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Oral health programme for athletes proves successful for sporting performance

A study on oral health behaviour in athletes has found that 93% of the participants were motivated to change their oral health routine to avoid inflammation in the body caused by poor oral health. (Image: Pavel1964/Shutterstock)
By Dental Tribune International
October 12, 2020

LONDON, UK: There are several reasons why athletes are more likely to have poor oral health. In addition to physical activity that causes a dry mouth, increasing the long-term risk of dental caries and gingivitis, regular sugar intake from energy supplements plays a role. Now, researchers at University College London (UCL) have designed a behavioural change programme for athletes and found that those who adopted simple oral health measures reported reduced negative effects on their performance.

Poor oral health is common among athletes, and its association with negative performance is not a new insight. “However, compared with other health and training pressures, oral healthcare is not a high priority in elite sport,” said lead author Dr Julie Gallagher from UCL Eastman Dental Institute in a press release from the university. In an effort to change that, FDI World Dental Federation has encouraged elite and amateur athletes to make their oral health needs their top priority.

In a previous study at UCL, researchers found that almost one in two elite British athletes suffer from oral health conditions, such as dental caries and gingivitis, that negatively affect their well-being and sporting performance. To help address this, researchers at the Centre for Oral Health and Performance, based at Eastman Dental Institute, designed a behavioural change programme aimed at better educating elite athletes about oral health. “We […] wanted to develop a programme which was aligned with the existing high-performance culture of the athletes and their teams,” noted Gallagher.

Increasing oral health knowledge and skills

Athletes from two Great Britain Olympic teams, rowing and cycling, and one Premiership Rugby club, Gloucester Rugby, were recruited to the study. They and their support teams were asked to watch short presentations which focused on building motivation to improve oral health and on increasing oral health knowledge and skills.

In addition, each athlete received an oral health screening to check for diseases such as caries and gingivitis. They were then given a bespoke follow-up report with tailored advice and an oral health kit containing a manual toothbrush, prescription fluoride toothpaste and floss picks. As a minimum, they were asked to brush their teeth for 2 minutes twice a day.

Of a total of 62 athletes, 89% completed the four-month study. On completion, they were asked to fill in an oral health knowledge questionnaire, undergo a follow-up gingival assessment and evaluate the oral health kit.

Athletic performance as motivation to change oral health behaviour

The study found that the behaviour change model was associated with both reductions in self-reported negative performance impacts and improvements in oral health behaviours. The number of athletes who used prescription-strength fluoride toothpaste increased from eight (12.9%) to 45 (80.4%), and those who used interdental cleaning aids at least two to three times per week increased from ten (16.2%) to 21 (34.0%). However, the gingival bleeding index remained unchanged. A desire to avoid inflammation in the body resulting from poor oral health was cited by 93% of participants as the key motivator to make changes to their oral health routine.

Gallagher commented: “Through our previous research and focus group sessions, we established that athletes’ motivations for taking part in the study were both appearance and athletic performance, with many keen to avoid gum inflammation affecting other parts of their bodies, which can happen in serious cases.”

Improvements in sporting performance were measured using the Oslo Sports Trauma Research Center Overuse Injury Questionnaire (OSTRC-O), developed to monitor illness and injury in elite athletes. The research team adapted the questionnaire to focus on oral health, investigating the extent to which the oral health problems affected sports participation, training volume and sporting performance and the extent to which the individual had experienced oral pain.

“With so many other competing interests, such as training, nutrition, sleep and mental health, it is remarkable to see such great rates of adherence to the new routines in a high-performance environment”
– Dr Ian Needleman, UCL

As a result of the behavioural change programme, the mean OSTRC-O score for the athletes reduced from 8.73 (out of 100) to 2.73. The decrease indicates a statistically significant reduction in negative sporting performance impacts associated with oral health problems.

“With so many other competing interests, such as training, nutrition, sleep and mental health, it is remarkable to see such great rates of adherence to the new routines in a high-performance environment,” said co-author Dr Ian Needleman, professor of restorative dentistry and evidence-based healthcare at Eastman Dental Institute.

In addition, the number of athletes who reported a zero score, meaning they had no negative sporting impact from oral health conditions, increased from 32 (51.6%) at baseline to 54 (98.2%) at the end of the study.

Dr Nigel Jones, head of medical services at the Great Britain Cycling Team, said: “My role with the Great Britain Cycling Team is to ensure the holistic well-being of our cyclists, and as oral health can have a big impact on immune function as well as being important in its own right, I wanted to support this project. The learnings which the riders took from the study have been invaluable and will be deployed across the whole team as we ramp up our preparations for the Tokyo Olympic and Paralympic Games next year.”

Dentist Dr Zak Lee-Green, a former member of the Great Britain Rowing Team who was interviewed by Dental Tribune International last year on dental medicine and sport, said: “As athletes we are acutely aware of the marginal gains required to achieve peak performance and maintaining good oral health is a prime example of an area often overlooked. This programme has gone a step further than showing the positive effect of excellent oral health on everyday life and has shown the potential benefits for improved performance, helping us reach the highest levels of sport. It can only be a step in the right direction if the sporting role models of the present and future are managing their oral health in the same way that they do their elite training.”

The study, titled “Implementation of a behavioural change intervention to enhance oral health behaviours in elite athletes: A feasibility study”, was published online on 18 June 2020 in BMJ Open Sport and Exercise Medicine.

Editorial note: This article was published in prevention―international magazine for oral health Vol. 4, issue 2/2020.

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