Significantly high levels of oral disease found among Britain’s elite athletes lead to lower performance on the pitch, research by UCL’s Eastman Dental Institute has concluded.
In the largest ever survey of its kind, more than 350 sportsmen and women from nine England Olympic teams, including swimming and rowing, along with Team Sky, England Rugby and Reading FC, underwent oral health screening.
This included assessments for tooth decay, tooth erosion and gum disease. The athletes also completed questionnaires to assess the impact of oral health on athletic performance and quality of life, such as sleep, eating and self-confidence.
Almost half (49.1%) of the athletes were found to have untreated tooth decay, 77% had gingivitis, an early indicator of gingivitis, and 39% reported having bleeding gums when brushing their teeth, a sign of gum inflammation. Only 1.1% of participants had “excellent” periodontal health.
More than a third (32%) reported that these conditions negatively affected their athletic performance, along with their ability to eat (34.6%), relax and sleep (15.1%), and smile and self-confidence (17.2%).
Lead author Professor Ian Needleman (UCL Eastman Dental Institute) presented the findings at the European Federation of Periodontology’s EurioPerio9 conference in Amsterdam today (Thursday 21 June 2018) and the paper will be published in Community Dentistry and Oral Epidemiologyon Monday (June 25, 2018).
“This is the most methodologically robust study to assess oral health and related effects on performance in elite athletes,” he said.
“Each sport examined revealed significant levels of oral disease, with the overall risk of tooth decay being higher for an elite athlete than the general population.*
“The odds of caries were also 2.4 times higher in team sports than endurance sports.
“We recommend regular screening and new intervention strategies to reduce the incidence of oral disease and the negative impact on performance.”
The study found that 97% of participants said they brushed their teeth twice a day and 40% said they cleaned between their teeth (flossed) once a day. This is higher than the general population, with 75% brushing twice a day and 21% flossing once a day**.
Commenting on the possible reasons for athletes’ higher risk of oral disease, Professor Needleman said: “Sports nutrition is highly dependent on the frequent intake of carbohydrates, 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, difficult breathing can make the mouth dry, so that the teeth lose the protective benefits of saliva, and there is evidence of lower saliva quality with intensive training.
“Anxiety is also clearly a risk factor, with some athletes reporting vomiting before every competition as a result of pre-competition anxiety.”
Moving forward Professor Needleman is leading a study on effective behavior change and interventions.
“We will be testing ways for athletes and their teams to incorporate oral health routines into their lives and training schedule. We also aim to understand how individual behavior can be influenced by the team, so we can come up with shared recommendations for the whole team, as well as with personalized advice,” he said.
“We know that oral disease can be prevented with simple interventions such as awareness and motivation to maintain good oral health, brushing, regular interdental cleaning, healthy eating and regular dental check-ups.”
The study was conducted prior to the 2016 Summer Olympics and the average age of the athletes participating in the study was 25 years (range 18-29) with 67% of respondents being male. Two previous studies conducted by UCL, conducted with Olympic athletes and professional footballers in the UK, found similar poor oral health outcomes.
Dr Mike Loosemore MBE, Chief Medical Officer, Team GB 2018 Winter Olympics and British Olympic Boxing, said: “By introducing regular dental check-ups to Team GB Boxing we have seen a significant reduction in time out of training and a noticeable improvement in dental health. “
This study was conducted by the Center for Oral Health and Performance at the UCL Eastman Dental Institute and builds on previous studies of professional footballers in 2015 and athletes in London in 2012.
All examinations were performed by an experienced dentist using clearly defined measures.
The researchers would like to thank those who took part, including GB Cycling, GB Swimming, GB Rowing, GB Sailing, GB Gymnastics, GB Hockey, GB Athletics and GB Rugby Sevens, England Rugby, Reading FC and Team Sky.
Notes
* in this STUDY 49.1% of athletes had tooth decay compared to 36% of adults aged 25-34 from the Adult Dental Health Survey (ADHS) 2009 – the most recent national oral health survey in England and Wales.
** Results of the most recent ADHD 2009.
Connections
Eastman Dental Institute
Research paper from 25 June 2018 in Community Dentistry and Oral Epidemiology
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