Oral Health Pathologies in Elite Athletes and Their Implications for Sports Performance - A Narrative Review
DOI:
https://doi.org/10.12775/QS.2026.56.72017Keywords
sports dentistry, elite athletes, oral health, athletic performance, dental erosion, dental caries, periodontitis, inflammation, mouthguards, dental trauma, nutrition, dental screeningAbstract
Background
Despite their exceptional fitness and access to specialised medical care, elite athletes consistently show oral health worse than would be expected for individuals of their age and condition. This counter-intuitive observation - sometimes called the "elite-athlete oral health paradox" - has prompted growing interest in how sport-specific factors shape oral disease and how oral health, in turn, affects training, recovery, and competitive performance.
Aim
The aim of this review was to summarise the most common dental conditions seen in elite athletes, examine the sport-specific factors behind their high prevalence, outline how oral health influences athletic performance, and translate these observations into practical recommendations for prevention and clinical management.
Materials and Methods
A narrative review of the current literature was conducted, focusing on the epidemiology of oral disease in elite athletes, sport-specific aetiological factors, performance-related consequences, and preventive strategies.
Results
Untreated caries, dental erosion, gingivitis, periodontitis, dental trauma, and temporomandibular disorders all occur at rates equal to or higher than in the non-athletic population. Around one in three elite athletes report that oral health interferes with training, sleep quality, or performance, with mechanisms including pain, impaired nutrition, disrupted recovery, low-grade systemic inflammation, and lost training time.
Conclusions
Oral health in elite athletes deserves to be treated as a performance factor, not a cosmetic one. Pre-participation dental screening, targeted education, dietary adjustments, fluoride and remineralisation strategies, custom-fitted mouthguards, and the routine integration of dentists into sports medicine teams are low-cost, evidence-based measures capable of preventing and reducing many of the issues currently seen in this population.
References
1. Saini R. Sports dentistry. Natl J Maxillofac Surg. 2011;2(2):129. doi:10.4103/0975-5950.94465
2. Ranalli DN. Sports dentistry and dental traumatology. Dent Traumatol. 2002;18(5):231–6. doi:10.1034/j.1600-9657.2002.00122.x
3. Ashley P, Di Iorio A, Cole E, Tanday A, Needleman I. Oral health of elite athletes and association with performance: a systematic review. Br J Sports Med. 2015 Jan;49(1):14–9. doi:10.1136/bjsports-2014-093617
4. Tripodi D, Cosi A, Fulco D, D’Ercole S. The Impact of Sport Training on Oral Health in Athletes. Dent J. 2021;9(5):51. doi:10.3390/dj9050051
5. Gallagher J, Ashley P, Needleman I. Implementation of a behavioural change intervention to enhance oral health behaviours in elite athletes: a feasibility study. BMJ Open Sport Exerc Med. 2020;6(1):e000759. doi:10.1136/bmjsem-2020-000759
6. Needleman I, Ashley P, Petrie A, Fortune F, Turner W, Jones J, et al. Oral health and impact on performance of athletes participating in the London 2012 Olympic Games: a cross-sectional study. Br J Sports Med. 2013;47(16):1054–8. doi:10.1136/bjsports-2013-092891
7. Yang XJ, Schamach P, Dai JP, Zhen XZ, Yi B, Liu H, et al. Dental Service in 2008 Summer Olympic Games. Br J Sports Med. 2010;45(4):270–4. doi:10.1136/bjsm.2010.075283
8. Kragt L, Moen MH, Van Den Hoogenband CR, Wolvius EB. Oral health among Dutch elite athletes prior to Rio 2016. Phys Sportsmed. 2018;47(2):182–8. doi:10.1080/00913847.2018.1546105
9. Gay-Escoda C, Vieira-Duarte-Pereira Dm, Ardevol J, Pruna R, Fernandez J, Valmaseda-Castellon E. Study of the effect of oral health on physical condition of professional soccer players of the Football Club Barcelona. Med Oral Patol Oral Cirugia Bucal. 2011;e436–9. doi:10.4317/medoral.16.e436
10. Gallagher J, Ashley P, Petrie A, Needleman I. Oral health-related behaviours reported by elite and professional athletes. Br Dent J. 2019;227(4):276–80. doi:10.1038/s41415-019-0617-8
11. Buczkowska-Radlińska J, Łagocka R, Kaczmarek W, Górski M, Nowicka A. Prevalence of dental erosion in adolescent competitive swimmers exposed to gas-chlorinated swimming pool water. Clin Oral Investig. 2012;17(2):579–83. doi:10.1007/s00784-012-0720-6
