Endurance Training May Be Wrecking Your Oral Health, Even If You Brush Twice a Day
A study of about 350 elite athletes published in the British Dental Journal found that despite regular brushing and flossing, half of them still had untreated tooth decay, and the majority of them had early signs of gum inflammation.
To protect your teeth, make an oral health strategy that includes bi-annual dental visits, high fluoride toothpaste, strategic use of sports supplements, and proper brushing and between teeth cleaning techniques.
Right now, I have two cracked molars that need major repair. One, on the top left, has been filled and refilled multiple times. Same story with one jagged nub of a tooth on the bottom right.
During the past several years, the roots of two teeth have “blown up,” sending me to the dentist to have them pulled, one mere days before boarding a plane to race for eight days in South Africa at ABSA’s Cape Epic Mountain bike stage race.
I’ve lost count of how many root canals I’ve had, so we’ll just say more than six. My most recent is awaiting a crown. And speaking of crowns, a few years ago, I had a crown lengthening procedure—a rather unpleasant affair where the dentist removes some gum and bone around a tooth to securely attach a crown following a root canal—only to have said crown come out midway through stage two of Hot Israel Epic just a few weeks later.
I shoved it in my jersey pocket, but subsequently lost it, likely as I was pulling a few raspberry Skratch Chews—the irony is not lost on me—from my food stash in the same pocket.
My dental history reads a little more robustly than I’d like it to, but it’s not because of lack of trying. Despite my best efforts, oral emergencies keep popping up.
It’s been somewhat reassuring to know I’m not alone: Over the years, there has been a slew of studies showing that endurance athletes have worse oral health than their sedentary peers.
Now, a new study published in the British Dental Journal echoes these findings and takes it even further, adding that even if you brush twice a day and clean your choppers more frequently than your couch-potato peers, you’re still likely to have poorer oral health.
Specifically, the researchers examined the dental records of 352 Olympic and professional athletes across 11 sports, including cycling, rowing, swimming, football, rugby, and athletics (a collection of competitive sporting events that include running, jumping, throwing, and walking), checking for tooth decay, gum health, and acid erosion.
They also had 344 of the athletes complete a survey about their oral hygiene habits, answering questions about what they did to keep their teeth and gums healthy.
The dental records were not a pretty picture. Nearly half (49 percent) of the athletes had untreated tooth decay; the majority of them had early signs of gum inflammation, and about a third (32 percent) said that their oral health had a negative impact on their training and performance.
And this was despite some pretty diligent dental hygiene: Ninety-four percent of them said they brushed their teeth at least twice a day, and 44 percent said they flossed regularly. That’s better than the general population, where only 75 percent report twice-daily brushing and a mere 21 percent floss regularly.
The problem? The athletes also bathe their teeth in a lot of stuff that eats away at tooth enamel. The study also found that 87 percent regularly sip on sports drinks; 70 percent suck down gels, and 59 percent chomp on energy bars.
“Generally, when we talk about sports dentistry, the topics revolve around mouth guards and limiting catastrophic trauma,” periodonist and study author Ian Needleman, Ph.D., aprofessor at UCL Eastman Dental Institute in London, told Bicycling. “But poor overall oral health can have a chronic impact in the form of mild to moderate ongoing pain and systemic inflammation, and acute infections can certainly lead to disrupted training and even missed medals.”
In fact, Needleman discovered exactly that in a 2012 survey of nearly 300 Olympic athletes he and his co-workers published in the British Journal of Sports Medicine. Not only did they have bad teeth—45 percent of the athletes had dental erosion, 55 percent had cavities, and 76 percent had gingivitis—but also 28 percent felt their oral health had a negative effect on their quality of life and 18 percent found it hurt their training and performance.
Though most of these studies are done on professional or Olympic level athletes, you don’t have to be gunning for a gold medal to experience extensive dental decay and damage, Needleman says.
“Anyone who trains and competes as part of their lifestyle—meaning you do this stuff a lot—is at risk for oral health problems,” he says.
But if brushing and flossing don’t seem to help, what’s an endurance junkie to do?
“You need to make an oral health strategy as part of your regular periodized training plan,” Needleman says. Here’s what he recommends.
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Make oral health part of your performance plan.
“Typically between 20 to 30 percent of athletes report that their oral health issues have a negative impact on their training and performance,” Needleman says. “So you need to plan your dental health the same way you do your other training to minimize these disruptions and optimize performance.”
Athletes need to see their dentist twice yearly, Needleman says. “Make one of those appointments during your low or off season, so you can manage any problems without having a significant impact on your training.”
