Oral Health in Athletes

Oral Health Problems in Athletes 

Despite reporting positive oral health behaviors such as brushing their teeth twice daily, elite athletes have a substantial amount of oral disease. Experts consider sports activities to be a risk factor for the incidence of a number of oral disorders, including:^1,2 

• Caries (15% to 75%)
• Dental erosion (36% to 85%)
• Dental trauma (14% to 70%)
• Pericoronitis (5% to 39%)
• Periodontal disease (up to 15%) 

The cause of the increased risk is related to a variety of factors. One possible cause of increased dental caries is a more frequent intake of carbohydrates through high-sugar sports drinks, gels, and bars. The low pH of acidic sports and energy drinks is a potential cause of dental erosion.³ 

Another potential cause is dry mouth due to decreased saliva flow during exercise.⁴ Saliva is a major component of oral health because it helps to clean teeth and gums, neutralize acids in the mouth, and protect tooth enamel from erosion. Heavy breathing in sports activities can contribute to oral dehydration and dental problems.⁵ 

While a possible link between exercise and immune suppression remains a controversial topic, some believe it is a possible factor in poor oral health in athletes.4 The immediate effects of an exercise session may temporarily reduce immune system markers. However, physical activity is correlated with health benefits, including reduced risk of infections, cancer, and chronic inflammatory diseases.⁶ 

Dental Trauma Prevention 

Sports activities can increase the risk of accidental dental trauma. Common dental injuries in athletes include tooth fractures; tooth intrusion, extrusion, and avulsion; and temporomandibular joint dislocation. High velocity, collision, and contact sports including basketball, football, hockey, martial arts, and boxing carry the highest risk of dental trauma. However, non-contact sports also carry a risk.⁷ 

The American Dental Association recommends the use of athletic mouthguards to reduce the incidence and severity of dental trauma. Mouthguards should be made of resilient material approved by the U.S. Food and Drug Administration. They should be properly fitted to the athlete, providing a resilient, protective surface on the dental arch, which has the highest risk of injury. They should stay in place comfortably and securely during sports activities, and be physiologically compatible with the wearer. They should be relatively easy to clean and maintain.⁸ 

In athletes who wear mouthguards for long periods of time, oral homeostasis changes can result and potentially lead to problems. For example, inadequately designed, improperly fitting, or defective mouthguards can cause injury to the oral mucosa. This can lead to an increased risk for oral or systemic bacterial infection.⁴ 

Oral Hygiene Tips for Athletes 

Athletes self-report high rates of behaviors that promote oral health. One survey of 352 elite and professional athletes found that 94.2% said they brush their teeth twice daily, while 40% said their most recent dental visit was within the previous six months.⁹ Despite that, athletes have an increased risk of oral disease. Here are some recommended tips athletes can follow to prevent oral health problems: 

• Practice good oral hygiene by brushing teeth thoroughly twice daily, flossing daily, and using mouthwash. 
• Drink plenty of water to stay hydrated. 
• Refrain from sugary energy and sports drinks, bars, gels, and products. 
• Wear a properly fitting, well-designed mouthguard consistently during training, particularly in high velocity, collision, and contact sports.
• Maintain regular dental visits. 

While more is to be learned about the reasons for increased oral health problems in athletes, maintaining good oral hygiene and getting preventive care can reduce the risk and severity of oral diseases. 

References 

1. Tripodi D, Cosi A, Fulco D, D'Ercole S. The Impact of Sport Training on Oral Health in Athletes. Dent J (Basel). 2021;9(5):51. Published 2021 May 3. doi:10.3390/dj9050051 
2. Frese C, Wohlrab T, Sheng L, et al. Clinical management and prevention of dental caries in athletes: A four-year randomized controlled clinical trial. Sci Rep. 2018;8(1):16991. Published 2018 Nov 19. doi:10.1038/s41598-018-34777-x
3. Lussi A, Megert B, Shellis RP, Wang X. Analysis of the erosive effect of different dietary substances and medications. Br J Nutr. 2012;107(2):252-262. doi:10.1017/S0007114511002820
4. Ashley P, Di Iorio A, Cole E, Tanday A, Needleman I. Oral health of elite athletes and association with performance: a systematic review. Br J Sports Med. 2015;49(1):14-19. doi:10.1136/bjsports-2014-093617
5. Brancher JA, Morodome F, Madalena IR, et al. Salivary pH and oral health of Brazilian para-athletes: Saliva and oral health of para-athletes. Spec Care Dentist. 2021;41(4):505-511. doi:10.1111/scd.12589
6. Campbell JP, Turner JE. Debunking the Myth of Exercise-Induced Immune Suppression: Redefining the Impact of Exercise on Immunological Health Across the Lifespan. Front Immunol. 2018;9:648. Published 2018 Apr 16. doi:10.3389/fimmu.2018.00648 
7. Young EJ, Macias CR, Stephens L. Common Dental Injury Management in Athletes. Sports Health. 2015;7(3):250-255. doi:10.1177/1941738113486077 
8. Athletic Mouth Protectors (Mouthguards). American Dental Association. Updated October 19, 2021. Accessed June 3, 2022. https://www.ada.org/resources/research/science-and-research-institute/oral-health-topics/athletic-mouth-protectors-mouthguards 
9. Gallagher J, Ashley P, Petrie A, Needleman I. Oral health-related behaviours reported by elite and professional athletes. Br Dent J. 2019;227(4):276-280. doi:10.1038/s41415-019-0617-8