Taking Care of Your Teeth in Sport

Have you ever wondered what Michael Phelps or Rob Kearney eats in a day?

One of the most frequently posed questions to professional athletes is about calorie intake.  Professional sport is continuously evolving to create quicker, leaner, more physically imposing athletes – increasing dietary intake, supplementation and higher collision forces in contact sports.

Often, athletes are expected to meet these increased physical demands while building an aesthetically pleasing media-friendly profile to attract sponsors and boost performance dependent revenues.

Sports dentistry is a multidisciplinary science which covers prevention and treatment of sports injuries, and explores ways to improve oral health and athletic performance.

As sports science has evolved, ‘prehab’ has played an increasingly greater role. By strengthening an athletes weaker areas, potential future injury can be minimised or avoided.

What is ‘Prehab’ when it comes to your teeth?

Prevention of injury and tooth decay. 10% of athletes are at risk of sustaining a severe injury to the face or mouth, while a UK survey shows 55% of athletes experience tooth decay and/or regular dental pain.

So how do we manage this?

Competitive athletes are generally required to consume approximately 4,000 – 6,000 calories per day.  Sugary foods and sports drinks are a cornerstone of fast acting carbohydrate replacement for athletes. These can be managed in a number of ways to reduce decay rates.

• Sipping sugar over a two-hour training session has a dissolving effect on tooth enamel; each time the saliva neutralizes the sugar to protect the teeth, it is hit by another dissolving dose of sugar.
• Replacing a sugary drink with water and a separate sugar gel pouch, taken once every 30-40min during hard cardiovascular exercise reduces the overall exposure of teeth to sugar.
• For less energy intensive sessions, water and a banana, or simply water during the session and a carbohydrate shake immediately afterwards to replace depleted glycogen.
• For strength based sessions where sugar can be avoided, water and immediate protein replacement afterwards should suffice.
• For endurance athletes, recent studies have shown they are at higher risk of decay due to a combination of mouth-breathing and decreased salivary flow during prolonged sessions. Similarly, boxers and rugby players with damaged/reduced nasal function resulting in mouth breathing incur higher levels of decay due to reduced saliva in the mouth.

 How can Athletes Combat this?

• Regular 4-6 month dental checkups, oral hygiene advice, dietary evaluation and monitoring for signs of cavitation or decay. Early identification of tooth decay can prevent it from extending to the pulp (requiring extraction or root canal).
• At-risk athletes can undergo further preventative treatment such as erosive lesion replacement, fissure seals and fluoride treatment.
• At the London 2012 games, 55% athletes were found to have tooth decay or gum disease and 20% reported diminished performance as a result [3]. Given that pain from dental decay would also have affected diet and sleeping patterns in the run up to the games, the true figure might well be higher.

Protective Devices

Mouthguards play a vital role in protecting the teeth from fracture and traumatic loss, as well as guarding the lip and gum tissue. Crucially they act as shock-absorbers to the underlying bone by up to 40-50%. However, despite this evidence, in many sports, compliance is poor. In 2014 the GAA issued a ruling where mouthguards were made compulsory at both senior and junior level. In rugby however wear levels are often as low as 30%, even in professional athletes.

Why are players not wearing them?

Discomfort, gag response (mouthguards which extend to the back of the mouth particularly), breathing difficulties and for both professional and amateur players’ difficulty in communicating were the biggest complaints. These issues are easily fixed however, through customised mouthguards and individual athlete mouth guard modification. By reducing the extension and bulk on the back teeth, gag response is eliminated. Similarly, modifications can be made to the areas in contact with the tongue for speech improvement. Mouthguard discomfort is easily reduced by smoothing irritating areas with the dentist in-surgery.

Tooth Position/ Occlusion

The alignment of an athlete’s teeth can also play a role in susceptibility to trauma. Protruding upper front teeth, in children and young athletes particularly, can significantly increase the risk of fracture or tooth loss. Similarly, loss of back molar teeth in athletes can lead to increased force on the front teeth- particularly in impact sports such as boxing and rugby. Trauma or poor biting stability can also result pain and problems with the TMJ (the hinge joint connecting the lower jaw to the skull) which can restrict jaw opening and function for athletes across every sport.

An occlusal assessment with the dentist can help identify any risk factors, and create a treatment plan to treat them before they cause problems. This can often be very simple, minor tooth alignment or tooth replacement for increased biting stability. Mouthguards can be modified to provide increased support to vulnerable areas (protruding teeth), while orthodontic (specialist) referrals can be made for more severe cases.

Quick tips for Prevention:

– Regular dental check ups

– Good oral hygiene, brushing and flossing regularly

– Diet assessment – reduction in frequency of sugar intake

– Customized mouthguard – a must! Modified if required

– Occlusal assessment – removal/reduction of risk factors

Dr Sally McCarthy, BDS, is member of the Academy of Sports Dentistry and International Association of Dental Traumatology.

Sally is based in Dental Care Ireland in Ashbourne in County Meath.  To make an appointment visit Asbhourne here or call 018350344.