Background In elite sport, the protection of an athlete's health is a priority. However, research indicates a substantial prevalence of oral disease in elite and professional athletes. The challenges to oral health from participation in sport require investigation to identify effective strategies and mitigate risk.
Aim To explore athlete-reported oral health behaviours, risks and potential for behaviour change in a representative sample of elite athletes based in the UK.
Method This was a cross-sectional study. We provided oral health screening for 352 elite and professional athletes from June 2015 to September 2016; 344 athletes also completed a questionnaire.
Results The median age was 25 years (range 18-39) and 236 (67%) were male; 323 (94.2%) said they brush twice daily while 136 (40%) said their most recent dental attendance was within the previous six months. Ninety-seven (28%) would be assessed as high consumers of sugar in their regular diet. The use of sports nutrition products was common with 288 (80%) reporting the use of sports drinks during training or competition but were positive about behaviour changes.
Conclusion Despite reporting positive oral health-related behaviours, athletes have substantial amounts of oral disease. Athletes are willing to consider behaviour change related to daily plaque removal, increased fluoride availability and regular dental visits to improve oral health.
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Ashley P, Di Iorio A, Cole E, Tanday A, Needleman I. Oral health of elite athletes and association with performance: a systematic review. Br J Sports Med 2015; 49: 14-19.
Needleman I, Ashley P, Meehan L et al. Poor oral health including active caries in 187 UK professional male football players: clinical dental examination performed by dentists. Br J Sports Med 2016; 50: 41-44.
Needleman I, Ashley P, Petrie A 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.
Gallagher J, Ashley P, Petrie A, Needleman I. Oral health and performance impacts in elite and professional athletes. Community Dent Oral Epidemiol 2018; 46: 563-568.
Engebretsen L, Soligard T, Steffen K et al. Sports injuries and illnesses during the London Summer Olympic Games 2012. Br J Sports Med 2013; 47: 407-414.
Moynihan P J, Kelly S A. Effect on caries of restricting sugars intake: systematic review to inform WHO guidelines. J Dent Res 2014; 93: 8-18.
Needleman I, Ashley P, Fairbrother T et al. Nutrition and oral health in sport: time for action. Br J Sports Med 2018; 52: 1483-1484.
Lussi A, Jaeggi T, Zero D. The role of diet in the aetiology of dental erosion. Caries Res 2004; 38 (Spec Iss): 34-44.
Needleman I, Ashley P, Fine P et al. Consensus statement: Oral health and elite sport performance. Br Dent J 2014; 217: 587-590.
Mulic A, Tveit A B, Songe D, Sivertsen H, Skaare A B. Dental erosive wear and salivary flow rate in physically active young adults. BMC Oral Health 2012; 12: 8.
Gleeson M. Immune function in sport and exercise. J Appl Physiol (1985) 2007; 103: 693-699.
Public Health England. Delivering better oral health: an evidence-based toolkit for prevention. 3rd ed. London: Public Health England, 2017. Available at https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/605266/Delivering_better_oral_health.pdf (accessed July 2019).
Needleman I, Ashley P, Fine P et al. Oral health and elite sport performance. Br J Sports Med 2015; 49: 3-6.
O Sullivan I, Lader D, Beavan-Seymour C, Chenery V, Fuller E, Sadler K. Foundation Report: Adult Dental Health Survey 2009 (Technical information). 2011. Available at https://files.digital.nhs.uk/publicationimport/pub01xxx/pub01086/adul-dent-heal-surv-summ-them-foun-2009-re14.pdf (accessed July 2019).
Scientific Advisory Committee on Nutrition. Carbohydrates and Health. London: Public Health England, 2015. Available at https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/445503/SACN_Carbohydrates_and_Health.pdf (accessed July 2019).
von Elm E, Altman D G, Egger M et al. The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies. PLoS Med 2007; 4: e296.
Azodo C C, Osazuwa O. Dental conditions among competitive university athletes in Nigeria. Odontostomatol Trop 2013; 36: 34-42.
Bryant S, McLaughlin K, Morgaine K, Drummond B. Elite athletes and oral health. Int J Sports Med 2011; 32: 720-724.
