Research shows a direct link between oral health and sports performance. Thus, Annimari Korte, a Finnish Olympic athlete, finds it disappointing that sports bodies such as her home country’s Olympic Committee do not support the oral health of competitive athletes like they support general health by paying for medical and physiotherapy services. Even though good oral health is known to improve sports performance and results. 

– Throughout the years I have represented Finland as a competitive athlete, there has been no official talk about the importance of oral health in top performances, says Annimari Korte, a top-performing hurdler.

Annimari believes insufficient information is the most significant reason official sporting organisations do not support their athletes' oral health more visibly.

– I hope this situation will change. Studies have shown that oral problems such as gingivitis and periodontitis have been shown to reduce performance significantly, says Annimari.

Top sport is a risk factor for oral health

Research indicates that elite sport is one of the most significant risk factors for the onset of oral diseases. According to one study, caries is found in up to 70% of competitive athletes, dental erosion in almost 40% and severe gum disease, periodontitis, in up to 15% of top athletes1.

Furthermore, studies show that the oral health of athletes appears to be poor in a wide range of sports. Various underlying medical conditions can hamper training results and impair sporting performance; oral infectious disease is no exception.

Concerns about the oral health of athletes are nothing new. For example, during the 2004 Athens Olympics, the second most requested health service for athletes after physiotherapy services was dental care2. Meanwhile, at the 2012 London Olympics, it was noted that Olympic athletes had poor oral health. Up to 55% of athletes had high caries levels, 76% had gingivitis, and 14% had periodontal disease3. 

One study examined the oral health of top Dutch athletes before the Rio 2016 Olympics. This study found that almost 50% of top athletes needed regular dental care and suggested that oral health screening, included in the overall preventive healthcare of elite athletes, is essential to ensure that athletes are fully healthy during competitions such as the Olympic and Paralympic Games4.

Dental Reasearch notes that oral health is not part of most sport and exercise or nutrition curricula or integrated within athlete health strategies. Consequently, the importance of good oral health is not fully understood despite the clear link between good oral health and athlete performance.

Inflammatory oral diseases such as gingivitis and periodontitis are common in top athletes. Oral diseases such as gingivitis and periodontitis have been reported to harm the performance of athletes. One reason is the pain and discomfort associated with oral diseases, making concentrating difficult and hampering training results. Links have been reported between muscle injuries and poor oral health in athletes.

There are many possible reasons for the high prevalence of inflammatory oral diseases in competitive athletes. Physical strain is one of the most important. Heavy training increases the body's stress levels, which directly affect oral health and susceptibility to the onset of various gum diseases. Physical exertion affects the composition of saliva during exercise and reduces its secretion5. Frequent oral breathing during exercise and dehydration further contribute to dry mouth. All these factors predispose to tooth decay and enamel erosion and contribute to the onset of inflammatory oral diseases.

Saliva secretion has a variety of effects on dental health. Saliva prevents decay by restoring the pH of the oral cavity from acidic to neutral after eating and by helping to restore minerals dissolved by acids to the tooth surface. Saliva also removes 2-4 grams of microbes daily from the mouth and tooth surface to the digestive tract.

Dietary choices also have a significant impact on the oral health of athletes. Rigorous training programmes require regular eating, supplemented by 'sports nutrition' such as carbohydrate gels and bars consumed during training. This strains oral health by increasing the number of daily acid attacks in the mouth.

A healthy mouth is an integral part of overall well-being

Annimari Korte held the Finnish record in the 100m hurdles 2019-2023. She has also represented Finland several times in world championships. However, she has not had an easy career, as a bout of illness forced her to take a five-year break from competition in 2012. However, the health challenges taught Annimari the importance of overall well-being, including good oral health.

According to Annimari, the Finnish Olympic Committee covers as part of its comprehensive health package visits to a doctor and physiotherapist, but not, for example, visits to a dentist or oral hygienist.

– Regular oral health professional visits would help detect oral health problems early. For example, severe and often asymptomatic periodontitis can be very detrimental to an athlete's overall health and well-being, says Korte.

– At least primary dental care should be covered for competitive athletes, as it affects their overall health and sporting performance.

