Dental health: The forgotten factor that can worsen your performance
In the pursuit of squeezing out every second or every watt, athletes pay close attention to countless variables, including the so-called “marginal gains”: structured training, carefully planned nutrition, or the latest equipment on the market. However, basic health factors that can also have a major influence on sports performance are often overlooked. One of the most neglected is oral health.
Poor oral health in athletes
Although athletes can generally be an example of good health, they are not usually a role model when it comes to oral health in particular. In fact, numerous studies show that athletes have a high prevalence of oral health problems. For example, a study carried out on more than 300 athletes during the London Olympic Games revealed that 55% of athletes had dental caries, 45% had enamel erosion, and a large majority showed gum disease, with 76% of cases involving gingivitis and 15% periodontitis.1
As a recent review summarizes, there are multiple risk factors in athletes that can affect their oral health.2 One of the most widely discussed factors today is the high consumption of simple carbohydrates. In an effort to increase carbohydrate intake, athletes consume large amounts of gels, isotonic drinks, and simple carbohydrates in their diet, which can damage tooth enamel and cause cavities. This happens because bacteria in the mouth break down these sugars and increase the acidity of the oral cavity, thereby damaging dental health. However, carbohydrate consumption is not the only risk factor. This is compounded by the phenomenon of dry mouth, caused by forced mouth breathing during intense exercise, which reduces salivary flow and eliminates its protective and acid-neutralizing function.2 In addition, after very demanding training sessions, temporary immunosuppression often occurs, which may facilitate the onset of periodontal infections.2
Impact on sports performance
Although poor dental health is already a problem in itself, what many athletes do not know is that it can also affect their sports performance. In fact, a meta-analysis of 8 studies concluded that athletes with periodontitis have a 55% higher risk of reporting a negative impact on performance during training or competitions.3 Furthermore, various studies have shown that these conditions alter physiological parameters that are crucial for sporting success. One study analyzed the physical fitness of a group of athletes according to their periodontal health.5 Those who showed signs of periodontitis had a 5.7% lower maximal oxygen consumption compared with athletes with healthy gums (55.9 versus 59.3 mL/min/kg on average).4 Similarly, in cycle ergometer tests, those with lower levels of gingival inflammation achieved higher maximum power outputs (5.0 W/kg versus 4.4 W/kg on average).4
Mechanisms involved
The pathways through which an infection or a cavity affects performance are diverse.5 Processes such as periodontitis generate systemic inflammation, which can interfere with muscle recovery processes and alter metabolism during exercise, worsening glycemic control and insulin sensitivity.5 Likewise, alterations in the bacteria of the oral cavity cause dysbiosis, which affects the overall microbiota, essential for immune modulation and nutrient absorption.5 Even from a psychological point of view, ongoing dental pain and discomfort reduce the quality of rest, decrease concentration, and increase perceived exertion.
Practical recommendations
In view of all the evidence mentioned above confirming the relevance of oral health for athletes, surprisingly, there are still few studies that have evaluated strategies to mitigate these adverse effects in this population. However, as a recent review published in the British Dental Journal summarizes,2 considering the evidence in the general population (although it is not specific to athletes) and common sense, we can recommend some strategies. For example, one of the most recommended strategies is to rinse the mouth with water after consuming gels or isotonic drinks during training, in order to dilute the concentration of sugars that remain in the mouth. On the other hand, it is also advisable to maintain proper hydration to preserve salivary flow, which, as mentioned, can decrease not only due to heat but also due to forced mouth breathing. In addition, other strategies such as regularly using fluoride toothpaste can help prevent cavities and other problems.
Conclusions
Taking care of your mouth should be part of every athlete’s invisible training. Adopting simple measures such as those mentioned above, and attending routine dental check-ups, are some of the fundamental strategies for protecting oral health. Before investing in marginal gains, taking care of your gums and teeth is an essential condition for not losing performance, and above all, health.
References
1. Needleman I, Ashley P, Petrie A, 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. Published online 2013:1054-1058. doi:10.1136/bjsports-2013-092891
2. Needleman I, Gallagher J, Ashley P. What do we know about elite athlete oral health? Br Dent J. 2026;240(4):217-222.
3. Ferreira RO, Frazão DR, Martins MK, et al. Periodontal disease and sports performance: a systematic review and meta-analysis. Res Sport Med. 2024;32(5):767-786. doi:10.1080/15438627.2023.2235048
4. Merle CL, Richter L, Challakh N, et al. Associations of Blood and Performance Parameters with Signs of Periodontal Inflammation in Young Elite Athletes — An Explorative Study. J Clin Med. Published online 2022.
5. Hollander K, Eshkol-yogev I, Zech A, Buti J, Needleman I. The influence of oral health on sports performance : an interdisciplinary perspective. Br Dent J. 2026;240(4):277-283.
