1. Introduction
The effects of oral health on sports performance are less known [1]. However, research findings have shown that the human body is a whole and not a series of independent systems, and within this framework, it has been observed that a number of underperformances in sports competitions are due to dental pain or its pharmacological treatment. Sports medicine physicians have therefore included dental consultations in the management of athletes [2].
However, this consultation is often neglected by athletes due to a lack of information, as well as by dental surgeons who are not well-versed in the specific needs of athletes [3]-[5].
In this article, we will address various topics related to the oral health of athletes. We will explore how regular sports practice can affect oral health, leading to phenomena such as dry mouth and early alveolar bone loss. We will also study dental traumas, barotraumas, and focal conditions in athletes. We will examine how dental occlusion can influence the athlete’s posture and how pain can impact sports performance. Additionally, we will discuss the nutrition and dietetics of athletes, as well as the dental management of athletes in the dental office.
2. Materials and Methods
The PRISMA protocol was followed and a literature search was performed on Pub Med, Google Scholar, and Science Direct using specific keywords.
Inclusion criteria were defined and duplicates were removed. Sixteen studies were selected for review, meeting the inclusion criteria.
The eight steps of the Cochrane methodology were followed to select the studies.
A search algorithm was used with the following keywords to highlight the most relevant articles on the topic:
(“Elite-atheletes” OR “Athletes” OR “High-level athletes” OR “professional athletes”) AND (“oral health” OR “oral conditions” OR “dental health”).
3. Results
The search strategy identified 1620 studies.
The selected articles were methodically critically reviewed to ensure that only articles of sufficient methodological quality were included. 1336 studies were identified after applying the following filters:
Finally, 16 original studies were included in our review. The articles were published between 2000 and 2022.
4. Discussion
4.1. The Oral Parameters Characteristic of the Oral Behavior of the Athlete
4.1.1. Salivary Ig
Moderate intensity exercise of 15 - 45 minutes alters salivary immunoglobulin concentrations.
High intensity training decreases salivary Ig A at rest, but moderate training increases it.
Salivary immunoglobulin concentration decreases significantly during maximal exercise, independent of training level.
4.1.2. Salivary pH
Salivary pH is acidified by strenuous exercise and alkalinized by moderate exercise.
4.1.3. Salivary Flow
Salivary secretion increases after moderate to high intensity exercise, with effects on the secretion of proteins, lysozyme, amylase and MUC5B.
However, an 8% water loss almost completely inhibits salivary secretion.
The consequences of these changes on the oral health of athletes can be significant (Figure 1).
Figure 1. Effect of exercise on salivary proteins. Saliva samples from 4 different individuals were collected at rest: 1, after moderate exercise intensity: 2, high exercise intensity 3 [6].
4.1.4. Salivary Cortisol in Athletes
High performance athletes can be subjected to a variety of stressful situations, which can be measured using salivary cortisol as an indicator of their mental health. However, comparisons of cortisol levels between athletes and non-athletes are inconclusive.
Studies suggest that athletes may have more effective coping mechanisms in response to stressful situations, which may explain the greater release of cortisol in these situations. Ultimately, cortisol concentrations in athletes appear similar to those in physically active and sedentary individuals, which is important for maintaining health [5] [7] [8] (Table 1).
Table 1. Descriptive characteristics of salivary cortisol studies in athletes and sedentary individuals.
Authors |
G |
Sport |
Gender |
N |
Age |
Concentration of salivary cortisol (nmol/l) |
Results |
Gouarné et al. [7] |
Ath Séd |
Triathlon – |
H H |
10 9 |
26.5 (2.7) 25.1 (1.4) |
10.6 (0.9) 13.9 (1.7) |
Ath H = Séd H |
Minetto et al. [8] |
Ath Séd |
Endurance sports – |
H H |
11 11 |
24.5 (5.1) 25.3 (5.4) |
9.9 (4.7) 10.2 (9.8) |
Ath H = Séd H |
Minetto et al. [25] |
Ath Séd |
Various sports – |
H H |
20 10 |
24.9 (7.6) 27.4 (2.4) |
12.5 (9.1) 10.2 (9.8) |
Ath H = Séd H |
Rimmele et al. [26] |
Ath Séd |
Running – |
H H |
18 24 |
24.7 (0.8) 23.6 (0.6) |
7.1 (2.4) 9.8 (5.6) |
Ath H = Séd H |
Rudolph et al. [10] |
Ath Séd |
Running – |
H |
13 13 |
19.8 (1.4) 21.0 (1.2) |
9.4 (5.5) 8.8 (4.1) |
Ath H = Séd H |
Georgopoulos
et al. [27] |
Ath |
Artistic gymnastics |
F H |
142 97 |
16.4 (1.3) |
F: 15.4 (7.4) * M: 10.2 (5.5) |
Ath F > Séd H Ath H = Séd H |
Séd |
– |
F H |
40 41 |
15.6 (1.7) |
F: 11.6 (8.3) M: 9.1 (8.3) |
|
Roupas et al. [28] |
Ath |
Artistic gymnastics |
F |
51 |
16.9 (2.6) |
15.7 (5.8) |
Ath F = Séd F |
H: men; F: women; Séd: sedentarity; Ath: athelets.
