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.

References:

The link between oral and general health is widely understood, but is this reflected in Finland's health care system and people's oral health? To mark World Health Day, Jukka Meurman, Professor Emeritus of Oral Infectious Diseases, and Tommi Pätilä, cardiac and transplant surgeon at the New Children's Hospital of HUS, reflect on the issue from the perspective of oral health.

World Health Day, launched by the World Health Organisation (WHO), is celebrated worldwide on April 7 to raise awareness of various health concerns. This year's theme – Health for All – focuses on health equity. In other words, the state in which everyone has a fair and just opportunity to attain their highest level of health. 

What about health equity in Finland? Does everyone have equal opportunities to attain their highest level of health in Finland, a country ranked the world's happiest for the sixth year in a row in 2023?

Health inequality is a national challenge also in Finland. Also, in terms of oral health equity. Although the health of Finns has improved considerably over the last decades, according to indicators such as morbidity, work capacity, and mortality, poverty and exclusion are also reflected in Finns' teeth and oral health.

Poor socio-economic status and low education and income levels have a negative impact on oral health. The Finnish Dental Society Apollonia has warned that there is still a lack of comprehensive and adequate oral health care services for the adult population. The poor oral health situation in Finland is also reflected in children.

According to Professor Jukka Meurman, the lack of resources for public oral health care is also directly reflected in the quality of oral health care for people with physical disabilities and, thus, in the prevalence of oral diseases. There is also an urgent need for more staff trained in oral health care for people with disabilities.

Cross-border cooperation for more efficient use of health resources

Oral health is directly linked to a person's overall health and well-being. However, oral health problems are challenging because they are often asymptomatic and may go unnoticed. Undetected chronic oral infections such as caries and periodontitis can contribute to the development of serious diseases such as cardiovascular disease, diabetes, and cancer and, for example, increase the risk of premature birth in expectant mothers (1). 

- Although the link between oral health and general health has been discussed since ancient times, much remains to be done, especially among the public. The issue is becoming well understood in the medical profession, but there is still a need to add dental education to medical curricula and vice versa, says Meurman.

According to the WHO, periodontal disease is estimated to affect around 19% of the world's adult population. This means more than one billion cases worldwide.

In Finland, it is estimated that up to two out of three people over 30 suffer from periodontitis. The disease is even more common in people with diabetes. If left untreated, persistent gum disease can put people at risk of tooth loss - but it is also linked to severe heart events. 

According to a study, the first heart attack is 30% more common in people with periodontal disease than in healthy people of the same age (2).

According to Meurman, many doctors in Finland check the oral health status of their patients in their practices and refer them for further treatment if necessary. Diabetes, for example, is a good example of a disease where the importance of latent inflammation is already widely understood.

Meurman further believes that cooperation between doctors and oral health professionals in Finland should be significantly increased, even during basic training. This would make sharing the workload and managing the health workforce easier. Finland should also consider offering new training programs to ease the shortage of resources in the dental healthcare sector.

- While current dental training takes 5-6 years, an "oral health therapist" training course would only take about 2.5 years, Meurman suggests.

The ideal situation would be for dental training to be similar to specialist training in, say, ophthalmology. Moreover, many practical dental procedures could be carried out by specialists with a university of applied sciences degree.

Meurman admits that such a situation has not yet been fully achieved anywhere in the world. However, in countries such as Singapore and New Zealand, professionals receiving Oral Health Therapist training have, for many years, already eased the workload of dentists. Oral Health Therapists examine dental decay and gum disease and provide routine dental treatments such as teeth cleaning, polishing, teeth extraction and treatment for patients under the prescription of dentists.

Preventive oral care brings benefits to individuals and society

Tommi Pätilä, a cardiac and transplant surgeon at the New Children's Hospital at HUS, believes that oral health is not sufficiently taken into account for patients coming to specialized care. The problem is the frequent lack of time. In specialized care, it is easy to think that a dentist can examine the patient's mouth in due course.

Oral health should always be considered at the basic examination stage for hospital patients. The information should be regularly recorded in the medical records – just like blood pressure values are routinely monitored, says Pätilä. 

More resources for oral health care would be necessary for Finland. It would also be economically worthwhile for society, as it would help prevent the onset of many general diseases.

