It’s not often you can say you’re in better shape than an Olympic athlete. But an American adult is half as likely as an Olympian to have cavities, based on data from the CDC and from a 2013 study of athletes competing in the 2012 London Olympics. And three quarters of these Olympians had gingivitis.
Of course, these athletes are set apart from the rest of us by the demands of Olympic-level training. Thirty percent of the athletes studied had received a blow to the mouth, jaw or face. And the average person doesn’t need an Olympic marathoner’s high-carb diet or sports drinks, which can contribute to tooth decay and other problems.
Professor Ian Needleman, who co-authored the 2013 study, explained the additional risk factors Olympic athletes face in an interview with Ars. Needleman, from the Center for Oral Health and Performance at the UCL Eastman Dental Institute in London, noted that “there is good evidence that intense exercise challenges immunity.” Prolonged exercise also leads to dryness in the mouth, he said, “and we have very good data showing that dehydration reduces saliva’s protection” against tooth decay, dental erosion and gum disease.
What is surprising is that athletes with these risk factors for poor oral health do not have better dental care, especially given the vast support systems Olympic athletes enjoy, at least in wealthy countries. Nine percent of the roughly 300 Olympians studied in 2012 had never even visited a dentist.
Another surprising finding regarding Olympic teeth is that poor oral health is universal. As Needleman, who continues to research the oral health of Olympic athletes, said, “We believe this is not fundamentally a question of socioeconomic division.” Needleman also found no major differences between Olympic athletes from developed and developing countries.
If true, this finding contrasts sharply with the situation for the general public, where social factors such as race, age and marital status are all linked to differences in the condition of people’s mouths.
Why would this be? Needleman pointed out that “athletes following high-intensity training programs may struggle to access other services that are not offered.” While medical care can be strong, dentistry is often neglected. So “athletes may not find time, or may not prioritize time,” he said for oral health. Affordability can also be a concern.
In the US, the Academy for Sports Dentistry (ASD) took note of the findings of the London Games. The ASD developed a proposal to the US Olympics Committee (USOC) where interested dentists in the ASD network would voluntarily offer their services to the nation’s top 1,000 elite athletes. About 30 percent of the ASD network, or 125 dentists, applied; they have since treated more than 350 athletes.
The president of ASD, Pennsylvania-based dentist Rick Knowlton, explained the motivation for these volunteers. “If we can help these athletes be the best they can be,” he said, “it’s great to be able to give back to our country and to our athletes.” Knowlton estimated that about 95 percent of the women’s Olympic hockey team has gone through his practice for treatments ranging from repairing knocked-out teeth to root canals.
Such treatments can make a difference to performance. Infection and pain from dental problems have long been shown to affect the performance of at least some Olympians. Knowlton pointed out that even minor health issues can make the difference between Olympic gold and disappointment. With oral infections like gingivitis, for example, “You have athletes who are in peak physical shape… but the reality is they’re not firing on all cylinders because their bodies are fighting infection.”
He also sees more unusual sports dental needs. Knowlton said one of the Paralympians seeking dental help from the USOC was an archer who used his teeth to shoot. When he damaged his teeth, he also lost his ability to compete.
Oral health and public health
The fact that a volunteer program is necessary for elite athletes to receive basic dental care in the world’s most successful Olympic country suggests greater problems in accessing health care. Yes, some sports administrations overlook oral health. But there is also the problem at the national level that dentistry is not included in health care systems. In the US, dental services are generally not covered by Obamacare or Medicare, and dental benefits are largely excluded from health insurance.
Even in countries with public healthcare, such as Canada and the UK, dental care is not included as standard. So perhaps it is not surprising that for Olympic athletes dentistry is often seen as an elective rather than essential.
While the wider social issue of access to dental care is a thorny one, Olympic athletes can take a few basic steps to keep their mouths healthy. First, according to Needleman, “It’s essential that they get a screening done at least twice a year.” Using high fluoride toothpaste can also help strengthen teeth, especially helpful for Olympic marathoners, triathletes and other endurance athletes.
Knowlton emphasized the importance of state-of-the-art custom laminated mouthguards. He said most US Olympic athletes use standard drugstore models, “but those mouth guards are absolutely worthless when it comes to protecting athletes from dental injuries.” Better mouth guards can provide better balance and support, leading to less risk of head trauma.
These recommendations are relatively inexpensive to implement; the mouthguard recommended by the ASD only costs about $25. Keeping oral care simple is partly a matter of pragmatism when it comes to Olympic athletes. As Needleman explained, “We have to be realistic and understand the pressures they live under.”