Michael Blackie BDS – Oral Health Impact on Performance in Elite Sport
The expert guest speaker for the Injury Rehab Network event on 3rd March 2022 was sports dentist Michael Blackie who provided an informative and educational presentation about the oral health and elite sport.
Michael started The Park Practice in late 1999. Having always had strong sporting interests, which were based around rugby, Michael realised the impact dental health can have on sporting performance. Over the last 10 years, Michael has developed a strong interest in the impact oral health can have on elite sporting performance.
Michael was involved at London 2012 Olympics, working “pitchside” at the contact sports. Mainly taekwondo, boxing, judo, and fencing, Michael also worked at the rugby sevens at the Glasgow 2014 Commonwealth Games.
The Park Practice is the official dentist for Team Scotland and provided an oral health toolkit for all athletes before the Commonwealth Games on the Gold Coast.
Since 2018 the Park Practice has had a contract with Glasgow Warriors professional rugby team, providing an emergency service whenever required and part of the pitchside medical team for every home match. As well as providing bespoke mouthguards for the squad.
Glasgow Rocks, who are Scotland’s representatives in the BBL professional basketball league, also work with The Park Practice, with their players being the first team to wear mouthguards when playing.
Sport Scotland refer athletes needing emergency treatment to The Park Practice and Michael has helped athletes from a whole range of sports, from curling to badminton and recently Olympic swimmers.
This online event was delivered in partnership with BASRaT with over 75 people joining the session live. Michael’s presentation explored:
- The history of oral health and sport
- The connection between oral health and performance
- Causes of poor oral health in athletes
- The importance of oral health screening
- The impact of poor oral health on sports performance
- Prevention is the solution
Watch the recording of the event here
Oral Health Impact on Performance in Elite Sport
Michael’s Sports Dental Background
Michael’s presentation started with his sports dental background where his passion for playing and coaching rugby has led to many opportunities to use his dental skills in professional and elite sports. Michael established The Park Practice in Glasgow in 1999 and has developed to become a leader in the field of sports dentistry.
London 2012 and Glasgow 2014 Sports Dentist
Michael was fortunate to provide dental services at the London 2012 Olympic Games and Glasgow 2014 Commonwealth Games where he provided advice and treatment for athletes taking part in combat and contact sports including fencing, taekwondo, boxing, wrestling and rugby.
Leading the Way in Sports Dentistry
Michael is proud to work with several professional and elite sports organisations including Glasgow Warriors (Rugby), Team Scotland (Commonwealth Games), sportscotland (elite sport) and Glasgow Rocks (Basketball) where he provides education and treatment to athletes and those who support sporting performance.
Oral Health and Sport in the News
Michael discussed how recent research into oral health and sport has made the headlines regarding the condition of athletes’ teeth and the impact of sports people’s high carb diets on their teeth.
Oral Health and Elite Athletes
Michael discussed how poor oral health is common in elite athletes with issues including:
- Acid erosion
- Gum disease
- Infected wisdom teeth
These issues can result in pain and sensitivity, difficulties eating and sleeping, risk of nerve damage or tooth loss, impact on daily function and critically for athletes an impact on sporting performance.
Oral Health and Sport History
Michael discussed a brief history of oral health and sport and how the ‘Chariots of Fire’ film highlights the importance of teeth. Michael described how scientific awareness of the impact of oral health on sports performance has been documented for around 100 years with the book ‘Athletics’ by Harold Abrahams in 1926 putting oral health at the forefront of athlete performance.
Evidence of Impact on Athletes
Michael discussed findings from recent research into oral health and athletes. Findings from a study with 278 athletes at the London 2012 Olympic Games showed that dental caries was present in 55% of athletes, with periodontal/ gum health affecting 75% of athletes and dental erosion caused by acidic products in 44% of athletes. 40% of athletes were bothered by oral health and 18% reported an impact from oral health on their training and performance.
A study at a Scottish Premiership football club found that 11 of 38 players required extensive dental treatment, 23 players required treatment to improve gum health and 18 players had levels of acid erosion from drink products. Michael described how oral health issues in athletes has led to top players player pulling out from international fixtures.
Toothache and Causes of Poor Oral Health
Michael discussed common causes of toothache including sensitive teeth, gum disease, impacted teeth, inflammation, tooth decay, sinus infection, abscess and cracked teeth.
Michael described how there are many challenges to good oral health for athletes with these issues mainly based around frequent carbohydrate intake from acidic sports drinks and energy gels. These nutritional and oral health challenges can be exacerbated by a heavy training load which leads to dehydration, a dry mouth and reduced saliva flow rate. All these factors lead to an athlete’s response by increasing their carbohydrate intake through energy drinks.
Michael presented the facts in relation to general causes of poor oral health including poor general health behaviours (diet), lack of awareness of oral health factors and lack of preventative support with many people not being registered with a dentist.
Sports Drink Facts
A 2012 study showed that the high acidity of sports drinks can damage tooth enamel. The consumption of sports drinks has increased with 62% of teens consuming sports drinks at least once per day. These drinks alone can make up a large proportion of the recommended daily allowance of sugar and 10-15% of the daily calorie intake of adolescents.
