The World Cup is upon us, and amongst the laughter, sweat and tears that the beautiful game inspires, I'd bet not many are thinking too much about the state of footballers' teeth.
And yet, the literature suggests that sports people often have a higher rate of decay than the average person in the street, which is a bit shocking, considering the amount of healthcare professionals some have working to keep them in tip top condition.
Some new research by Needleman et al, Nutrition and oral health in sport: time for action, further adds to the evidence in previous studies
I think it's time all healthcare professionals signed up to work together to ensure athletes oral health are not forgotten about or at the bottom of the pile when looking after health.
The dental profession faces a massive challenge, yet plays an important role in the sports medicine wheel for complete care of an athlete. Currently we have small isolated groups of dentists working within sport in the UK, and we aim to work together so that we can share ideas and compare strategies.
I'd like to encourage all dental professionals to get involved in the education and treatment for sports personnel to tackle this issue, and for us to work in more joined-up way, and that athletes are given good advice on caring for their oral health, as well as their general health.
Sports peoples' poor oral health: what's the problem?
A sportsperson's metabolic needs vary during game time or with certain high endurance sports.
Oral dehydration with a decreased salivary flow is a result of increased competition and energy expenditure- and therefore high carbohydrate and acidic beverage intake is often seen as the way to give them energy and help rehydration, as well as to maintain blood glucose levels.
The effects on their teeth just isn't something they think about - Bryant's (2011) triathlete study worryingly showed only 3.2% of the athletes were able to associate training and dietary patterns as being detrimental to their dentition.
Needleman et al study on the treatment of sports patients during the London 2012 Olympic and Paralympic games showed high levels of preventable conditions such as caries, erosion, and periodontal diseases – 30 per cent of participants reported an impact of oral health on their quality of life and 20 per cent on training and performance.
I also witnessed these issues first hand, when I treated patients in the athlete's village dental clinic.
By comparison to the 2009 Adult Dental Health Study (ADHS), Needleman et al's study on professional footballers showed higher dentine caries rates in the 16–24 age group (38.3 per cent) compared to 30 per cent in the ADHS. Almost four out of 10 players had untreated dental caries.
Dental erosion was present in over half of footballers with gingivitis was seen in 80 per cent of players and irreversible periodontitis in 5 per cent. Sixteen per cent of players reported current problems or pain in their mouths on presentation. Almost half of all players (45%) reported to being 'bothered' by their oral health.
This is somber reading.
I am especially concerned at the increasing noted trend of chewing tobacco (snus) use in professional sport and the impact this is having on oral health, as this seems to be a growing problem. Aside from the general health concerns about using this type of tobacco, there's the potential impact on oral health and the risk of mouth or oral cancers, and more studies need to be done on this.
Starting out right: ensuring younger sports people value oral health
I work as a sports dentist in professional rugby and football and I've see a multitude of dental issues in the early to mid-twenty year olds, particularly.
Many athletes go into sport at a young age, with multiple games, events or training sessions attended weekly. This may result in 'snacking' during journeys and training, relying on sugary items to replace spent energy.
It's really important that they are encouraged to start off with good habits – sports and energy drinks are not necessary, water is all they need, alongside a healthy and balanced diet. Many do not get appropriate dietary and nutritional advice, and that is something that would help set them up for their future careers.
First hand, I've seen mixed messages being given to sports people, by different personnel involved in their well-being, with conflicting nutritional advice being given and adding to the confusion. This needs to change.
I feel that dental health is often a low priority for athletes and staff, until a problem arises. Players have attended for emergency treatment the day before a game with irreversible pulpitic symptoms or intra-oral/ extra-oral swellings. They then want a 'quick fix' so they can play.
What can we do to make it better?
Several sport and exercise medicine positions and consensus statements promoting good oral health have been published – these need to be spread wider and included as a core part of athlete's health regime.
Oral health education for sports professionals shouldn't just focus on tooth decay, but also the impact of dental trauma, and how to prevent and manage it – prevention is always better than cure.
Pre-season screening should be the "norm" to flag up dental conditions in advance that may hamper an athlete's participation and concentration – we can do so much better for our sports professional patients.
Interestingly military personnel, divers, and pilots have a professional responsibility and code of conduct to adhere to and maintain an optimal level of oral health – as all these roles can be adversely affected at work by dental pain. Following this code helps to minimize dental issues impacting on their ability to work and concentrate optimally.
Considering the money involved in some professional sports by comparison, couldn't we offer the same professional responsibilities and code of conduct and level of care for our sportspeople, considering the current evidence of poor oral health?
Surely sports teams and clubs have a dental duty of care to their athletes?
I whole heartily echo, champion the cause and bang the drum, of the dental profession, in promoting oral health awareness to the sports medicine world and ensuring our athletes teeth are better looked after.
Dentist to Welsh Rugby Union Welsh Football Association and Cardiff City Football Club
Special interest in Endodontics, Sports Dentistry and Dental Trauma
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