydrate intake might also increase the risk of periodontal disease.²

For athletes performing in sports where body weight, consumption and aesthetics are important factors, eating disorders can be problematic. It has been shown that the elite athlete is more susceptible to eating disorders than the average member of society.

The need to reduce weight in sports such as boxing, horse riding, gymnastics and long-distance running can lead to severe weight loss methods. Early detection through screening for not only dental disease but also the first signs and symptoms of tooth erosion as a result of eating disorders is essential to help protect individuals.²

Behaviours, knowledge and environment
Little is known about the health behaviours, beliefs, knowledge or access to preventative programmes that elite competitors have, although given the high number of oral health problems their awareness of the risks appears low. Oral health of an individual athlete is likely to be influenced or even dependent on the surrounding network of peers, support staff and organisations. There is a call for national sports funders and policy organisations to take the lead on integrating regular assessments of oral health by a dental professional. Preseason checks would be particularly helpful and would allow for early treatment of any dental disease, as well as personalisation of prevention plans.²

Interventions
Oral diseases are preventable and simple interventions can have a dramatic impact on an individual’s oral health. However, many interventions rely on or are affected by health behaviours which are notoriously difficult to change. For example, change related to diet, acidic drink use patterns and the use of custom-made mouth guards for participation in sports at risk of trauma. Simple changes, such as using a Waterpik® Water Flosser can aid athletes in maintaining optimum oral hygiene. This innovative adjunct is clinically proven to reduce pro-inflammatory mediators measured in the gingival crevicular fluid and blood, along with a reduction in ROS compared to traditional oral hygiene methods.^9,10

Good oral health is important to overall health and well-being, but it has consistently been shown to be poor among elite athletes. Caries, dental erosion, periodontal disease and pericoronitis have all been reported, which can each have a detrimental impact on an individual’s quality of life, training, confidence and performance, as well as potential long-term consequences. The optimal preventative, health promotion and risk mitigation strategies within the elite sport are yet to be developed, however educating patients on the importance of oral health remains key.

For more information on Waterpik International, Inc. please visit www.waterpik.co.uk. Waterpik® products are available from Amazon,

Deborah Lyle received her Bachelor of Science degree in Dental Hygiene and Psychology from the University of Bridgeport and her Master of Science degree from the University of Missouri - Kansas City. She has 18 years clinical experience in dental hygiene in the United States and Saudi Arabia with an emphasis in periodontal therapy. Along with her clinical experience, Deborah has been a full-time faculty member at the University of Medicine & Dentistry of New Jersey, Forsyth School for Dental Hygienists and Western Kentucky University.

She has contributed to Dr Esther M. Wilkins’ 7th, 8th, 9th and 10th editions of Clinical Practice of the Dental Hygienist and the 2nd and 3rd edition of Dental Hygiene Theory and Practice by Darby & Walsh. She has written numerous evidence-based articles on the incorporation of Pharmacotherapeutics into practice, risk factors, diabetes, systemic disease and therapeutic devices. Deborah has presented numerous continuing education programs to dental and dental hygiene practitioners and students and is an editorial board member for the Journal of Dental Hygiene, Modern Hygienist, RDH, and Journal of Practical Hygiene and conducted several studies that have been published in peer-reviewed journals. Currently, Deborah is the Director of Professional and Clinical Affairs for Waterpik, Inc.