12. Frese C, Frese F, Kuhlmann S, Saure D, Reljic D, Staehle HJ, et al. Effect of endurance training on dental erosion, caries, and saliva. Scand J Med Sci Sports. 2014;25(3). doi:10.1111/sms.12266
13. Gallagher J. ORAL HEALTH OF UK ATHLETES AND IMPACT ON PERFORMANCE. Br J Sports Med. 2017;51(4):320.3-321. doi:10.1136/bjsports-2016-097372.94
14. Gallagher J, Ashley P, Petrie A, Needleman I. Oral health and performance impacts in elite and professional athletes. Community Dent Oral Epidemiol. 2018 Dec;46(6):563–8. doi:10.1111/cdoe.12392
15. Ljungqvist A, Jenoure P, Engebretsen L, Alonso JM, Bahr R, Clough A, et al. The International Olympic Committee (IOC) Consensus Statement on periodic health evaluation of elite athletes March 2009. Br J Sports Med. 2009 Sep;43(9):631–43. doi:10.1136/bjsm.2009.064394
16. Needleman I, Gallagher J, Ashley P. What do we know about elite athlete oral health? Br Dent J. 2026 Feb 27;240(4):217–22. doi:10.1038/s41415-025-8909-7
17. Featherstone J. Dental caries: a dynamic disease process. Aust Dent J. 2008 Sep;53(3):286–91. doi:10.1111/j.1834-7819.2008.00064.x
18. Strużycka I. The Oral Microbiome in Dental Caries. Pol J Microbiol. 2014;63(2):127–35. doi:10.33073/pjm-2014-018
19. Featherstone JDB. The Continuum of Dental Caries—Evidence for a Dynamic Disease Process. J Dent Res. 2004 Jul;83(1_suppl):39–42. doi:10.1177/154405910408301s08
20. Jeukendrup AE. Carbohydrate feeding during exercise. Eur J Sport Sci. 2008 Mar;8(2):77–86. doi:10.1080/17461390801918971
21. Selwitz RH, Ismail AI, Pitts NB. Dental caries. The Lancet. 2007 Jan;369(9555):51–9. doi:10.1016/S0140-6736(07)60031-2
22. Hara AT, Zero DT. The Caries Environment: Saliva, Pellicle, Diet, and Hard Tissue Ultrastructure. Dent Clin North Am. 2010 Jul;54(3):455–67. doi:10.1016/j.cden.2010.03.008
23. Mulic A, Tveit AB, Songe D, Sivertsen H, Skaare AB. Dental erosive wear and salivary flow rate in physically active young adults. BMC Oral Health. 2012 Dec;12(1):8. doi:10.1186/1472-6831-12-8
24. Lussi A, Jaeggi T, Zero D. The Role of Diet in the Aetiology of Dental Erosion. Caries Res. 2004;38(Suppl. 1):34–44. doi:10.1159/000074360
25. Meurman JH, Ten Gate JM. Pathogenesis and modifying factors of dental erosion. Eur J Oral Sci. 1996 Apr;104(2):199–206. doi:10.1111/j.1600-0722.1996.tb00068.x
26. Bartlett DW. The role of erosion in tooth wear: aetiology, prevention and management. Int Dent J. 2005 Aug;55:277–84. doi:10.1111/j.1875-595X.2005.tb00065.x
27. Moazzez R, Bartlett D. Intrinsic Causes of Erosion. In: Lussi A, Ganss C, editors. Monographs in Oral Science [Internet]. S. Karger AG; 2014 [cited 2026 May 8]. p. 180–96. Available from: https://karger.com/chapter/doi/10.1159/000360369 doi:10.1159/000360369
28. Milosevic A. Sports drinks hazard to teeth. Br J Sports Med. 1997 Mar;31(1):28–30. doi:10.1136/bjsm.31.1.28
29. Mathew T, Casamassimo PS, Hayes JR. Relationship between Sports Drinks and Dental Erosion in 304 University Athletes in Columbus, Ohio, USA. Caries Res. 2002;36(4):281–7. doi:10.1159/000063927
30. Centerwall BS, Armstrong CW, Funkhouser LS, Elzay RP. EROSION OF DENTAL ENAMEL AMONG COMPETITIVE SWIMMERS AT A GAS-CHLORINATED SWLMMTNG POOL. Am J Epidemiol. 1986 Apr;123(4):641–7. doi:10.1093/oxfordjournals.aje.a114283
31. Abdelrahman HH, Ammar N, Hassan MG, Essam W, Amer H. Erosive tooth wear and salivary parameters among competitive swimmers and non-swimmers in Egypt: a cross-sectional study. Clin Oral Investig. 2023 Nov 4;27(12):7777–85. doi:10.1007/s00784-023-05367-7
32. Gleeson M. Immune function in sport and exercise. J Appl Physiol. 2007 Aug;103(2):693–9. doi:10.1152/japplphysiol.00008.2007
33. British Society of Periodontology. Basic Periodontal Examination (BPE) [Clinical Guidelines] [Internet]. London: British Society of Periodontology; 2019 Jan. Available from: https://www.bsperio.org.uk/assets/downloads/BSP_BPE_Guidelines_2019.pdf
34. Lam R. Epidemiology and outcomes of traumatic dental injuries: a review of the literature. Aust Dent J. 2016 Mar;61(S1):4–20. doi:10.1111/adj.12395
35. Lee-Knight CT, Harrison EL, Price CJ. Dental injuries at the 1989 Canada games: an epidemiological study. ET J. 1992 Oct;58(10):810–5. PubMed PMID: 1356606.