4.2. Barotrauma
Barotraumatisms are painful phenomena linked to barometric depression localized to one or more teeth or to the dental sector.
Healthy teeth: anatomical and functional predispositions associated with favouring factors are necessary to observe pain in aviators and divers.
Decayed teeth: Decay is the most common cause of aerodontalgia, but does not necessarily cause pain.
Teeth with recent fillings: it seems that the more recent the filling, the more likely the tooth is to be the site of aerodontalgia.
Faulty fillings: air trapped under a filling is not a likely cause of aerodontalgia, but an air bubble may appear when the filling is made or when the tooth is brought down to a loose filling joint.
4.3. Early Alveolysis in High Level Athletes
Higher rate of alveolysis: high level athletes (74%) vs basic athletes (6%).
Variation between 20.8%, 27.3%, and 18% of athletes with early alveolysis.
Etiological factors observed: poor oral hygiene,dental avulsions, occlusodontic problems, medication.
1) Interleukin I and TNF metabolism associated with exercise
Interleukins 1 stimulate bone resorption in culture, but regular and moderate exercise has anti-inflammatory effects that help prevent many chronic diseases.
TNFs have a similar but lesser effect than IL 1 in inducing bone resorption.
Increased interleukin and TNF metabolism associated with heavy exercise.
2) Calcitonin and exercise (Ca)
In highly trained athletes with decreased gonadal secretion, a low calcitonin level is observed.
This value seems to be one of the factors of the decrease in bone density.
3) Parathyroid hormone (PTH)
In athletes who train for long periods of time and intensively, parathormone is low.
When training stops, its level increases.
It has a double role of bone resorption and formation.
4) Prostaglandin (Pg)
Early alveolysis in high-level athletes is mainly due to dry mouth, poor oral hygiene and a specific diet that is harmful to periodontal health, which may or may not be associated with bruxism [9].
4.4. Dry Mouth
Dry mouth in athletes can have different causes, such as emotion, stress, water loss during exercise, mouth breathing, medication or bimetallism. The consequences of hyposialia, which is the absence or decrease of saliva, can be periodontal lesions, candidiasis, dental caries and somatic complications [10].
Recommended treatments include improved oral hygiene, solid diet, milk consumption, limiting harmful foods, stopping hyposial medications and smoking, and drinking plenty of water.
4.5. Occlusion, Posture and Sports Practice
Occlusion is the alignment of the teeth and the contacts between the antagonistic teeth.
The orthostatic posture is a unique position of the human being that calls upon postural reflexes and the permanent contraction of many skeletal muscle groups.
It is possible to imagine a causal relationship between occlusion and posture.
Leroux and Patrick’s studies examined the effect of mouthguards on athletes. Leroux and colleagues found that artificial occlusal disruption increased.
the proportion of athletes with asymmetrical muscle contractions and induced a significant decrease in their muscle power. The study by Patrick et al. confirmed that mouthguards have an effect on strength and power production in athletes [11].
4.6. Diet and Doping in Sport
For a long time, people have sought to improve their performance, including that of sports, by using artificial methods. Ancient athletes were already using methods to influence their performance.
However, the use of doping substances such as amphetamines, anabolic steroids, cortisone, EPO, beta-blockers and others can lead to serious side effects such as cardiovascular risks, neuropsychiatric disorders, digestive problems and long-term health problems.
