We see many patients who are at high risk for cavities and periodontal disease, and we know that patients with conditions such as diabetes, heart disease, polypharmacy, and cancer may require special treatment plans. I understand. However, dental professionals should be aware that athletes should also be added to the list of high-risk patients.
Research shows athletes at risk
The high prevalence of untreated oral problems in athletes was first reported at the 1958 FIFA World Cup in Sweden. His dental visits at the 2012 London Summer Olympics accounted for 30% of all medical visits.1 An oral health examination conducted on Dutch elite athletes before the 2016 Rio Olympics found that almost 50% required dental treatment to ensure a healthy participation in the Olympics.2, 3
You may also be interested… What elite athletes can tell us about dry mouth
Research conducted by Azeredo, Guimarães, and Gallagher shows that athletes have poor oral health. It was found that 46% of the athletes studied suffered from tooth decay.4,5 Gingival inflammation was common in 58% to 85%, and 5% to 41% of athletes had periodontitis.4,5 The erosion affected almost the second athlete.6,7
Oral health doesn't just affect your mouth
Athletes may not know that periodontal disease is associated with many systemic diseases and conditions. Cardiovascular diseases (eg, atherosclerosis, stroke, acute myocardial infarction) and respiratory diseases (eg, pneumonia, bronchitis, emphysema) are associated with periodontal disease.8 Therefore, an athlete's oral health can impact both performance and overall health.
Supplements and sports drinks make the problem worse
Intense training for athletes such as marathoners, Ironman triathletes, 30K/50K racers, and swimmers may include daily or twice-daily training. Energy replenishment is critical to staying active and maintaining and improving athletic performance.8 To achieve peak performance, athletes consume foods high in carbohydrates and sugar, sports/energy drinks, energy bars, gels, and gummies.2 Many mineral salt substitutes are very acidic in composition.8 Athletes replenish energy not only during competition but also during training. There are many different sports drinks and supplements on the market today that can be used before, during, and after training. Sports/energy drinks are highly acidic, with a pH between 2.4 and 4.5 (Figure 1).8
Many sports supplements and sports drinks are also high in sugar.2 A study conducted by Kahn on sports drink consumption found a high rate of use (66.7%) among elite athletes. Other studies have shown even higher prevalence among college athletes.2 The frequent acid attacks from these supplements increase the risk of tooth decay and erosion in athletes (Figure 2).
Dehydration is also a common problem among athletes and can lead to dry mouth. Using supplements or sports drinks instead of water for hydration, and without an adequate amount of protective saliva, athletes are at risk for cavities and erosions. For endurance athletes, the problem can be even more complicated. This is because strenuous exercise can cause immunosuppression, change the composition of saliva, and reduce its protective properties.1, 2 Intense physical activity produces high concentrations of CO2 in the bloodstream, which moves into saliva and lowers pH.9
Chlorinated water is a concern for swimmers
Swimmers are at risk for erosion not only from sports and energy drinks, but also from constant exposure to chlorinated water. This is especially true if your swimming pool is not maintained at an optimal pH of 7.4.Ten Swimmers may experience tooth sensitivity or clear teeth on the edges of their front teeth. Swimmers who spend more than six hours a week in chlorinated water are at risk of developing “swim mouth.”11 Swimmers' mouths are covered with brownish dirt and tartar. It accumulates where water passes through the teeth while swimming.12
A 2017 study found that swimmers consume an average of 32 mL of water per hour.12, 13 This high exposure to chlorine affects saliva volume and composition, reducing salivary flow and phosphate composition. Exposure also increases calcium and fluoride levels.11 These changes in the oral cavity caused excessive tartar formation.12
Educating athletes to avoid long-term negative effects
In a study by Nascimento et al., of the 254 athletes surveyed, most did not use dental floss or interdental cleaners, and only 186 had seen a dentist in the past two years. It became clear that most of them lacked knowledge about the relationship between oral health maintenance and health. sports practice.7 Poor oral hygiene in elite athletes can have both short- and long-term effects. Short-term effects can include pain, suffering, and difficulty eating and sleeping.1 Pain from tooth decay or periodontal disease can disrupt your training session or workout and affect your performance. Long-term effects include tooth loss, increased treatment time, and loss of oral function. Oral disease can also affect performance, as inflammation can occur.1 Inflammation can increase levels of cytokines.7 These cytokines are involved in causing muscle fatigue and oxidative stress. Muscle fatigue can cause exercise-related muscle spasms, leading to a decreased ability to absorb energy.7 This can make your muscles more susceptible to injury.