36. Soporowski NJ, Tesini DA, Weiss AI. Survey of orofacial sports-related injuries. J Mass Dent Soc. 1994;43(4):16–20. PubMed PMID: 9509008.
37. Kumamoto DP, Maeda Y. A literature review of sports-related orofacial trauma. Gen Dent. 2004;52(3):270–80; quiz 281. PubMed PMID: 15206262.
38. Gass M, Kühl S, Connert T, Filippi A. Dental trauma in showjumping – A trinational study between Switzerland, France and Germany. Dent Traumatol. 2016 Jun;32(3):174–9. doi:10.1111/edt.12242
39. Glendor U. Epidemiology of traumatic dental injuries – a 12 year review of the literature. Dent Traumatol. 2008 Dec;24(6):603–11. doi:10.1111/j.1600-9657.2008.00696.x
40. Labella CR, Smith BW, Sigurdsson A. Effect of mouthguards on dental injuries and concussions in college basketball: Med Sci Sports Exerc. 2002 Jan;34(1):41–4. doi:10.1097/00005768-200201000-00007
41. Knapik JJ, Marshall SW, Lee RB, Darakjy SS, Jones SB, Mitchener TA, et al. Mouthguards in Sport Activities: History, Physical Properties and Injury Prevention Effectiveness. Sports Med. 2007;37(2):117–44. doi:10.2165/00007256-200737020-00003
42. Palau S C. Awareness and Use of Mouthguards in Athletes with a High Risk of Oral Trauma in Barcelona. Dentistry. 2014;04(09). doi:10.4172/2161-1122.1000254
43. Schiffman E, Ohrbach R, Truelove E, Look J, Anderson G, Goulet JP, et al. Diagnostic Criteria for Temporomandibular Disorders (DC/TMD) for Clinical and Research Applications: Recommendations of the International RDC/TMD Consortium Network* and Orofacial Pain Special Interest Group†. J Oral Facial Pain Headache. 2014 Jan;28(1):6–27. doi:10.11607/jop.1151
44. Lobbezoo F, Ahlberg J, Glaros AG, Kato T, Koyano K, Lavigne GJ, et al. Bruxism defined and graded: an international consensus. J Oral Rehabil. 2013 Jan;40(1):2–4. doi:10.1111/joor.12011
45. Freiwald HC, Schwarzbach NP, Wolowski A. Effects of competitive sports on temporomandibular dysfunction: a literature review. Clin Oral Investig. 2021 Jan;25(1):55–65. doi:10.1007/s00784-020-03742-2
46. Saccò M, Meschi M, Regolisti G, Detrenis S, Bianchi L, Bertorelli M, et al. The Relationship Between Blood Pressure and Pain. J Clin Hypertens. 2013 Aug;15(8):600–5. doi:10.1111/jch.12145
47. Ohrbach R, Larsson P, List T. The jaw functional limitation scale: development, reliability, and validity of 8-item and 20-item versions. J Orofac Pain. 2008;22(3):219–30. PubMed PMID: 18780535.