Former athletes who have practiced intensively report that in 50% of cases, their addiction began in association with doping products. For some, the pursuit of athletic performance and environmental pressures create an unfavorable mindset for the future, with the need for “outside input” to succeed.
The quest for the “magic potion” plays an important role in children’s imaginations.
5. Oral Health Prevention and Monitoring
Dental prevention in athletes involves six key objectives, such as selection and referral of athletes, regular oral health monitoring, provision of appropriate treatment, information on dental implications for sports performance, and individualized preparation for each athlete.
These goals are essential for dentists working with athletes, as outlined in Table 2 and Table 3 of the major roles of the sports medicine dentist.
Table 2. The main roles of the dentist in sports medicine.
Actions |
Select |
Sometimes it is necessary to remove from competition, temporarily, depending on the level of the athlete and the opinion of the coach, |
Orient |
Any subject presenting a particular fatigability, because of dysmorphoses or a traumatic or infectious history
deserves to be directed towards professionals able to |
Monitor |
systematic search for caries and periodontal pathology, verification of the vitality of anterior teeth and those with a history of trauma |
Treat |
The athlete’s therapy is the restoration of perfect oral health |
Informe |
Many authors have been interested in the implications of dental pathologies on sports performance. |
Prepare |
All preventive measures must be undertaken and adapted to each athlete according to their level of competition, |
Table 3. Results compared to literature data.
Authors |
years |
Title |
TYPE |
Botelho et al. [12] |
2021 |
Periodontal Health, Nutrition and Anthropometry in Professional Footballers:
A Preliminary Study |
Transversal |
Needleman et al. [13] |
2013 |
Oral health and impact on performance of athletes participating in the London 2012 Olympic Games: a cross-sectional study |
Transversal |
Marks et al. [14] |
2015 |
Oral cleanliness and gingival health among Special Olympics athletes in Europe and Eurasia |
Retrospective |
Ashley et al. [15] |
2014 |
Oral health of elite athletes and association with performance: a systematic review |
Review |
Gallagher et al. [16] |
2020 |
Implementation of a behavioural change intervention to enhance oral health
behaviours in elite athletes: a feasibility study |
Transversal |
Ligtenberg et al. [6] |
2015 |
The effect of physical exercise on salivary secretion of MUC5B, amylase and lysozyme |
Transversal |
Minty et al. [17] |
2018 |
Oral health and microbiota status in professional rugby players: A case-control study |
Case-control |
Bryant et al. [1] |
2011 |
Elite Athletes and Oral Health |
Transversal |
Hamamcilar et al. [18] |
2019 |
Effect of dental caries and the consequential variation in blood parameters on the
anaerobic performance of rowing athletes |
Transversal |
Merle et al. [19] |
2022 |
Associations of Blood and Performance Parameters with Signs of Periodontal
Inflammation in Young Elite Athletes—An Explorative Study |
Retrospective |
G. loos et al. [9] |
2000 |
Elevation of Systemic Markers Related to Cardiovascular Diseases in the Peripheral Blood of Periodontitis Patients |
Transversal |
Merle et al. [20] |
2021 |
Orofacial conditions and oral health behavior of young athletes: A comparison of
amateur and competitive sports |
Retrospective |
Bramantoro et al. [21] |
2020 |
The impact of oral health on physical fitness: A systematic review |
Review |
Solleveld et al. [22] |
2015 |
Associations between poor oral health and reinjuries in male elite soccer players: a cross-sectional self-report study |
Transversal |
Schildknecht et al. [23] |
2012 |
Dental injury and its prevention in Swiss rugby |
Transversal |
Leroux et al. [24] |
2018 |
Influence of dental occlusion on the athletic performance of young elite rowers:
a pilot study |
Transversal |
6. Conclusions
Oral and dental disorders can affect sporting activities at all levels but have a greater impact on top-level athletes due to the increased demands placed on their bodies during exercise.
Prevention and oral-dental monitoring can prevent problems and improve sporting performance. Unfortunately, the importance of oral health is often overlooked in athletes, which can lead to under-performance and injury.
Health professionals should include an inspection of the athlete’s mouth in their annual medical check-up, and sports federations should encourage the use of endo-buccal protection. Awareness of oral health preservation should be developed to prevent dental-maxillary trauma in athletes.
Conflicts of Interest
The authors declare no conflicts of interest.