Research in 2018 into endurance athletes showed that athletes may be more prone to tooth erosion and caries. This is due to the requirements of endurance athletes for regular carbohydrate intake. As saliva flow decreases during training, and athletes’ intake of energy products increases during the longer training time.
Results of Poor Oral Health
Michael discussed how oral health issues can range from enamel erosion to full mouth neglect, oro-facial infection and systematic inflammatory responses which could lead to inflammation and infection in other areas of the body. Michael stated that even the very best athletes can be affected by poor oral health.
Michael described some of the challenges for weight-sensitive sports such as boxing, gymnastics, judo and taekwondo where athletes are under additional pressure to maintain and meet their weight requirements. This can lead to dry mouth, acid erosion and sensitive gums. Athletes in these sports may also clench and grind their teeth more frequently.
Effects of Poor Dental Hygiene and Impacts of Dental Inflammation
Michael described the effects of poor dental hygiene on the body including halitosis, tooth loss, heart disease, clogging of the Carotid Artery, diabetes, respiratory problems and erectile dysfunction.
Michael considered the potential for dental inflammation to lead to a systematic inflammatory response and how bacteria may enter the bloodstream from dental inflammation and affect other areas of the body.
Solution = PREVENTION!
Michael discussed how the solution to the problem of poor oral health in performance sport is prevention. Those working in sports rehabilitation and performance can raise awareness of the effects of higher sugar consumption and athletes can reduce their daily sugar episodes. Michael described how a team effort is required by the athlete coach and all those involved in supporting sports performance.
A simple solution is for athletes to drink more water. This should be supported through regular dental screening and dental hygienist treatment.
Michael has produced educational resources for the organisations and athletes he supports with information about the increased risk of oral health issues for athletes, the importance of regular check-ups, the need to avoid unnecessary supplements, ways to modify the oral health environment, methods to optimise oral hygiene, being aware of early signs of problems and applying simple risk mitigation strategies.
Ahead of athletes travelling to competitions, Michael has provided a range of information and simple equipment to help athletes to maintain good oral hygiene through an ‘oral health toolkit’.
Michael has worked closely with several sports teams to ensure their oral health is protected through sports mouthguards. Michael advocates for mouthguards to be worn in all contact sports (and sports where there is a high risk of contact), and described the benefits of mouthguards including:
- Cushions teeth against impact
- Protects against jaw joint injuries
- Protects against soft tissue injuries
- Helps prevent neck and jaw injuries
- It may help reduce concussion
Michael discussed the importance of dental fitted mouthguards which are made using impressions and increasingly digital scans. The key aspects of dental fitted mouthguards are they are stable and retentive, enable easy communication, provide good tongue space and the biting surfaces are well balanced.
Key Recommendations for Action
Michael described his key recommendations for action to improve oral health in sport including:
- Regular dental screenings
- Avoid supplements not benefitting training – identify alternatives including water, milk and ‘real food’.
- Modify the oral environment – regular use of fluoride mouthwash and toothpaste.
- Optimise oral hygiene – regular visits to a dental hygienist
- Simple risk mitigation strategy – water after carbohydrates
Watch the recording of the event here
Q & A
Michael kindly answered several questions from those who joined the session.
Question 1 – Is there any impact on sports participation for people who have artificial teeth or dental implants?
Answer – Veneers could break and it may be necessary to reinforce mouthguards to ensure implants are protected.
Question 2 – Would you advise the use of fluoride toothpaste and products?
Answer – Fluoride is an absolute must for strong teeth.
Question 3 – Is it recommended for endurance athletes to balance the consumption of sports drinks with water?
Answer – The energy requirements depend on the training load but consumption of isotonic drinks should be followed by water if possible.
Question 4 – Is the increased risk of oral health issues in athletes higher due to the growing use of gels and drinks as opposed to eating fruit for energy?
Answer – Consumption of energy drinks and products is often due to a lack of understanding of the potential impact on oral health. These products limit the chance to increase saliva flow.
Question 5 – How often should athletes visit their dentist?
Answer – If possible athletes should visit their dentist every 6 months to 1 year.
Question 6 – What would you recommend as a good dental hygiene routine?
Answer – Hydrate with water. Use fluoride toothpaste and mouth rinse to mitigate against energy gels and drinks.
Question 7 – Are electric toothbrushes recommended?
Answer – Electric toothbrushes are good and are an effective way to clean teeth. People should ensure that they don’t apply too much pressure as this can cause damage to gums.
Question 8 – Can oral health be affected by increased breathing when exercising?
Answer – Increased breathing through the mouth can cause a dry mouth which may, in turn, lead to increased consumption of energy products. The physical effects of exercise affect the mind and behaviour. Treatment may be to reduce fatigue in some training sessions.
Question 9 – Is it possible that oral infections can spread to other areas of the body?
Answer – It is possible as infection could spread through the bloodstream. The oral infection causes fatigue and this could lead to a weakened immune system and increased risk of further infection in other areas of the body.
Question 10 – Does mouthguard fitting with athletes provide a good opportunity for oral health screening?
Answer – Yes this would be a good opportunity to supplement visits to the dentist and to assess the oral health of athletes.
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