Oral-systemic health: Effects on athletic performance

Research reveals a direct link between oral health and sports performance. Finnish Olympic athlete Annimari Korte finds it disappointing that sports organizations such as her home country’s Olympic Committee do not support the oral health of competitive athletes like they do general health by paying for medical and physiotherapy services. She sees insufficient information as the main reason for this lack of support. Korte says, “I find this surprising, as oral problems such as gingivitis and periodontitis are shown to reduce [athletic] performance significantly.”

Elite sport is a risk factor for oral health

Research indicates that elite sport is one of the most significant risk factors for the onset of oral diseases. According to one study, caries is found in up to 70% of competitive athletes, dental erosion in almost 40%, and severe gum disease (periodontitis) in up to 15% of top athletes.1

As well, studies show that the oral health of athletes appears to be poor in a wide range of sports. Various underlying medical conditions can hamper training results and impair sporting performance. Oral infectious disease is no exception.

Concerns about the oral health of athletes are nothing new. During the 2004 Athens Olympics, the second most requested health service for athletes after physiotherapy services was dental care.2 Meanwhile, at the 2012 London Olympics, it was noted that Olympic athletes had poor oral health. Up to 55% of athletes had high caries levels, 76% had gingivitis, and 14% had periodontal disease.3 

One study examined the oral health of top Dutch athletes before the Rio 2016 Olympics. This research found that almost 50% of top athletes required regular dental care. It also suggested that oral health screening should be offered to all top-level athletes to help ensure that they are fully healthy during competitions such as the Olympic and Paralympic Games.4

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Oral-systemic connection

Inflammatory oral diseases such as gingivitis and periodontitis are common in top athletes, causing harm to their athletic performance. Pain and discomfort associated with oral conditions can hamper training results. Links have also been reported between muscle injuries and poor oral health in athletes.

There are many possible reasons for the high prevalence of inflammatory oral diseases in competitive athletes. Physical strain is one of the most important factors. Heavy training increases the body’s stress levels, which directly affect oral health and susceptibility to the onset of various gum diseases.

Physical exertion affects the composition of saliva during exercise and reduces its secretion.5 Frequent oral breathing during exercise and dehydration further contribute to dry mouth (xerostomia). All these factors predispose individuals to tooth decay and enamel erosion and contribute to the onset of inflammatory oral diseases.

Saliva secretion has a variety of effects on dental health. Saliva prevents decay by restoring the pH of the oral cavity from acidic to neutral after eating and by helping to restore minerals dissolved by acids that contact the tooth surfaces. Saliva removes 2–4 grams of microbes daily from the mouth and tooth surface to the digestive tract.

Dietary choices also have a significant impact on the oral health of athletes. Rigorous training programs require regular eating supplemented by “sports nutrition,” such as carbohydrate gels and bars consumed during training. This strains oral health by increasing the number of daily acid attacks in the mouth.

A healthy mouth is linked to overall well-being

Annimari Korte held the Finnish record in the 100-meter hurdles from 2019–2023. She has also represented Finland several times in world championships. But she has not had an easy career; a bout of illness forced her to take a five-year break from competing in 2012. The health challenges she faced taught her the importance of overall well-being, including good oral health. “Regular oral health professional visits would help detect oral health problems early. For example, severe and often asymptomatic periodontitis can be detrimental to an athlete’s overall health and well-being,” says Korte. She believes at least primary dental care should be covered for competitive athletes as it affects their overall health and sporting performance.

Juuso Simpanen, a trail runner turned professional, echoes Korte’s views on the importance of oral health for athletes aiming for the top. He says, “Only a fully healthy athlete can achieve top results. If your mouth is not in good shape, it will also hurt your results.” As an endurance athlete, Simpanen says he eats often to meet the high-energy demands of training. At his worst, during a 20-hour race, he eats or drinks something sugary every 15–20 minutes throughout the race. “That’s why I pay special attention to my oral health. I brush my teeth every morning and evening, floss, and use antibacterial photodynamic Lumoral treatment regularly,” he says.

