The Significance of Oral Inflammation in Elite Sports: A Narrative Review

Abstract

Recently, there has been intense discussion about sports dentistry and potential interactions between oral health and athletes’ performance. This narrative review aims to provide a comprehensive overview of the available literature about oral inflammation in sports. For this purpose, it presents the most common types of oral inflammation (gingivitis, periodontitis, pericoronitis, apical periodontitis), and their prevalence in athletes. Both the impact of oral inflammation on performance and causes for oral inflammation in athletes are discussed by presenting current literature. Finally, international recommendations for dental care in sports are presented. Several studies stated a high prevalence of oral inflammation in athletes, especially of gingivitis (58–97%) and periodontitis (41%). Also, many athletes report oral pain (17–30%) and a negative impact of oral health on training (3–9%). Besides this, a systemic impact of oral inflammation is discussed: In periodontitis patients, blood parameters and physical fitness are changed. In athletes, associations between muscle injuries and poor oral health are reported. There are deficits in oral health behavior. Furthermore, systemic changes due to physical stress could influence oral tissues. Overall, complex bidirectional interactions between competitive sports and oral inflammation are possible. Regular dental examinations and prevention strategies should be implemented in sports.

Does the guideline-based physical activity level for cardiovascular health also benefit periodontal health?

“…We found that the possibility of periodontitis was higher in young adults with moderate intensity PA levels <150 min/wk, which is below the level suggested by the American guideline for cardiovascular health. 11 In addition, there were no additional benefits for the lower prevalence of periodontitis if the moderate intensity PA levels were over 300 min/wk. The benefits of PA on periodontitis may be offset by an increased risk of periodontitis in highly fit individuals, i.e., athletes.…”

“…The benefits of PA on periodontitis may be offset by an increased risk of periodontitis in highly fit individuals, i.e., athletes. 11 …”

“…Athletes, particularly long-distance runners, would experience dry mouth due to mouth breathing and fluid loss, which increase periodontitis burden. 11 In addition, higher PA levels also decrease immunoglobulin A (IgA) concentration in saliva and increase serum pro-inflammatory markers, such as tumor necrosis factor alpha (TNF-α), interleukin (IL)-1β, IL-6, IL-8, IL-10 and C-reactive protein, and stress hormones, e.g., cortisol and adrenaline, 24 , 25 , 26 , 27 , 28 which will temporarily reduce cellular defense. 29 These negative reactions to intensive physical exercise may favor oral infections (open window theory).…”

“…Greater levels of PA have been demonstrated as a protective factor of periodontitis 8 or not as a predictor of periodontitis 9 , 10 in the general populations, and in contrast as a risk factor of periodontitis in elite athletes. 11 …”

Physical activity as a modifiable risk factor for periodontal disease

“…From a behavioral perspective, athletes may place greater focus on improving physical fitness and ignore other aspects of health including oral care. Periodontal disease could arise due to poor compliance with dental appointments and oral hygiene instruction (64), as well as frequent consumption of carbohydrate-rich sports drinks which have been associated with higher BPE scores (21). Finally, as several of the studies on elite athletes' periodontal conditions collected data in the lead up to or during high profile athletic events such as the Olympics (53, 55) and regional championships (52), the impact of psychological stress in the athletes surveyed should be considered when interpreting these results.…”