Oral health and performance impacts in elite and professional athletes

To measure dental caries, erosive tooth wear (ETW), periodontal health, self-reported oral health problems and performance impacts in a representative sample of UK elite athletes from different sports using standardized conditions clearly defined clinical indices and a measure of impact on performance with evidence of validity in sport.

Cross-sectional study, with single, calibrated examiner, conducted in the local facilities of elite and professional UK athletes (UCL ethics number 6388/001). Main oral measures: dental caries (ICDAS), erosive tooth wear (BEWE), periodontal health (BPE) and athlete-reported performance impacts.

We recruited 352 athletes from eleven sports. The mean age was 25 years (range 18-39), and 67.0% were male. We found caries (ICDAS code ≥3) in 49.1% of athletes, ETW (BEWE score of ≥7) in 41.4%, gingival bleeding on probing/presence of calculus (BPE score 1 or 2) in 77.0% and pocket probing depths of at least 4 mm (BPE score 3 or 4) in a further 21.6%. One in five athletes reported previous wisdom teeth problems. The odds of having caries were 2.4 times greater in team sport than endurance sport (95% CI 1.3-3.2). The odds of having erosion were 2.0 times greater in team sport than endurance sport (95% CI 1.3-3.1). Overall, 32.0% athletes reported an oral health-related impact on sport performance: oral pain (29.9%), difficulty participating in normal training and competition (9.0%), performance affected (5.8%) and reduction in training volume (3.8%). Other impacts were difficulty with eating (34.6%), relaxing (15.1%) and smiling (17.2%). Several oral health problems were associated with performance impacts.

This is the first large representative sample study of oral health in athletes from different sports at elite level. Although experience of oral disease differs by sport, the prevalence, in UK elite and professional athletes, is substantial, with common self-reported performance impacts. Regular screening and use of effective oral health promotion strategies may minimize performance impacts from poor oral health.