Influence of oral health on sports performance

Whether you are a professional or amateur athlete, or even if you are a mere fan of your local team, you will be interested to know that there is a relationship between oral health and sports practice. Although other physical problems cause more attention, dental problems are frequent in elite athletes.

1) Oral health and sports performance: a bidirectional relationship

There is a bidirectional relationship between oral health and sport. Having a good oral health benefits sport performance while wearing an active life can promote oral well-being. Practicing sports requires a physical effort, more so in elite athletes, so the body, including the mouth, has to be at an optimal level to develop it.

2) This is how some oral problems influence the practice of sport

Bacterial plaque, malocclusions, bruxism and other oral conditions are closely related to the appearance of lesions in elite athletes. For this reason, more and more elite sports teams are incorporating craniofacial, oral cavity and dentition examinations into their medical examinations.

2A) Periodontitis and sports performance

Various studies indicate that the bacteria and inflammatory mediators that cause gum disease can travel through the bloodstream to other parts of the body and can affect joints, bones and, in more serious cases, the heart. These include: Interleukin-1 (IL-1), Tumor Necrosis Factor Alpha (TNF-α), Interleukin-6 (IL-6), C-Reactive Protein (CRP) and Prostaglandin E2 (PGE2). 

2A.a) This is how gum disease can influence sports

These are some of the problems that can cause periodontal disease in sports.

2A.aa) Fatigue and muscle weakness

Chronic inflammation can cause fatigue and weakness, decreasing the ability of athletes to train and compete.

2A.ab) Increased risk of injury

The inflammation can weaken musculoskeletal structures, increasing susceptibility to injuries such as sprains, muscle tears and joint problems.

2A.ac) Slower recovery

The presence of inflammatory mediators can delay post-training and post-competition recovery, affecting tissue repair.

2A.ad) Respiratory complications

Oral infections and inflammation can affect lung efficiency and aerobic capacity, crucial for performance in endurance sports.

2A.ae) Stress and anxiety

The pain and discomfort associated with oral problems can increase stress and anxiety, negatively impacting concentration and performance.

2A.b) Studies on the relationship between periodontitis and sports success

There are more and more studies that relate the bacterial plaque index and the number of lesions. An study of the British Journal of Sports Medicine conducted on British professional footballers, 77% of those evaluated had gingivitis and 80% suffered periodontal disease. Footballers from all over the world are beginning to raise awareness of oral care as a tool to improve the quality of life and sport performance. These problems not only affect football players. In 2013 Needleman et col.; analyzed 278 Olympic athletes at the London Olympics and reported that 18% of athletes admitted that their oral problems had affected or were negatively affecting their athletic performance. Similar results were obtained two years later by Ashley et col. evidencing again the negative influence of oral problems on sports results.

2A.c) Sport: an ally against periodontal disease

A link has been established between periodontitis and metabolic syndrome, that is, the risk factors for developing cardiovascular disease, being sport one of the main ways to combat this syndrome. Therefore, it could be said that practicing sports also has a preventive and protective effect against periodontal disease.

2B) Oral infections can influence sports performance

Other oral infections, whether caused by cavities, trauma, pericoronitis of a wisdom tooth... can release bacteria and toxins into the bloodstream, which leads to a systemic inflammatory response. This inflammation can affect multiple systems in the body, including the musculoskeletal, and can weaken body structures, increasing susceptibility to muscle and joint injuries.

Arjen Robben, a former professional soccer player, suffered various injuries throughout his career. One of the lesser-known causes of his physical problems was a dental infection. According to various reports, Robben suffered from an infection in his oral cavity that may have contributed to his sports injuries. Another footballer, Jamal Musiala, experienced several recurring muscle injuries that affected his performance on the field. After multiple evaluations and unsuccessful conventional treatments, it was discovered that the underlying cause of his muscle problems was an oral pathology related to his wisdom teeth. Musiala underwent surgery to remove his affected wisdom teeth. After the intervention, a significant improvement was observed in his physical condition, and recurrent muscle injuries resolved.

2C) Malocclusion and its relationship with injuries

There is also a close relationship between dental malocclusions and the control of body posture and muscle problems, relating it to a higher rate of injuries. The lack of teeth and / or their malposition can lead to headaches, problems in the chewing muscles and digestive problems due to the difficulty of correctly chewing food. It is therefore extremely important to carry out a correct craniofacial diagnosis of the patient to detect this type of malocclusion problems and to be able to carry out the necessary treatment to correct it. It is also important to evaluate the upper airways, which significantly influence sports performance. Having a narrow upper airway is related to dental malocclusion problems and lower athletic performance. Correcting malocclusions entails, in many cases, an increase in the volume of the upper airways and, with it, an improvement in sports development.

One of the first demands Pau Gasol had to face when he was transferred to Los Angeles Lakers, was to undergo orthodontic treatment to correct his dental crowding (and associated malocclusion) to avoid problems of balance and continuous discomfort in the neck and back that dragged from its passage through the Memphis Grizzlies. Another example of this was the frustrated signing of the football player Aly Cissokho to Milan, in which the doctors concluded in their examination that the player suffered a malocclusion and this could have bony and muscular consequences on the spine, increasing the risk of injuries. Some of these claims may seem exaggerated, but all of them have scientific support. According to a research carried out by the Department of Physiology of the University of Barcelona with the University of Innsbruck (Austria), published in Neuroscience Letters and Motor Control: “There is a reciprocal influence between the trigeminal nerve and the vestibular nucleus, that is, those responsible for the functions of chewing and balance, and the masticatory and cervical muscles. When there is fatigue, the balance in conditions of maximum instability is significantly higher among individuals who have a bad dental occlusion”.

