You don’t need me to tell you how rubbish it feels to get out on the bike and hit the inevitable bonk when you haven’t paid attention to your fuelling. You also don’t need me to tell you how annoying it is when your dentist approaches you with statements like “try to eat less sugary things between meal times”, because as an athlete, that’s often not realistic in terms of fuelling your sport.
But oral health among athletes, amateur and professional alike, isn’t great. In fact, some studies suggest that being an athlete, automatically casts you way down on the leaderboard of good teeth. Dental decay, acid erosion and dental trauma are just a selection of the things we see more prevalently among those in the world of sports than across “normal” populations and getting a toothache is a sure fire way to hamper your performance in training and racing. But is there anything we can do to prevent it?
Well, I think there is. As a dentist and nutrition coach for amateur athletes, I’m used to adapting my advice to optimise health while still staying in line with what’s actually possible for athletes and here, I want to share a few top tips about how you can keep tooth decay away and avoid that dreaded emergency dental appointment…
What are the risks?
The mouth likes to keep itself at a healthy pH neutral range. Our teeth are made of mineral substance – namely calcium hydroxyapatite. This mineral, just like minerals occurring elsewhere in nature, are vulnerable to damage from acids. Acids in the mouth can come from a lot of places:
- Acid producing bacteria – these are the ones that produce dental decay. They digest carbohydrates in our food and turn them into acids, which create cavities.
- Extrinsic acids – these are the things we put in our mouth from outside e.g. citrus fruits, fizzy drinks.
- Intrinsic acids – these are the acids that cause damage from within the body e.g. stomach acid when vomiting or experiencing acid reflux.
The saliva in your mouth is the hero ingredient here. Saliva does a magical job at “buffering” all the acids that enter your mouth, to make sure you don’t find your teeth dissolving away before your eyes and also to protect the delicate soft tissues like your cheeks, lips and tongue. Every time you eat something and an acid environment is created, your saliva not only helps start to digest your food, but also helps you to taste it and wash it down and out of the mouth. It then helps, as quickly as it can through minerals contained in the saliva itself, to re-neutralise the mouth and return it to a neutral pH as fast as it can.
Why are athletes more at risk?
But as athletes, we can do a good job of challenging this system beyond its capacity. We have a high and frequent ingestion of carbohydrates for acid producing bacteria to digest, consume acidic sports drinks which naturally challenge the enamel of our teeth and we sometimes even push ourselves so hard we are sick… We also experience dry mouths and dehydration from our exertions, which limit the amount of saliva we have to combat the acidic environment we create.
All this means that compared with the average Joe, we’re likely to see way more acid showing up in our mouths and we’re likely to have less capacity to buffer it and recover from it. That means we’re more at risk from dental caries (a.k.a. tooth decay) and acid erosion, both of which can cause pain, sensitivity and more importantly, put the brakes on training!
Below, you can see an example of a “Stephan curve”. This is basically a graph showing the critical point at which teeth start to decay from acid. While the pH is important, what’s more important here is demonstrating how key frequency of occasions below that critical pH really impacts us.
You can see, that every time this person consumes a snack or meal, the pH in their mouth drops below the critical pH. This is normal. And under normal circumstances, the saliva buffers this action and the pH returns to normal levels after about 20mins or so, depending on the nature of the food or drink. However, when you’re munching your way consistently through lots of either acidic foods and drinks, or those containing sugars which are fermented by bacteria in the mouth to produce decay-causing acids, you can see the mouth simply doesn’t have time to recover. Think of it as doing a whole session of intervals without the proper recovery – you’re going to see some effects at the end and need some good recovery time! If you keep doing it, you’ll break!
So what can we do about it?
1. Up your Fluoride exposure: Fluoride has been consistently shown to be AMAZING when it comes to prevention of tooth decay. It not only strengthens the enamel and makes it more resistant to decay, but also helps inhibit acid producing bacteria AND can remineralise early decay before it turns into a cavity needing a filling. While most of us are using a fluoride toothpaste twice daily, it’s also really easy – and justified – to add in a fluoride mouth rinse somewhere else int he day. This could be after a long session on the bike or a race, where you’ve had to take on a consistent buffet of carbs to keep you rolling, or it could just be a habit to employ in the middle of the day to get an additional fluoride hit wherever you are. Rinses such as Colgate’s fluorigard or Sensodyne’s pronamel mouthwash come in at around £5 a bottle and are easy to keep in a locker or glove compartment for on the go enamel repair!
2. Timing Matters: If you can, try and think actively about when you’re eating during the day. Focus on good, nutritious healthy meals consisting primarily of whole foods (which tend to pose less of a threat to our mouths than more processed foods where sugars are easier for bacteria to access) and then top up with snacks around training where you need to. Try and stick to plain water, unsweetened milk, tea or coffee as your main drinks during the day and leave the carb drinks to the training sessions if that’s an option.
3. Stay Hydrated: Staying well-hydrated can help maintain saliva production and reduce the risk of dry mouth, which can contribute to tooth decay. On this note, you can also consider taking two bottles on your bike; one of whatever electrolyte or carb concoction you prefer, and one of plain water. After you’ve eaten a bar or snack or had a swig from your sports drink, just give your mouth a little rinse with water. It will help neutralise the acids in your mouth quicker and will also aid physical rinsing of food particles so they’re not sitting in between your teeth and providing a feast for decay causing bacteria!
4. Oral Hygiene: Brushing your teeth twice a day and flossing daily is crucial. If you consume an acidic drink or food, wait at least 30 minutes before brushing to prevent brushing away any enamel softened by acids.
5. See your dentist regularly: Studies have shown that one of the best ways to keep everything in check, is to make sure you’re seeing the dentist regularly, preferably every six months. They will not only be able to diagnose early warning signs of problems such as caries and erosion, but will also be able to provide specific treatments such as additional fluoride varnish to exposed areas of vulnerable teeth, perhaps additional fluoride products if required for additional protection and early interventions to avoid nasty toothaches that will stop you in your tracks.