Oral Health and Performance in Athletes

Several features of an athlete's routine work against oral health, which is why the picture is worse than the general fitness of this group would suggest.

The demands of training are fuelled by frequent carbohydrate, and sugary sports drinks, gels and bars bathe the teeth in sugar many times a day, which drives tooth decay. Many of the same drinks are also acidic, which erodes the tooth surface directly. Prolonged or intense exercise, with dehydration and mouth breathing, may reduce the flow of saliva and its protective effects, and since saliva normally protects and repairs the teeth, this removes a natural defence. On top of this, heavy training can affect the immune system, and awareness of oral health and time for dental care are often low. These factors combine, so the same habits that support performance can quietly damage the teeth.

Dental caries, or tooth decay, occurs when bacteria in dental plaque turn dietary sugar into acid that dissolves the tooth. Both the total amount of free sugar and how often it is taken matter, since each exposure produces a fresh acid attack, so the repeated sipping of sports drinks and frequent gels and bars during long sessions is particularly damaging. Prevention rests on brushing twice a day with a fluoride toothpaste and spitting rather than rinsing afterwards, reducing how often sugar is taken, and regular dental review.

Periodontal disease is inflammation of the gums and the tissues that support the teeth, caused by plaque. It ranges from reversible gum inflammation, gingivitis, with red, swollen and bleeding gums, to periodontitis, where the supporting bone is lost and teeth can loosen. It is common in athletes and is associated with low-grade, body-wide inflammation. Good daily oral hygiene and professional cleaning are the mainstays of prevention and treatment.

Dental erosion is loss of the tooth surface by acid, without any bacteria being involved, which is what distinguishes it from decay. The acid is usually external, and frequent exposure to acidic sports and energy drinks increases the risk, while in some athletes stomach acid reaches the mouth through reflux or through recurrent vomiting. Eroded teeth look smooth, glossy and worn, with cupped, hollowed surfaces and increasing sensitivity as the protective enamel thins.

Prevention focuses on reducing how often acidic drinks are taken, drinking them quickly or through a straw rather than sipping, rinsing with water afterwards, and not brushing straight after an acid exposure, since the softened surface is then easily worn away, while fluoride helps to strengthen the enamel. Where erosion is due to recurrent vomiting, this should be explored sensitively, as it can point to reflux disease or to an eating disorder that needs its own assessment and support.

Poor oral health is associated with effects beyond the mouth. Pain and infection can interfere with eating and therefore with an athlete's carefully planned nutrition, disturb sleep and recovery, and cost training and competition time, and they are associated with low-grade inflammation, while the effect on appearance and confidence should not be underestimated. A meaningful number of athletes report that their oral health has affected their training or performance, which is why it is increasingly treated as a performance factor rather than a cosmetic one, although the evidence that treating it improves performance remains limited.

The encouraging point is that the main conditions are largely preventable with simple measures. The SEM doctor can screen for problems, give straightforward advice on fluoride, on the timing of sugar and acid, and on oral hygiene, address reflux, and ensure access to a dentist, integrating oral health into the wider approach to athlete health and nutrition. A properly fitted mouthguard additionally protects against the dental trauma that this group is prone to in contact and collision sport.

• •Poor oral health is common in elite athletes and reported consistently since the 1968 Olympics.
• •Frequent sugary sports drinks, gels and bars drive caries; both the amount of free sugar and how often it is taken matter.
• •Acidic sports and energy drinks, and stomach acid from reflux or vomiting, cause dental erosion.
• •Reduced saliva from dehydration and mouth breathing removes a natural defence during exercise.
• •Poor oral health is associated with pain, impaired nutrition, sleep and self-reported effects on training.
• •Prevention: twice-daily fluoride toothpaste (spit, do not rinse), minimise repeated sugar and acid, avoid brushing straight after acid, dental review, and a properly fitted mouthguard for contact sport.