Chadwick B, White D, Lader D, Pitts N. 5: Preventive behaviour and risks to oral health - a report from the Adult Dental Health Survey 2009. 2011. Available at https://files.digital.nhs.uk/publicationimport/pub01xxx/pub01086/adul-dent-heal-surv-summ-them-the5-2009-rep7.pdf (accessed July 2019).
Pegoretti C, Antunes A E C, Manchado-Gobatto F D B, Capitani C D. Milk: An Alternative Beverage for Hydration? Food Nutr Sci 2015; 6: 547-554.
Shirreffs S M, Sawka M N. Fluid and electrolyte needs for training, competition, and recovery. J Sports Sci 2011; 29 (Spec Iss): S39-S46.
Needleman I, Ashley P, Fine P et al. Infographic: oral health in elite athletes. Br J Sports Med 2017; 51: 757.
Twetman S. Consistent evidence to support the use of xylitoland sorbitol-containing chewing gum to prevent dental caries. Evid Based Dent 2009; 10: 10-11.
Dijkstra H P, Pollock N, Chakraverty R, Alonso J M. Managing the health of the elite athlete: a new integrated performance health management and coaching model. Br J Sports Med 2014; 48: 523-531.
National Institute for Health and Care Excellence. Dental checks: intervals between oral health reviews. 2004. Available at https://www.nice.org.uk/guidance/cg19 (accessed July 2019).
Hill K B, Chadwick B, Freeman R, O'Sullivan I, Murray J J. Adult Dental Health Survey 2009: relationships between dental attendance patterns, oral health behaviour and the current barriers to dental care. Br Dent J 2013; 214: 25-32.
Needleman I, Ashley P, Weiler R, McNally S. Oral health screening should be routine in professional football: a call to action for sports and exercise medicine (SEM) clinicians. Br J Sports Med 2016; 50: 1295-1296.
European Federation of Periodontology. EFP provides clear guidance to public on interdental cleaning in response to media controversy about flossing. 2016. Available at https://www.efp.org/newsupdate/efp-guidance-on-interdental-cleaning-and/ (accessed July 2019).
Jepsen S, Blanco J, Buchalla W et al. Prevention and control of dental caries and periodontal diseases at individual and population level: consensus report of group 3 of joint EFP/ORCA workshop on the boundaries between caries and periodontal diseases. J Clin Periodontol 2017; 44 (Spec Iss): S85-S93.
Marinho V C, Chong L Y, Worthington H V, Walsh T. Fluoride mouthrinses for preventing dental caries in children and adolescents. Cochrane Database Syst Rev 2016; CD002284. DOI: 10.1002/14651858.CD002284.pub2.
Walsh T, Worthington H V, Glenny A M, Appelbe P, Marinho V C, Shi X. Fluoride toothpastes of different concentrations for preventing dental caries in children and adolescents. Cochrane Database Syst Rev 2010; CD007868. DOI: 10.1002/14651858.CD007868.pub2.
Pretty I A. High Fluoride Concentration Toothpastes for Children and Adolescents. Caries Res 2016; 50 (Spec Iss): 9-14.
Asimakopoulou K, Newton J T. The contributions of behaviour change science towards dental public health practice: a new paradigm. Community Dent Oral Epidemiol 2015; 43: 2-8.
Michie S, van Stralen M M, West R. The behaviour change wheel: A new method for characterising and designing behaviour change interventions. Implement Sci 2011; 6: 42.
Newton J T, Asimakopoulou K. Minimally invasive dentistry: Enhancing oral health related behaviour through behaviour change techniques. Br Dent J 2017; 223: 147-150.
We wish to acknowledge the input from our advisory group, the athletes and support staff from all the sports who so generously gave of their time to contribute to this research project. Thank you also to Miss Sarah Needleman and Mrs Karen Wigmore for data entry and to Mrs Karen Wigmore, Mrs Alison O'Neil and Miss Laura Wigmore for assistance during data collection. We are grateful to Professor Susan Michie and Professor Robert West of the UCL Centre for Behaviour change for advice regarding the design of the behaviour change elements of the questionnaire.
This project was jointly funded by a grant from GSK and UCL IMPACT (award number 157,871). The authors declare no conflict of interest. The Centre for Oral Health and Performance is part of the UK IOC Research Centre for Prevention of Injury and Protection of Athlete Health with the Institute of Sport Exercise and Health (ISEH) and the National Centre for Sport and Exercise Medicine (NCSEM).