Juuso Simpanen, a trail runner turned professional, echoes Korte's views on the importance of oral health for athletes aiming for the top.

– Only a fully healthy athlete can achieve top results. If your mouth is not in good shape, it will also hurt your results, says Simpanen.

As an endurance athlete, Simpanen says he eats very often to meet the high-energy demands of training.

– Consuming high amounts of energy exposes my teeth to constant acid attacks. That's why I pay special attention to my oral health. I brush my teeth morning and evening, floss and use antibacterial photodynamic Lumoral-treatment regularly, says Simpanen.

In Simpanen's opinion, support for professional athletes to maintain their oral health would be very welcome.

– At least annual dental check-ups at the dentist would be worthwhile, and why not guide athletes in using new, scientifically proven, effective dental methods? This would prevent many infections in the mouths of top athletes. This would also reduce inflammation, injuries and illnesses in athletes.

– Only a fully healthy athlete can achieve top results. If your mouth is not in good shape, it will also hurt your results, says Juuso Simpanen.

Gingivitis is a severe inflammatory disease

Athletes must get their bodies in the best possible condition to reach the top. Extensive research shows that dental and oral bacteria are linked to many chronic diseases of the body. In addition to heart disease, oral diseases are linked to lung disease, diabetes and metabolic problems in healthy people.

Periodontal disease is a long-standing inflammation of the gums. Over time, the inflammation damages the attachment tissue of the teeth, causing the collagen fibres that hold the teeth to the jawbone to break and, in the worst case, lead to tooth loss. Early signs of periodontal disease include reddened and swollen gums, bleeding of gums and bad breath.

Inflammation of the gums causes low-grade inflammation in the body, which is linked to vascular health and the performance of athletes. Oral bacteria lingering on tooth surfaces and gum pockets are spread throughout the body when teeth are brushed and food is chewed. Even asymptomatic oral conditions can affect the health of the whole body.

– Statistics show that people with a healthy mouth live longer. Each missing tooth reduces life expectancy. This is far too little talked about, says Tommi Pätilä, a specialist in cardiac and organ transplant surgery at HUS New Children's Hospital. He is one of the developers of the antibacterial Lumoral method.

According to Pätilä, it is estimated that up to two out of three people over the age of 30 suffer from periodontitis. This common gum disease can lead to tooth loss if left untreated - but it is also linked to severe heart events. According to a study, a first heart attack is 30% more common in people with periodontal disease than in healthy people of the same age6.

Effective oral hygiene prevents oral disease

According to Simpanen, there is minimal discussion among athletes and sports managers about the risk factors for oral health in elite sports. However, there is good reason to do so.

– During long training sessions and intense competitions, drinking sports drinks and eating energy gels puts teeth and gums under strain. Scientific studies also show this, Simpanen admits. 

At his worst, Juuso says that in a 20-hour race, he eats or drinks something sugary every 15-20 minutes throughout the race.

– In addition, almost every week, I do one long training session of 4-8 hours, where I also practice taking energy and sports drinks like in the race.

Juuso says he takes oral health seriously. He takes care of his teeth by brushing twice daily and regularly cleaning his interdental spaces, as specialists recommended. For the last eight months, he has also regularly used a new oral care device based on antibacterial photodynamic therapy7.

– It is crucial for endurance athletes to take care of their oral health outside training and competition, as sports drinks and energy gels are consumed heavily during competition and long training sessions.

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For a top athlete, sport is the number one thing in life – everything else is on its terms. Annimari Korte's days consist almost entirely of training, eating, and resting. Her two Siberian Huskies named Tokyo and Cairo and mixed-breed dog friend Raad provide a counterbalance to her sports-filled everyday life.

– Competitive sport is an everyday mental stress and rush for an athlete, Annimari surprises when asked if sport is a good counterbalance to the mental stress and rush of everyday life.

– Sport is often very stressful; every single training session and training day is meaningful to an athlete and can affect the whole year. Of course, it also brings the most joy to an athlete’s life, and that's why you do it, she explains.