According to Meurman, preventive health care, including using the antibacterial Lumoral method to improve oral hygiene, will quickly pay for itself.

Pätilä stresses that investing in oral health care and prevention would reduce the development of chronic diseases and the exacerbation of those that have already developed. This would be particularly important for people with cardiovascular disease, diabetes, and rheumatic diseases.

- Preventive oral health care brings significant savings to society. This applies not only to dental care but to the entire healthcare system. Lumoral supports regular mechanical dental hygiene and helps to achieve gum health and prevent inflammation when regular dental hygiene is not enough, says Pätilä.

References:

1) Jacobsson B, Kacerovsky M, Menon R, Musilova I, Radochova V, Slezak R, Stepan M, Vescicik P (2019) ‘Association between periodontal disease and preterm prebalor rupture of membranes'. Journal of Clinical Periodontology.

2) Rydén L, Buhlin K, Ekstrand E, de Faire U, Gustafsson A, Holmer J, Kjellström B, Lindahl B, Norhammar A, Nygren Å, Näsman P, Rathnayake N, Svenungsson E, Klinge B: Periodontitis Increases the Risk of a First Myocardial Infarction. A Report From the PAROKRANK Study. 13.1.2016 Circulation. 2016;133:576–583 

Finnish health technology group Koite Health showcased its Lumoral method at the Igienista Dentale 3.0 (Dental Hygienist 3.0) congress held in Italy, Rome, on March 4, 2023. At the Lumoral stand company consultant Gianfranco Panzironi explained to a highly interested group of Italian and Spanish dental professionals how the antibacterial Lumoral method is designed to enhance oral home care for the prevention and treatment of gum diseases and dental caries.

As in other parts of the world, oral diseases are also common in Italy. Although awareness of periodontal disease has increased in the last years, about 60% of the Italian population suffers from gingivitis and periodontitis. Thus, there is a need to improve the dental hygiene habits of the people living in the country.

–The high number of dental implants placed in the mouths of Italians increases the risk of peri-implantitis because maintaining good oral hygiene continues to be problematic for patients. Regular dental hygiene sessions associated with antimicrobial photodynamic therapy fight and prevent oral diseases, Italian dental hygienist professional and Lumoral consultant Gianfranco Panzironi notes.

Panzironi, what did the dental experts visiting the Lumoral stand think about Lumoral?

– The Lumoral method has been a big surprise for everyone! As professionals, we are familiar with antibacterial photodynamic therapy and its benefits, but until now, we have only seen such technology used in dental clinics. Carrying home this kind of treatment is cutting edge in oral hygiene.

What is your personal view on Lumoral – How did you learn about the method?

– During my visit to IDS Cologne in September 2021, I saw the dual-light device and some green tablets on the desk of the Lumoral stand. Lumoral caught my eye immediately at the International Dental Show! As I had already used such technology in non-surgical periodontal therapy, I immediately understood the indications of using such an excellent tool. Furthermore, I was impressed by the highly professional and kind Lumoral staff I met at that congress. They offered me complete and competent information about the Lumoral method.

After being introduced to Lumoral, Panzironi wrote a scientific paper titled "Home photodynamic therapy as a means of prevention for biofilm control." In this article, he explores the role of dental plaque in causing oral problems and the benefits of Lumoral in preventing oral problems.

– Prevention is the pillar against oral diseases, and compliance with correct oral hygiene techniques is essential to preserve the normal microbiome and maintain the health of the oral cavity. Among the new technologies that allow the patient to control the biofilm comfortably and effectively, a device for the home application of antibacterial photodynamic therapy stands out, Panzironi explains.

Italy is an important market for Lumoral. Thus, the Igienista Dentale 3.0 congress was an important event for the company to attend.

– Koite Health aims to expand to some of the largest nations in the European Union as fast as possible. This way we can offer our European customers access to better oral hygiene. Through our expansion we seek to give patients who suffer from periodontitis a chance to stop the progression of the disease and to help tackle the ever-growing problem of peri-implantitis, notes Koite Health's Chief Commercial Officer Tero Pasanen.

–About 150 colleagues came to the Igienista Dentale 3.0 congress from different cities in Italy and Spain. The atmosphere was very friendly, because these are occasions for us to meet colleagues and share ideas and experiences about our profession. We had an exciting day at the event that will be remembered! concludes Panzironi.