Education is important to prevent oral problems. Athletes should be aware that many supplements are high in sugar and acid and should consider substituting or rinsing with water after taking supplements to reduce tooth decay rates. Brushing and cleaning between teeth is essential, and some athletes may benefit from more frequent visits to the dentist or hygienist. It is necessary to introduce fluoride treatment at the dental clinic and at home.
Dental hygienists have the responsibility of coaching athletes, who must be able to perform without complications from poor oral health.
Editor's note: This article was published in the January/February 2024 print edition. RDH magazine. Dental hygienists in North America are eligible for a free print subscription. Sign up here.
References
- Needleman I, Ashley P, Fine P, et al. Oral health and elite sports performance. Br J Sports Med. 2015;49(1):3-6. doi:10.1136/bjsports-2014-093804
- Khan K, Kadir A, Trackman G, and other elite athletes' consumption of sports drinks and energy drinks, oral health issues, and effects on performance. nutrients. 2022;14(23):5089. Published November 30, 2022. doi:10.3390/nu14235089
- Kragt L, Moen MH, van den Hoogenband CR, Walvius EB. Oral health of Dutch elite athletes before Rio 2016. physics sports med. 2019;47(2):182-188. doi:10.1080/00913847.2018.1546105
- Azeredo FN, Guimarães LS, Ruiz W, Fialulho S, Alves-Antunes LA, Antunes LS. Estimating dental caries prevalence in athletes: an epidemiological systematic review and meta-analysis. Indian J Dent Less. 2020;31(2):297-304. doi:10.4103/ijdr.IJDR_764_18
- Gallagher J, Ashley P, Petrie A, Needleman I. Effects on oral health and performance in elite and professional athletes. Community Dent Oral Epidemiol. 2018;46(6):563-568. doi:10.1111/cdoe.12392
- Mahr CL, Richter L, Charak N et al. Orofacial status and oral health behaviors in young athletes: A comparison of amateur and competitive sports. Scand J Med Sci Sports. 2022;32(5):903-912. doi:10.1111/sms.14143
- de Queiroz Gonçalves, PHP, Guimarães, LS, de Azeredo, FNA other. Prevalence of dental erosion in athletes and its relationship with isotonic drinks: a systematic review and meta-analysis. Sports Science Health 16, 207–216 (2020). https://doi.org/10.1007/s11332-020-00624-8
- Nascimento BL, Zen IR, DeMenci LS, Mazetto NC, Spada PP. Triathlon athletes' knowledge of the relationship between oral health and performance. R.S.B.O. 2015:12(4),352-355.
- Athletes and their oral health. Century Dental. September 20, 2022. www.centurydental.org/athletes-and-their-oral-health
- Tanabe Ikegawa M, Takahashi T, Tadanori H, Mitsuyama A, Ueno T. Interactive effects of dilute sports drink hydration and water gargles on salivary flow, pH, and buffering capacity during ergometer exercise in young adult volunteers. J Oral Science. 2018;60(2):269-277. doi:10.2334/josnusd.17-0183
- Moore AB, Calleros C, Aboytes D. Oral health risks posed by swimming. Dental hygienist dimensions. 2018;16(8):45-48.
- A study by Race R. found that swimmers were six times more likely to see dirty teeth. swim swim. August 11, 2021. swimswam.com/study-finds-swimmers-six-times-more-likely-to-see-stained-teeth
- Strauss R. Are you a frequent swimmer? Your oral health may deteriorate further. Oral health group. December 23, 2022. www.oralhealthgroup.com/features/frequent-swimmer-your-oral-health-may-be-grimmer
- Dufour AP, Behimer TD, Cantu R, Magnuson M, Weimer LJ. Ingestion of pool water by recreational swimmers. J Water Health. 2017;15(3):429-437. doi:10.2166/wh.2017.255
Sherry Basham, MSDH, RDH He received degrees from Northern Arizona University and Old Dominion University. Sherry is an active member of the Virginia Dental Hygienists Association and serves as a liaison between VDHA and the Virginia Association of Free and Charitable Clinics. She is a public health advocate and passionate about building health awareness in her community. She and her husband are avid runners and enjoy traveling to various races.