Annimari knows what she is talking about. She is the fastest Finnish 100m hurdler of all time holding a national record of 12.72. She has run the qualifying standard to the Tokyo Olympics eight times, more than any other Finnish athlete, and represented Finland several times in world championships.

However, she has not had an easy career. Success has required determination and a positive attitude – a major dose of Finnish sisu as well when a bout of illness forced her to take a five-year break from competing in 2012.

Health comes first

– For a top athlete, sport is often the biggest content in life, but it's good to have other counterbalances, such as family and friends. Family is also a big help to me hen my dogs need someone to look after them during races and training camps.

Annimari now trains six days a week. She used to train 12 times a week, but since the autumn – after she started making her own training schedule – she has switched to a new training routine. Less is sometimes more.

– We usually start at 9.30 a.m. and finish between 12 and 1 p.m. I started planning my own training programme in August, and I have a coach who supervises all my training, says Korte.

Korte admits that although sacrifices are required in elite sport, it's up to you to decide what you consider to be sacrifices.

– There are many things an athlete can't do because they would take away from recovery or risk injury. When you succeed or achieve the results you've always dreamed of, it's worth all the sacrifices, pain, and stress, however.

Annimari's career has been marred by numerous health problems, the most challenging being eosinophilic esophagitis, an allergic inflammation of the esophagus, and Tietze syndrome, which causes chest pain.

– Allergies have had a huge impact on my daily life. Because of them, there is always a low-grade inflammation in my body. Because of the eosinophilic esophagitis, I also had to take a break from sports.

Because of the health challenges, Annimari must be particularly careful with her diet. Adequate rest is also essential to stay fit for training and competitions.

– I eat a lot of meat, cooked vegetables, and gluten-free carbohydrates. The importance of rest as an athlete increases with age. Now, I've been resting up to three days on my “light trainings weeks” since this fall, whereas before a light week meant two days of rest.

Oral health supports an athlete’s performance

Top-level sport creates special demands on oral health. Not only the body but also the teeth are often put to the test, because high levels of training require sufficient energy to pass through the mouth. This in turn can be reflected in the number of times you eat.

In addition, heavy breathing during hard training reduces oral saliva secretion and dries out the athlete's mouth. Saliva naturally provides good protection for the teeth. When this is no longer present, bacteria can enter the mouth to form caries.

Annimari brushes her teeth with an electric brush twice a day, as recommended by professionals. She also flosses regularly. Even with a good oral hygiene routine, Annimari's teeth have still been a problem for her – frequent gum problems and a few years ago two of her teeth chipped completely.

This is where Lumoral, a treatment developed by Finns, comes in handy as it improves dental self-care and oral health even when traditional methods fail. Lumoral is a new oral hygiene method developed by Finnish researchers that can remove 99.99% of plaque bacteria from the surface of teeth. Lumoral is a targeted treatment, which means that the normal, important bacterial flora of the mouth is preserved. At the same time, gingivitis is treated.

– I've been using Lumoral for a while now and have noticed how my gums no longer bleed when I clean the spaces between my teeth. It's great that a device has been invented to help keep the mouth healthy.

– Many people don't realise how much oral health affects health in general and sporting performance especially. I think sports organisations should do more to make sure that everyone from top athletes to children are aware of the importance of oral health! she stresses.

A positive attitude to life is the way forward

Annimari returned to competing in 2017 and since her return she has achieved almost all of her dreams she thought were impossible. In addition to the Finnish record, she has broken the Kalevala record and was undefeated in Finland in 2020 and 2021.

– I broke the Tokyo Olympic barrier eight times, more than any other Finnish athlete, she says.

Annimari was named the Most Positive Finn of the Year 2020.

– Positivity helps when times are difficult. My goal is to see my limits as a hurdler and inspire others not to give up and to believe in their dreams. I want to show that nothing is impossible. Positivity has certainly helped me to reach the top after all the difficulties!

Last Autum, Annimari told her Instagram followers that she recently graduated as a dog trainer.

– In the summer, when I couldn't compete, I thought what better thing to do than study. Everyone probably knows that dogs are the most important thing to me besides hurdling. I could start running various dog training courses, but they'll have to wait for a couple of years, Korte posted on her website.