Oral Health in Sport
The Faculty of Sport and Exercise Medicine (FSEM) UK recognises that poor oral health of athletes is a consistent finding in research studies and has produced this six point guide for sport and exercise medicine practitioners.
There is insufficient data to determine differences between sports in this regard. However, poor oral health can have impacts such as pain and reduced quality of life. It can also negatively affect training and performance and induce systemic inflammation. In the longer-term, poor oral health will increase an individual’s life-long dental treatment burden.
1 – Dental trauma in ‘at-risk’ sports (i.e. any sport with increased risk of head injury) is common. Prevention (using mouthguards) and management is well established.
2 – The prevalence of oral diseases in athletes is high with common self-reported negative effects on training, performance and wellbeing. On average, the percentage of athletes affected are: dental caries and dental erosion 50%, more severe gum disease 20%. Other oral conditions such as infections around wisdom teeth, pericoronitis, may also affect athletic performance.
3 – There are a number of possible causes of poor oral health in sport. These may include nutrition (carbohydrate intake and erosive potential), lack of awareness of oral health, oral dehydration from mouth drying and reduced salivary flow, negative health behaviours such as poor oral hygiene and exercise-induced immune suppression.
4 – Oral diseases are preventable and simple interventions with good evidence of efficacy exist. A prevention toolkit for athletes based on best available evidence is available*. Key simple messages including, minimising carbohydrate intake and acidic sports drinks not essential for training, performance or recovery (both amount and frequency), between tooth cleaning before toothbrushing, toothbrushing twice daily for two minutes, use of fluoride toothpastes with at least 1,450ppm fluoride but preferably 2,800ppm or higher and dental examinations twice yearly including application of sodium fluoride varnish.
5 – Strategies to promote oral health should be embedded within Sport and Exercise Medicine. Key components include, identifying opportunities to promote oral health across the different strata and stakeholders in sport, understanding the determinants of oral health in athletes, prevention of oral diseases and setting responsibilities for delivering oral health promotion.
6 – All athletes should receive a comprehensive dental examination, at least twice yearly including pre-season. Guidance on dental screening is available **.The dental examination should lead to a personalised preventive plan as well as the provision of any treatment required. Illness surveillance should include sufficient detail on oral health to allow evaluation of the impact of oral health promotion.
©Faculty of Sport and Exercise Medicine UK – Oral Health in Sport October 2014, reviewed and updated March 2018, next review due March 2021.
Authors: Prof Ian Needleman, Dr Paul Ashley & Dr Julie Gallagher, Centre for Oral Health and Performance, UCL Eastman Dental Institute & UK IOC Research Centre for Prevention of Injury and Protection of Athlete Health, UCL Eastman Dental Institute, Dr Mike Loosemore, UCL Institute for Sport Exercise and Health & UK IOC Research Centre for Prevention of Injury and Protection of Athlete Health & Dr Lyndon Meehan, Dental Practice.
Needleman et al. Oral health and impact on performance of athletes participating in the London 2012 Olympic Games: a cross-sectional study. Br J Sports Med 2013 47: 1054-1058
Needleman I, Ashley P, Meehan L, Petrie A, Weiler R, McNally S, Ayer C, Hanna R, Hunt I, Kell S, Ridgewell S, Taylor R. Poor oral health including active caries in 187 UK professional male football players: clinical dental examination performed by dentists. British Journal of Sports Medicine 2016, British Journal of Sports Medicine; 50: 41-44
Needleman I, Ashley P, Fine P, Haddad F, Loosemore M, Di Medici A, Donos N, Newton T, Van Someren K, Moazzez R et al. 2017 Infographic: Oral health in elite athletes British Journal of Sports Medicine 51:757
Gallagher J, Ashley P, Petrie A, et al. Oral health and impact on performance in elite and professional sport. British Journal of Sports Medicine 2017; Monaco abstracts 51: 320-321; DOI: 10.1136/bjsports-2016-097372.94
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