Inflammation has become a big buzzword in the health and fitness industry, and rightly so in many circumstances: Systemic inflammatory effects can significantly impact endurance, recovery, and overall performance. We are learning to utilise inflammation to improve recovery and how things like minor sports injuries might actually benefit from allowing cells and processes involved in natural inflammation to aid healing. We’re also learning how much we can influence our own systemic and chronic inflammation levels and what various impacts this can have on us as healthy humans and importantly, as athletes.
From my perspective as a dentist, one of the most chronic and common areas of inflammation, is in the mouth in the form of gum disease or inflammation of the gums. The bad news is, this can have a plethora of effects on your health and performance…but the good news is, you can probably solve most of these with the power of the little stick and bristles gadget sitting in your bathroom cabinet!
Why are your gums bleeding and why is it a problem?
Gum disease – technically known as periodontal disease – is a chronic inflammatory condition affecting the gums and supporting structures of the teeth. The basics of the process are that your mouth is FULL of bacteria, some a little friendlier than others. We all carry different levels of “good” and “bad” bacteria. What we know is, that when the bad bacteria are allowed to breed freely, they begin to form sticky little communities around the gums which your body – rightly so – doesn’t like. The immune system kicks into action detecting the “infection” and starts trying to get rid of it. The sticky little bacterial communities are difficult for you to get to to remove and any areas where fibrous foods can’s slough through the bacteria strongholds, or areas where saliva can’t flush them out adequately, will result in areas where the body forms an attack. Unfortunately, the body’s only mechanism of defence is to create inflammation which progresses in two distinct forms when it comes to diagnosing the level of inflammation in your gums:
- Gingivitis: Mild inflammation of the gums, often reversible with good advice and lifestyle measures and/or professional dental cleaning.
- Periodontitis: More advanced inflammation where the body’s response is to eat away at the bone and gums around the teeth that hold them in place in a desperate bid to remove the bacteria hidden in these spots. This stage can result in wobbly teeth, teeth falling out, severe recession of the gums and other nasty symptoms and side effects. It often needs treatment over several appointments with a dentist or hygienist and will need lifelong maintenance, monitoring and review.
Here’s where it gets serious for athletes: Periodontal disease isn’t just confined to the mouth. The infection triggers a systemic inflammatory response, releasing pro-inflammatory cytokines like interleukin-6 (IL-6), tumor necrosis factor-alpha (TNF-α), and C-reactive protein (CRP) into the bloodstream. Now that all sounds dull and nerdy but these markers are known to impair vascular function, reduce oxygen delivery, and negatively affect recovery and performance. YOUR GUM DISEASE IS AFFECTING HOW WELL YOU’RE DELIVERING OXYGEN TO YOUR MUSCLES GUYS!!
According to research carried out at the London 2012 Olympics, 91% of athletes competing were walking around with some degree of inflammation varying from gingivitis right through to full blown periodontitis. This is staggering when we consider what the impact might be on performance…
VO2 Max and Systemic Inflammation: How Oral Health Fits In
We all know VO2 max; it’s what you’re trading instead of Pokemon cards with your team mates these days or marvelling over when you’re snooping through someone else’s training stats. V02 max, or maximal oxygen uptake, measures how efficiently your body can use oxygen during intense exercise. It’s a cornerstone for assessing aerobic fitness. But systemic inflammation from chronic gum disease can reduce VO2 max by interfering with several key processes:
- Reduced Vascular Function: Inflammatory cytokines can impair the endothelium (the inner lining of blood vessels), reducing nitric oxide (NO) production. Nitric oxide is crucial for vasodilation and blood flow regulation, which are vital for oxygen delivery to muscles – it’s the thing you’re scoffing all that beetroot juice for.
- Mitochondrial Dysfunction: Inflammatory mediators can also interfere with mitochondrial function, reducing energy production and oxygen utilisation at the cellular level.
- Increased Fatigue and Recovery Time: Elevated inflammatory markers have been associated with increased perception of fatigue and slower recovery, limiting training capacity and adaptation.