48. Halson SL. Sleep in Elite Athletes and Nutritional Interventions to Enhance Sleep. Sports Med. 2014 May;44(S1):13–23. doi:10.1007/s40279-014-0147-0
49. Al-Jewair T, Shibeika D, Ohrbach R. Temporomandibular Disorders and Their Association with Sleep Disorders in Adults: A Systematic Review. J Oral Facial Pain Headache. 2021 Feb;35(1):41–53. doi:10.11607/ofph.2780
50. Smith MT, Wickwire EM, Grace EG, Edwards RR, Buenaver LF, Peterson S, et al. Sleep Disorders and their Association with Laboratory Pain Sensitivity in Temporomandibular Joint Disorder. Sleep. 2009 Jun;32(6):779–90. doi:10.1093/sleep/32.6.779
51. Ide M, Jagdev D, Coward PY, Crook M, Barclay GR, Wilson RF. The Short‐Term Effects of Treatment of Chronic Periodontitis on Circulating Levels of Endotoxin, C‐Reactive Protein, Tumor Necrosis Factor‐α, and Interleukin‐6. J Periodontol. 2004 Mar;75(3):420–8. doi:10.1902/jop.2004.75.3.420
52. Loos BG, Craandijk J, Hoek FJ, Dillen PMEW, Van Der Velden U. Elevation of Systemic Markers Related to Cardiovascular Diseases in the Peripheral Blood of Periodontitis Patients. J Periodontol. 2000 Oct;71(10):1528–34. doi:10.1902/jop.2000.71.10.1528
53. Peake JM, Neubauer O, Della Gatta PA, Nosaka K. Muscle damage and inflammation during recovery from exercise. J Appl Physiol. 2017 Mar 1;122(3):559–70. doi:10.1152/japplphysiol.00971.2016
54. Lilja M, Mandić M, Apró W, Melin M, Olsson K, Rosenborg S, et al. High doses of anti‐inflammatory drugs compromise muscle strength and hypertrophic adaptations to resistance training in young adults. Acta Physiol. 2018 Feb;222(2):e12948. doi:10.1111/apha.12948
55. Solleveld H, Goedhart A, Vanden Bossche L. Associations between poor oral health and reinjuries in male elite soccer players: a cross-sectional self-report study. BMC Sports Sci Med Rehabil. 2015 Dec;7(1):11. doi:10.1186/s13102-015-0004-y
56. Fernández-Real JM, Ricart W. Insulin Resistance and Chronic Cardiovascular Inflammatory Syndrome. Endocr Rev. 2003 Jun 1;24(3):278–301. doi:10.1210/er.2002-0010
57. Pessin JE, Saltiel AR. Signaling pathways in insulin action: molecular targets of insulin resistance. J Clin Invest. 2000 Jul 15;106(2):165–9. doi:10.1172/JCI10582
58. Needleman I, Ashley P, Fine P, Haddad F, Loosemore M, De Medici A, et al. Oral health and elite sport performance. Br J Sports Med. 2015 Jan;49(1):3–6. doi:10.1136/bjsports-2014-093804
59. Broad EM, Rye LA. Do current sports nutrition guidelines conflict with good oral health? Gen Dent. 2015;63(6):18–23. PubMed PMID: 26545270.
60. Edwards M, Ashwood RA, Littlewood SJ, Brocklebank LM, Fung DE. A videofluoroscopic comparison of straw and cup drinking: the potential influence on dental erosion. Br Dent J. 1998 Sep;185(5):244–9. doi:10.1038/sj.bdj.4809782
61. Hara AT, Zero DT. Analysis of the erosive potential of calcium‐containing acidic beverages. Eur J Oral Sci. 2008 Feb;116(1):60–5. doi:10.1111/j.1600-0722.2007.00513.x
62. Nordström A, Birkhed D. Preventive Effect of High-Fluoride Dentifrice (5,000 ppm) in Caries-Active Adolescents: A 2-Year Clinical Trial. Caries Res. 2010;44(3):323–31. doi:10.1159/000317490
63. Dodds MWJ, Hsieh SC, Johnson DA. The Effect of Increased Mastication by Daily Gum-chewing on Salivary Gland Output and Dental Plaque Acidogenicity. J Dent Res. 1991 Dec;70(12):1474–8. doi:10.1177/00220345910700120101
64. ADA Council on Access, Prevention and Interprofessional Relations; ADA Council on Scientific Affairs. Using mouthguards to reduce the incidence and severity of sports-related oral injuries. J Am Dent Assoc. 2006 Dec;137(12):1712-20; quiz 1731. doi: 10.14219/jada.archive.2006.0118
65. Stamos A, Mills S, Malliaropoulos N, Cantamessa S, Dartevelle J, Gündüz E, et al. The European Association for Sports Dentistry, Academy for Sports Dentistry, European College of Sports and Exercise Physicians consensus statement on sports dentistry integration in sports medicine. Dent Traumatol. 2020 Dec;36(6):680–4. doi:10.1111/edt.12593
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