Why worry about oral health?

As an athlete, the dedication of training, eating well, staying hydrated and meeting nutritional goals are all aimed to achieve success and performance. Athletes consult with their Sports Physicians and Physiotherapists for physical health, their Sports

Dietitian for a performance nutrition edge, but oral health is often overlooked. While oral health may not directly affect your day-to-day performance, or win you this year’s Best & Fairest, the consequences of poor oral health can catch up with you in the near future.

Dental professionals have been concerned for some time about increasing rates of dental problems amongst active people of all ages from pre-school children through to adults. The outer surface of a tooth is susceptible to acids that can result in dental decay, dental erosion or both. Dental erosion occurs when the hard, outer covering of teeth (tooth enamel) weakens exposing the softer, underlying tooth material (dentine) to abrasion. Recent reviews of dental health in elite athletes showed that they are at higher risk of dental caries and erosion.

In some cases, the increased rate of erosion has been linked to consumption of sports products, including sports drinks, intra-workout supplements and carbohydrate gels or sports lollies. So although these products can positively impact performance they need to be used carefully or you may be forced to reconsider your smile!

What causes dental erosion?

Several factors associated with exercise can cause dental erosion. These include:

 Acidity of food/fluids

Tooth enamel is composed of minerals, including calcium and phosphate. Both enamel and dentine are weakened and dissolved by acid (at pH lower than 5.5). The enamel layer in primary teeth (the first set of teeth in children) is thinner and less mineralised making them particularly vulnerable. The pH of commercially available sports drinks is 2.4 – 4.5. Many intra-workout supplements also have ingredients such as malic acid or citric acid included, both of which can be damaging to tooth enamel leading to dental erosion. Soft drinks (pH 2.5 – 3.6) and fruit juices (pH 3.4 – 3.6) can also be a concern for your teeth, and the added sugars further can increase risk of decay. Sports gels often include ingredients such as citric acid or malic acid can help to create a tart flavour to gels while sodium benzoate or potassium sorbate act as preservatives to keep the product shelf-stable. These ingredients can reduce the pH (increase the acidity) of the gels (pH 3.5 – 4.2) increasing the potential for dental erosion.

Frequency and duration of exposure to acidic products

Saliva neutralises acids and provides calcium and phosphate to remineralise tooth enamel. Frequent sipping of sports drinks, intra-workout supplements or soft drinks increases the contact time that teeth are exposed to an acidic environment making them more ‘vulnerable’ to erosion. Swilling or rinsing your mouth with sports drinks or intra-workout supplements also increases exposure time and therefore increases risk of erosion. Research indicates that athletes with higher training volumes have increased risk of dental caries or erosion due to their more frequent consumption of food or fluids that may potentially damage teeth. Chilled drinks will cause less erosion than those at room temperature.

Sugar content

Cola drinks, sports drinks, intra-workout supplements, energy drinks, carbohydrate gels and sports lollies (and any other type of food which may be “sticky” e.g. honey) are sources of sugar in a form that adheres to teeth more than saliva and provide a ‘food’ for additional acid production by oral bacteria, increasing risk of dental decay.

Decreased salivary flow

Saliva plays a vital role in protecting teeth. It dilutes and clears liquids at the tooth surface. It neutralises acids in the mouth and provides a mineral source including calcium and phosphate for remineralisation (enamel hardening). Dehydration is a common issue for many athletes and causes the mouth to become dry, reducing salivary flow which increases the potential for tooth erosion and decay.

Common sports products that may contribute to dental erosion

Sports Drinks

Sports drinks can be a concern for oral health for a number of reasons. Not only are they acidic and high in sugar (carbohydrate), active people also tend to sip frequently on sports drinks during exercise (rather than gulping all at once) increasing the time that teeth are exposed and vulnerable to decay and erosion.

Intra-workout supplements

Intra-workout supplements are often overlooked as a potential cause of tooth decay. However, the addition of acidic ingredients as well as the fact that people sip frequently on these over a training session makes them a potentially concerning product for your teeth.

Sports gels or lollies

Sports gels or sports lollies are highly concentrated forms of sugar (carbohydrate) that have the potential to “stick” to your teeth after eating them, which can lead to dental decay. They can also contain ingredients that increase the acidity of the gel further increasing the risk of erosion to regular users of the product.

Signs of dental erosion

• Loss of the surface of the tooth leading thin enamel, especially on the edges of the front teeth – often causing chipping.
• Signs of dental erosion on the back teeth include the formation of depressions on the biting surface of the teeth.
• Fillings may start to become more prominent if the surrounding tooth surface is dissolving away due to erosion.

Common dental myths

The “Water Chaser”

A mouthful of water following a mouthful of sports drink (also called a “water chaser”) does not prevent dental erosion. Water can help to flush some of the solution away but most damage to the teeth has already been done at the time of ingestion, so it is best to avoid frequent consumption.

Brushing makes it OK?

Brushing teeth within 60 minutes of consuming sports drink, soft drink or intra-workout drinks can cause further damage as the tooth surface is still soft. The frequent use of highly abrasive toothpastes (e.g. some whitening toothpastes) may also result in the removal of the outer layer of tooth enamel.

Minimising dental problems

For children and low intensity sports

• Tap water is appropriate for maintaining hydration.
• If carbohydrate is needed, food options such as bananas are a good choice

For higher intensity and/or prolonged exercise

• If sports drinks, intra-workout supplements or de-gassed cola drinks are required; these fluids should be used carefully.
• Foods rich in calcium and phosphate (like milk, cheese and yoghurt) can help to remineralise the tooth surface.
• Specialised dental products such as neutralizing products, fluoride varnishes, gels or rinses, remineralising agents such as CPP-ACP added to chewing gum, lozenges, mouthwashes can help to remineralise tooth surfaces.
• Bicarbonate and calcium can also be added to drinks to reduce their erosive potential but may also affect the taste and palatability.

Other tips

• When preparing sports drinks from powders, make them up correctly with cold water. Less water than specified will increase the concentration of the sugar which may lead to a more syrupy beverage that may be more damaging to your teeth.
• Avoid holding or swishing sports drinks, intra-workout drinks or soft drinks in your mouth.
• Drinking via a straw (if possible) also reduces contact with teeth.
• Don’t rinse your mouth with sports drink, rinse with water instead.
• When using carbohydrate gels or lollies, drink water instead of sports drinks to dilute the concentrated sugar content.
• Avoid dehydration to lower risk of dental decay from reduced salivary flow.
• Teeth brushing should be delayed for at least 60 minutes after consuming sports drink, intra-workout drinks or soft drinks to enable the tooth surface to re-harden.
• Avoid consuming acidic foods or beverages immediately before bed.
• Discuss your training and hydration regime with your dentist. A regular dental review will detect early damage and offer preventive advice.