Dental health of elite athletes is poor, say researchers

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An extracted tooth with a cavity.
An extracted tooth with a cavity. © Diganta Talukdar

High carbohydrate diets, acidic sports drinks and a heightened risk of eating disorders arising from the need to control weight are taking their toll on the teeth of athletes, according to dental specialists.

The researchers made particular mention of sports such as horse riding, boxing, gymnastics and long-distance running as disciplines where eating disorders were likely to be a factor in poor dental health due to the need to control weight.

Eighteen researchers from Britain and North America issued what they described as a call to action to tackle the problem in an open-access article published in the British Journal of Sports Medicine.

Their consensus statement said diet was not the only culprit. There was little in the way of education or encouragement to help athletes appreciate the importance of good dental health on their training and performance, they said.

“Our purpose with this consensus statement is a call to action regarding oral health in sport since there is no evidence of an improving situation,” they wrote.

The report draws on a comprehensive review of the published evidence and a recent symposium on the lessons of the London 2012 Olympic Games.

The authors – all experts in dental health and sport and exercise medicine – point out that dental consultations accounted for almost a third of all medical visits at London 2012, and that demand has continued to increase at subsequent major competitive events.

Their review of the published evidence, which includes 39 studies on elite or professional sports men and women, showed that poor dental health was widespread: tooth decay, gum disease, enamel erosion, and infected wisdom teeth or impacted molars were the most commonly reported problems.

Tooth decay affected 15-75 percent of athletes; moderate to severe gum disease up to 15 percent; enamel erosion 36-85 percent; and infected wisdom teerth/impacted molars accounted for 5-39 percent.

Damage caused by trauma was reported by between 14 percent and 57 percent of athletes in high-risk sports.

Athletes from rich countries were no less likely to be affected than those from poor countries, the data showed.

Overall, the dental health of athletes was on a par with that of non-athletes living in deprived communities.

Unsurprisingly, up to two-thirds of those who had sustained trauma to their teeth said that this had adversely affected them.

Up to 40 percent said that their dental health “bothered” them or affected their quality of life, while between one in 20 and one in five said that it had affected their performance.

The researcher said there was a wealth of published evidence to show the impact of poor dental health on wellbeing. “With clear psychosocial impacts of oral health, it would be surprising if training and performance were not affected in those athletes with poor oral health,” they said.

And this could be especially important in competition, where marginal gains or losses could make all the difference, they said.

Athletes with poor dental health were likely to suffer pain, difficulties sleeping and eating, systemic inflammation, a dent to their confidence and may be generally out of sorts, all of which could be detrimental to their performance, the writers suggest.

So what is behind the prevalence of poor dental health among athletes? The authors point to the preference for a high-carbohydrate diet and acidic sports drinks during training and performance, the impact of which is likely to be worsened by a dry mouth during competition.

Eating disorders were also likely to be a factor, they said, particularly in sports such as boxing, horse riding, gymnastics, and long-distance running where body weight, composition, and aesthetics were crucial.

There has been little research on elite athletes’ attitudes to dental health, they said, but what there was suggested that their understanding of its importance is relatively poor. And it does not appear to be a priority for trainers and sporting bodies either, say the authors.

The steps needed to prevent poor dental health and maintain good mouth hygiene were simple and cheap, the authors said, but they stressed that they needed to be integrated at all levels.

“To achieve a sustained effect, oral health should be embedded within other aspects of health promotion, taking into account the structural issues and inter-relationship of athletes within their sport and peer networks,” they wrote.

“National sport funders and policy organisations should take a lead in integrating such an approach,” they added.

Ian Needleman, Paul Ashley, Peter Fine, Fares Haddad, Mike Loosemore, Akbar de Medici, Nikos Donos, Tim Newton, Ken van Someren, Rebecca Moazzez, Rod Jaques, Glenn Hunter, Karim Khan, Mark Shimmin, John Brewer, Lyndon Meehan, Steve Mills, Stephen Porter.
Oral health and elite sport performance
Br J Sports Med doi:10.1136/bjsports-2014-093804
The full report can be read here

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