Gingivitis is a severe inflammatory disease

Research shows that oral bacteria are linked to many chronic diseases of the body. In addition to heart disease, oral diseases are linked to lung disease, diabetes, and metabolic problems. Periodontal disease is a long-standing inflammation of the gums. Over time, inflammation damages the attachment tissue of the teeth, causing the collagen fibers that hold the teeth to the jawbone to break and, in the worst case, lead to tooth loss. Early signs of periodontal disease include red and swollen gums, bleeding of gums, and bad breath (halitosis).

Inflammation of the gums causes low-grade inflammation in the body, which is linked to vascular health and athletic performance. Oral bacteria lingering on tooth surfaces and in gum pockets spread throughout the body when teeth are brushed, and food is chewed. Even asymptomatic oral conditions can affect the health of the whole body.

The Lumoral method

Statistics show that people with a healthy mouth live longer; each missing tooth reduces life expectancy. This is far too little talked about, says Dr. Tommi Pätilä, a specialist in cardiac and organ transplant surgery at Helsinki University Hospital (HUS) New Children’s Hospital. He is one of the developers of the antibacterial Lumoral method.

According to Dr. Pätilä, it is estimated that up to two out of three people over the age of 30 suffer from periodontitis. This common gum disease can lead to tooth loss if left untreated, but it is also linked to severe heart events. According to one study, a first heart attack is 30% more common in people with periodontal disease than in healthy people of the same age.6

The Lumoral treatment, developed by Finnish researchers, is said to improve dental self-care and oral health when traditional methods are insufficient. It is an effective antibacterial treatment that significantly reduces inflammation in the mouth. The effect of the treatment has been demonstrated by a significant reduction in gum bleeding, inflammatory biomarkers, and deepened gingival pockets. Lumoral is a targeted treatment, which means that the “normal” and important bacterial flora in the mouth are preserved and, simultaneously, gingival inflammation is controlled.7,8

Editor’s note: This article first appeared in Through the Loupes newsletter, a publication of the Endeavor Business Media Dental Group. Read more articles and subscribe to Through the Loupes.

References

  1. Merle CL, Wuestenfeld JC, Fenkse F, et al. The significance of oral inflammation in elite sports: a narrative review. Sports Med Int Open. 2022;6(2):E69-E79. doi:10.1055/a-1964-8538
  2. Vougiouklakis G, Tzoutzas J, Farmakis ET, Farmakis EE, Antoniadou M, Mitsea A. Dental data of the Athens 2004 Olympic and Paralympic Games. Int J Sports Med. 2008;29(11):927-933. doi:10.1055/s-2008-1038489
  3. Opazo-García C, Moya-Salazar J, Chicoma-Flores K, Contreras-Pulache H. Oral health problems in high-performance athletes at 2019 Pan American Games in Lima: a descriptive study. BDJ Open. 2021;7:21. doi:10.1038/s41405-021-00078-1
  4. Kragt L, Moen MH, Van Den Hoogenband CR, Wolvius EB. Oral health among Dutch elite athletes prior to Rio 2016. Phys Sportsmed. 2019;47(2):182-188. doi:10.1080/00913847.2018.1546105
  5. Gallagher J, Ashley P, Petrie A, Needleman I. Oral health-related behaviours reported by elite and professional athletes. Br Dent J. 2019;227(4):276-280. doi:10.1038/s41415-019-0617-8
  6. Tripodi D, Cosi A, Fulco D, D’Ercole S. The impact of sport training on oral health in athletes. Dent J (Basel). 2021;9(5):51. doi:10.3390/dj9050051
  7. Rydén L, Buhlin K, Ekstrand E, et al. Periodontitis increases the risk of a first myocardial infarction. a report from the PAROKRANK study. Circulation. 2016;133(6):576-583. doi:10.1161/CIRCULATIONAHA.115.020324
  8. Pakarinen S, Saarela RKT, Välimaa H, et al. Home-applied dual-light photodynamic therapy in the treatment of stable chronic periodontitis (HOPE-CP)—three-month interim results. Dent J (Basel). 2022;10(11):206. doi:10.3390/dj10110206

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