2D) Dental caries, a common problem in elite athletes

We know that for an athlete, nutrition is almost as important as their training. And it is precisely the high intake of carbohydrates and energy drinks, which is related to a high rate of cavities, even greater when it is associated with poor hygiene habits. The immunological changes caused during the practice of sport or the stress and tension inherent to competitions also affect.

2E) Bruxism and its relationship with competitive sports

The functional overload associated with bruxism (teeth grinding) also produces muscle contractures, which can cause headaches and neck pain. Having the muscles of the jaw contracted makes it difficult to have good control over the movements of head, neck and shoulders, which will significantly limit the performance in some sports. For this purpose, mouth protectors (sports splints) are made that not only protect the teeth from potential blows, but also help to avoid fractures and overloads that athletes suffer during stress situations. These mouth guards relieve the muscles related to chewing and, by extension, the musculature of the back and neck. The potential advantage is also being studied by increasing the passage of air by facilitating a more advanced positioning of the jaw. Tiger Woods or Cristiano Ronaldo are some elite athletes who have already used some type of sports splint to improve their performance. Currently we also have a device that detects tooth by tooth the pressure and contact exerted when biting. This allows us to adjust the bite so that the loads are distributed in a uniform manner and that each tooth exerts a similar pressure and contact. With this we get a balanced bite that will prevent possible muscular and joint problems derived from it.

2F) Edentulism and physical performance

One of the pillars for sports performance is balanced nutrition adapted to the conditions of each person. One of the keys to having a good diet is to chew correctly, since this allows us to make the most of the nutritional capacity of food and avoid heavier digestion. For this reason, edentulism, that is, the partial or total lack of teeth, also negatively affects performance in sports, although this problem is more common in very elderly people.

2G) The importance of saliva in the oral health of athletes

Saliva plays a crucial role in oral health by acting as a protective agent that helps neutralize acids produced by bacteria in the mouth and remineralize the teeth. Athletes, especially those who train intensely, may experience xerostomia (dry mouth) due to dehydration. Lack of saliva can increase the risk of tooth decay and periodontal disease.

2H) Dental trauma in contact sports

Contact sports such as rugby, hockey and boxing present a high risk of dental trauma. Injuries can range from tooth cracks or fractures to complete tooth loss. Wearing custom mouthguards can significantly reduce the risk of these injuries by protecting teeth and surrounding structures.

2I) Dental erosions in swimmers

Swimmers face a particular risk of dental erosion, especially those who train in chlorinated pools. Chlorine and other chemicals used to keep pool water clean can increase the acidity of the water, which in turn can lead to tooth enamel erosion. A study published in the "Journal of the Canadian Dental Association" found that low pH in chlorinated pools may contribute to tooth erosion in swimmers. Likewise, a pH high level of pool water can promote Tartar buildup in swimmers who spend a lot of time in pool water.

3) Oral health tips for athletes

Presented the most common oral problems and their relationship with sports, we are going to give a series of dental advice that can benefit sports practice.

3A) Dental hygiene, an ally in this and other fields

The majority of oral diseases are related to poor oral hygiene habits, so taking care of our mouth properly is essential also in this field. From here we recommend brushing your teeth after each meal with the proper technique and flossing at least once a day. Regular professional cleanings are also essential.

3B) Keep hydrated

It is essential to hydrate properly before, during and after sports practice. On too many occasions, this hydration is done with sugary and/or carbonated drinks, which can favor the development of cavities and dental wear. Therefore, it is advisable not to abuse these types of products and, if you do, brush your teeth thoroughly.

3C) Protect your teeth

It is advisable to use mouth guards to protect teeth from possible impacts if you do any type of contact sport. Cracks, fractures or dental avulsions are the order of the day in these cases. 

3D) Adjust your activity to your physical condition

There are many reasons why exceeding your body's capabilities is a bad idea, but also when we talk about oral health. Sports performed at high and prolonged intensities increase inflammation and risk of oral damage.

4) Dental check-ups are essential for professional athletes

If dental check-ups are important for all patients, in athletes they are essential. For this reason, the athlete has to be in good shape, control their diet and cardiovascular health, but also closely monitor the condition of their mouth and teeth.

4A) The importance of craniofacial diagnosis in athletes

Diagnosis is the most important part of any treatment. With the 3D craniofacial diagnosis we achieve a complete analysis of both the mouth, teeth, soft tissues, joints and bones of the face, which will be the starting point for multidisciplinary treatments, among which orthodontics is especially important. With this we are able to obtain all the necessary data to be able to carry out an individualized diagnosis and treatment plan for each patient. Most cases of malocclusion and joint and / or muscle problems can be resolved through orthodontic treatment.

4B) We are the reference dental clinic of the R.C. Deportivo de la Coruña

At the Pardiñas Clinic we have been the reference dental clinic of the Real Club Deportivo de La Coruña for several seasons, so we are in charge of the oral check-ups of the players. The control of oral health has been incorporated into the club's demands on its players to achieve the best possible performance from them. If you practice elite sports and you live in A Coruña, we can also accompany you in your professional career.