A recent trip to the dentist sparked this blog post. A slight dull ache in my mouth, thinking I might need a filling has revealed that I have a big hole and waiting to find out if it’s bad enough to need root canal treatment. Most people would go home and feel sad about the impending treatment, I went to do a literature search and implemented a strict dental hygiene routine. The dentist asked about my diet and snacking habits. When I told her about my endurance running and cycling and general exercise she said that my tooth presentation then didn’t surprise her. So are athletes at higher risk?
How does tooth decay happen?
Tooth decay happens when sugary and starchy foods stick to our teeth and are broken down by the natural bacteria in our mouth. When this happens a small amount of acid is released and the pH in our mouth decreases and this dissolves the tooth enamel. Over time, this causes damage and can lead to tooth cavities. It takes around 20 minutes for the pH of the mouth to return to normal. This is why snacking can be bad for your teeth as it means there is repeated exposure to this acid across the day (for more information see the Patient Info Website).
Top strategies for dental health
I am not a dentist and therefore I am not the best person to advise this, so here are some top tips from the NHS:
- Brush your teeth twice a day
- Floss between your teeth
- Cut down on sugar, and other lifestyle tips
- Have regular dental check-ups
What do dietitian's recommend?
As a dietitian we learnt a small amount in our training about nutrition for oral and dental health. Limiting exposure of sweet food to our teeth, healthy eating and good oral hygiene – brush your teeth etc., but not much more than that.
However, those principles are often pushed aside when advising clients. When I work with cancer patients in the NHS we often recommend ‘little and often’ as a strategy to deal with poor appetite. Encouraging the choice of high calorie foods (often high sugar) as often as possible, disregarding their impact on oral health. Whilst this contradicts the advice from the dentist, nutrition is likely to take priority due to pressing issue of their health and ensuring they can make it through their cancer treatment. Once weight and appetite has stabilised then general healthy eating principles are back on the table.
But when thinking about my sports nutrition clients, who generally are in good health, should we be considering dental health more frequently when recommending nutrition strategies?
So are athletes at higher risk?
Athletes are considered higher risk for dental issues, there are two main reasons for this. Dietary carbohydrate intake is one of the most common causes for dental caries and acidic foods and drinks are the main factors causing erosion (Needleman et al 2015). With high carbohydrate diets often required, especially for endurance athletes and high use of carbohydrate rich food and drinks during exercise this puts them a higher risk. Dehydration and drying of the mouth during activity might increase the impact of food on causing erosion and caries, as saliva has a protective property in keeping the mouth and teeth healthy.
When it comes to sports nutrition advice this is where it often contradicts the dentist. Whilst there are preventative measures that can be considered, the issue of fuelling whilst exercising remains tricky. However not all hope is lost; a recent study in France found that ultra-trail runners’ oral health was better than the average French population (Coudert et al 2022). They concluded that regular dental hygiene and preventative dentist trips counterbalance the increased risks for athletes. But an English study found that despite positive oral health behaviours there are still substantial amounts of oral disease (Gallagher et al 2019). Whilst the research has mostly been performed using elite or professional athletes, this is still relevant to the general population who exercise.
So should we be ditching the sports drinks, gels, sweeties and dried fruit? Well without a suitable alternative it isn’t really an option. We need to fuel our exercise, otherwise this will lead to multiple other issues including decreased performance. But perhaps we need to be sensible and ensure that dental hygiene is more of a priority around other areas of our training schedule.
What can we do to minimise the risk:
- Make oral health part of your performance plan
o Schedule regular check-ups
o Let your dentist know what kind of exercise you do and your eating habits
- Good general oral and dental hygiene:
o Floss
o Brush your teeth
o Ensure your toothpaste contains fluoride
o Spit out toothpaste but don’t rinse
- Ensure you have a healthy diet and minimise the frequency of sweet foods you consume on days when you are not training.
- Snacks
o Do you need to snack? Think of it strategically, it may still be necessary to snack 1-2x day to provide you with sufficient nutrition (in general or for performance) however continual grazing during the day may be unnecessary and causing dental issues.
o Don’t snack before bed
o Some tooth friendly snacks to consider: cheese, yoghurts, plain nuts, sugar-free sweets, oatcakes and hummus, carrots, celery and apples.
- If you are using gels consider swilling out your mouth with water after taking them.
- If possible, have two bottles if you are using carb containing sports drinks
o One sports drink, one plain water
o Every time you sip the carb drink, follow this with water
- Use a straw when drinking fizzy or sugary drinks
o I appreciate this isn’t the easiest if under time pressure during a race!
o But try to follow at other times, this is still the case even if it is a diet drink.
- Consider brushing your teeth after your exercise session or race.
Remember prevention is better than cure - book in regular check-ups with the dentist.
o Yes, it may be expensive – however delaying it is only likely to make it more expensive
o No, it is no ones favourite trip (apologies to any dentists out there), but it is necessary
o Follow their advice, they are the experts!
o If you aren’t sure how you can fuel correctly following your dentists advice, then speak to a dietitian who will be able to support you with some strategies to minimise your risk.
References and resources
Patient Info. The best snacks for healthy teeth
Oral Health Foundation. Diet and my teeth
Coudert S, Jacq R, Bas AC. The evaluation of oral and dental health and behavioural risk among ultra-endurance athletes: a cross-sectional epidemiological study. Res Sports Med. 2022 Feb 24:1-9.
Gallagher, J., Ashley, P., Petrie, A. et al. Oral health-related behaviours reported by elite and professional athletes. Br Dent J 227, 276–280 (2019).
Needleman I, Ashley P, Fine P et al. Oral health and elite sport performance. Br J Sports Med. 2015 Jan;49(1):3-6.