And once you are there, treat your dentist like your oral health coach.
“Tell your dentist that you do a lot of sport; tell them what you do; bring your nutrition plan to your appointment, and say, ‘This is what I use,’” he says.
Dentists are trained to assess diet diaries for the potential impact on oral health, Needleman says. “You’ll be able to get personalized advice on what you need to do to minimize your risks.”
Get high-performance toothpaste.
The typical strength of most over the counter toothpaste is around 1,100 to 1,450 parts per million (ppm) fluoride. That’s fine for most people, but high-risk athletes need a high fluoride toothpaste, Needleman says.
“High fluoride toothpaste is 2,800 to 5,000 parts per million,” he says. “It’s usually available through a prescription from your dentist or on sale at the dental office. You use it in place of your ordinary toothpaste.”
It’s important to note that prescription toothpaste should be treated like any medical prescription and kept out of the hands of children. High fluoride toothpaste can have toxic side effects if you swallow it.
Brush the right way.
Brushing removes dental plaque—a blend of bacteria and their acids and sticky byproducts—as well as food remnants from your teeth before they can cause trouble. It also coats your teeth with fluoride, which helps prevent tooth decay and replaces lost minerals to make them stronger.
For brushing to work, you need to do it right. Most of us don’t. For one, you should be brushing two times a day—once before bed and once early in the day—for two minutes. Set a timer on your phone and meticulously scrub the fronts, backs, and tops of all your teeth.
Once you’re done, spit out the toothpaste, but do not rinse. If you rinse, you wash away the fluoride. This simple change in technique, can make a measurable difference. Research shows it can reduce tooth decay by 25 percent.
Floss—or even better, brush—between your teeth.
Clean between your teeth once a day, at least, Needleman says. Floss is okay, but for even better results, use little dental brushes that really scrub those tight spaces.
Your dentist can show you the best approach for using them on your teeth, Needleman says. “Take them to your appointment and ask for help perfecting your technique.”
Be strategic with sports nutrition.
Sugar can wreak havoc on your teeth, as the bacteria in your mouth consume the sweet stuff and create acids that dissolve the minerals and leave microscopic holes in the surfaces of your teeth.
Your saliva helps remineralize your teeth, as does brushing with fluoride toothpaste. But if you assault your teeth with a steady stream of sugar, those defenses are overwhelmed. That’s where athletes typically run into trouble: sipping sports drinks and nibbling on chews delivers repeated sugar hits to your teeth for a prolonged period of time.
“People sometimes demonize the sports drinks and gels, but they have their place,” Needleman says. “When you are doing your sport, use the sports nutrition you really need. But also look at your nutrition plan and be critical. You likely don’t need a lot of carbs in a typical work and training day. Try to avoid them outside of training and recovery, and prioritize real foods, and those rich in protein, to protect your oral health.”
Employ a two-bottle strategy.
As if it’s not bad enough that the bacteria in your mouth are leaving behind acid as they metabolize the sugar you consume, sports drinks also are acidic, which only contributes to the erosion of your tooth enamel.
“If you are sipping every 15 to 20 minutes, as is often recommended, you are maintaining nearly constant acidity in your mouth. Over a period of time, that will take away the enamel on your teeth,” Needleman says.
He recommends employing a two-bottle strategy when possible. “If it fits in your nutrition and hydration strategy, have one bottle with your carbs in it and one bottle with plain water,” he says. “Immediately after drinking the carb solution, swish down some water. It will help reduce the acidity.
Ditch the mouthwash.
Your saliva moistens and remineralizes your teeth. The quality of your saliva and your oral microbiome help determine how well you can prevent oral disease, Needleman says.
During intensive training, you have a drier mouth and less protective saliva, so it’s important to do what you can to keep your oral microbiome healthy.
“Avoid antimicrobial mouth rinses,” Needleman says. They kill the good bacteria you need, which not only harms your teeth, but also can be detrimental to your performance and even your health.
That’s because the bacteria in your mouth reduce nitrates into nitrites. They are they converted to nitric oxide, which widens your blood vessels to increase blood flow and lower blood pressure, he says.
If you use antiseptic mouth rinse, you kill those bugs and abolish the ergogenic benefit, especially if you’re using a nitrate supplement like beetroot juice. Mouthwashes that contain only fluoride may be fine.
Talk to your dentist about eating disorders.
Sadly, eating disorders are fairly common in competitive cycling circles. Conditions like bulimia can cause significant dental erosion, as well as have other serious health consequences, so it’s important to address them with a qualified specialist. Your dentist can help you take measures to protect your teeth while you get the treatment you need.
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