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.

Keywords: athletic performance; dentistry in sports; elite athletes; gingivitis; oral health; periodontitis.

Fig. 1

Clinical and radiographic impressions of different types of oral inflammation: Gingivitis ( a – c ), (marginal) periodontitis ( d – f) , pericoronitis ( g – j ), apical periodontitis ( k – n ). a – c ) Gingivitis: Redness and swelling (S) of the gingiva indicate acute inflammation and probing or even toothbrushing often results in bleeding ( b , c ). Note the causal dental plaque-biofilm (B) at the gingival margin and the dental calculus (C). d – f ) (Marginal) Periodontitis: The inflammation of the tooth-supporting tissues (periodontium) leads to its destruction. The resulting attachment loss is clinically visible as resulting recessions (R) with exposed root surfaces ( d , f ). The corresponding radiography ( e ) allows the evaluation of the extent of the interdental bone loss. g – j ) Pericoronitis: Remaining tissue partially covers the wisdom tooth (W) and leads to a niche ( g ). The corresponding radiography ( h ) shows a correct vertical position but an anatomic position in the ascending part of the mandibula. Also, a clinical unerupted wisdom tooth (W) can lead to niche and subsequent inflammation ( i ). The radiography ( j ) shows the connection to the oral cavity and an angular dislocation that inhibits the eruption. k – n ) Apical periodontitis: The typical radiographic manifestation of chronic apical periodontitis ( k ) shows a clearly visible periapical bone lesion (L). After dental trauma, apical resorption (D) can occur ( l ). An intraoral visible fistulae (F) drainages pus from an exacerbated apical inflammatory process ( m ). The radiography ( n ) shows resorption (D) of the root apex of the tooth with insufficient root canal treatment. Source for Fig 1d : Dr. Elena Günther. Source for Fig 1g and Fig 1m : Tilman Riemer.

Fig. 2

a and b Example of periodontal damage in young years: This young, systemically healthy, active sporting woman showed localized severe periodontitis in her early 20s. ( a ) Clinical situation with only slight signs of recession (R) mesial of 46. The external appearance may seem healthy at the first glance. A screening by probing revealed the periodontal pocket. ( b ) The radiograph shows the extent of periodontal damage: The vertical bone defect (BD) mesial of 46 reaches up to the middle of the root.

Fig. 3

The complex network of possible mechanisms of a bidirectional interaction of competitive sports and oral inflammation