Reflections on dental disease prevention in sub-elite competitive endurance sports: a mixed-methods analysis

Competitive athletes consistently demonstrate high rates of oral disease. This mixed-methods study investigated and compared the knowledge, beliefs and attitudes of athletes, coaches and dental healthcare professionals (DHPs) regarding oral disease prevention in a cohort of predominantly endurance athletes to inform future targeted health promotion. An online questionnaire was used to collect quantitative and qualitative data from sub-elite competitive endurance athletes, coaches, and DHPs, which were analysed using a mixed-methods approach. Responses from 67 athletes, 33 coaches, and 33 DHPs were analysed. Median knowledge scores were poor for athletes and coaches (36.4%) and DHPs (45.5%), with 0% as the lowest possible score and 100% the highest. Few coaches considered dental disease prevention part of their role, although most acknowledged responsibility for broader athlete health. DHPs applied evidence-based preventive principles to all patients but exhibited limited awareness of sport-specific risk factors and reported barriers in treating athletes, including time constraints and limited knowledge of the competitive sports environment. Overall, knowledge of dental disease prevention in competitive sport was low across all groups. Targeted educational and behavioural interventions could help reduce disease burden and its impact on athlete performance and well-being.