There is more and more specific research being done in this area and let me tell you, the results are not by any means insignificant. While evidence currently is only correlative and not causative (a much harder link to prove), I think it is only a matter of time before we see that evidence appear…
What This Means for Athletes
If you’re an endurance athlete, maintaining your utilisation of oxygen and your efficiency with it is crucial – you already know that! Chronic low-grade inflammation from untreated gum disease can be a performance limiter, reducing your aerobic capacity and slowing your recovery time. Even if you feel healthy, underlying inflammation can act as a silent drain on your performance potential:
- Reduced cardiovascular efficiency: Impaired blood flow means less oxygen gets to working muscles.
- Longer recovery: Inflammation prolongs the repair process, delaying muscle recovery and adaptation.
- Increased fatigue: Higher levels of inflammatory markers are linked to an increased perception of fatigue.
You’re spending so much time and money on trying to really maximise these things, and yet if you’re not brushing your teeth properly, or you’re not getting the treatment you need from your hygienist, you’re really missing out on the low hanging fruit!
Steps to Optimise Oral Health for Performance Gains
The good news? Improving your oral health can reduce systemic inflammation and potentially improve your VO2 max and recovery. Here’s how to get started:
- Brush Twice Daily (Correctly)
Electric brushes often are advantageous compared with the average Joe’s use of a manual toothbrush, but the evidence strongly supports oral B’s oscillation-rotation technology (please note I am NOT affiliated with Oral B in any way, they just make the most effective toothbrushes!). The new iO brush really is the best one I’ve used yet and anecdotally it seems to be making a massive impact on my patients’ health. If you’re using a manual brush (I know a lot of people prefer to travel with manual brushes, worrying about keeping brushes charged etc), then make sure you get the right advice from your dentist or hygienist about how to use it correctly. It sounds silly, but we’re usually taught by our parents how to brush our teeth, who were taught by their parents…etc. When has a professional ACTUALLY ever stepped in and shown you?! It can make a massive difference… - Floss Daily
Flossing removes bacteria between teeth that brushing alone can’t reach. It’s non-negotiable if you want to reduce gum inflammation. But remember floss isn’t the only option; you can ask for advice on other options such as floss picks or interdental brushes. Speak to your dental professional about what method might work best for you and ask for a demo to make sure you’re using the method correctly. I am also seeing some positive results with waterpiks, although my preference is still for the good old fashioned methods for now… - Regular Dental Check-Ups
Aim for at least two check-ups per year. Your dentist can spot early signs of gum disease before it becomes a problem. As an athlete, you’re high risk and so catching problems early could not only save you a lot of time, money and pain in the long run, but it could also be a really easy way to avoid dips in performance caused by undiagnosed inflammation you didn’t even know you had! - Anti-Inflammatory Nutrition
Diet plays a role in reducing overall inflammation. Load up on omega-3 fatty acids (salmon, walnuts, flaxseeds), antioxidants (berries, leafy greens), and whole foods to make sure you’re really providing a supportive environment for your own body’s immune system and inflammatory levels.
Remember that solutions and improvements over the long term are NEVER about one thing in isolation. Brushing your teeth well, visiting your dentist and using floss won’t solve everything if you’re not getting the nutrients you need from a well balanced diet. Likewise, you’re unlikely to jump from age group mid-packer to olympic athlete purely from adding an extra brushing episode in once daily. But consider the overall positive impact of incorporating some of these ideas into your daily routine and see what it looks like in a few months time eh?
Oral health is a performance tool.
Oral health isn’t just about having a nice smile for the finish-line photo. For athletes, it’s an essential part of maintaining optimal performance and recovery. The link between periodontal disease, systemic inflammation is well-established. The truth is, we don’t know just how much you could be sacrificing in terms of times on the track, purely from neglecting your gums!
Taking care of your gums is simple, but the impact on your performance can be profound. Don’t let chronic inflammation hold you back – a little prevention can go a long way toward maximising your potential.