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Teeth will not help you to win a triathlon, but they can help you to lose one. If a tooth which constantly aches disturbs your preparation, or a tooth which is acutely sensitive each time you hydrate stops you hydrating, there is a good chance you will not perform at your peak. A recent New Zealand study of elite triathletes set out to determine their oral health. They found an above average decay rate and found that all athletes were in a high-risk group for developing dental erosion. So what is decay and what is dental erosion? Why are triathletes more likely to suffer from them and what can be done to moderate their risk without affecting their performance? Decay is demineralisation of tooth enamel. It occurs when oral bacteria metabolise sugar from your diet and produce lactic acid. This acid lowers the pH within dental plaque until calcium is dissolved from the tooth surface. Should progressive demineralization occur then a cavity will form. Decay will usually appear in the same areas in which plaque accumulates – at the gum line, between teeth and within deep grooves. Erosion occurs when man-made acidic foods and fluids cause demineralization of enamel. The enamel becomes weaker and is more easily abraded. Erosion is usually seen on exposed tooth surfaces not protected by the tongue and cheeks. In a triathletes mouth decay and erosion may be more prevalent as:

  • Your diet contains a high amount of carbohydrate – these sugars are termed ‘simple’ meaning that they are easily and quickly available to working muscles without the delay that digestion would cause. It also means that bacteria are able to metabolise this food source with similar speed.

  • This sugar is frequently taken - triathletes often describe fluid intake as ‘little sips, often’. This constant fueling of bacteria, leads to a constant production of acid and a sustained low oral pH in which enamel will dissolve.

  • The sugar arrives in a dehydrated mouth – during exercise the body’s priorities are to maintain a circulating volume, which allows nutrition to be carried to, and waste products to be carried from, the muscles. It also allows the body to regulate body temperature, through sweat production. These functions occur at the expense of the gastrointestinal system, leading to a decrease in saliva production. The mouth’s moisture is further reduced due to increased breathing rate, causing saliva evaporation. Many medications including NSAID’s will also cause a dry mouth. All of this wouldn’t be an issue if saliva weren’t the primary defence against decay. It contains buffers, which help to neutralise oral acidity and proteins, which aim to reverse calcium loss.

  • The sugar is taken in a sticky form - Obviously the longer sugar stays in the mouth, the greater the problem.

  • Significant plaque deposits are present around the teeth – not just a triathlete problem! If your brushing and flossing aren’t up to scratch, then more bacteria will be present to cause demineralisation

  • You use sports drinks - These drinks are acidic. This acidity may be in the form of citric acid; this particular acid resists neutralisation by saliva and can produce sustained pH change.

It would be counter productive to stop fueling your body so that you had pristine teeth to smile at competitors as they passed your exhausted body miles from the finish line! So what can be done to prevent the necessary intake of sugars from compromising your oral health? The key to maintaining a stable dentition is to remember that even in an unstressed mouth calcium is continually being lost and added to the enamel. As long as you balance the time your dentition is under attack and losing mineral with the time your dentition has to remineralise you should be able to prevent cavity formation and reduce the risk of erosion. Strategies you could choose outside training and race times might include:

  • Reduce simple sugar intake.

  • Enhance remineralisation. Several specialist products are now available that promote the transfer of calcium, phosphate and fluoride back into tooth enamel. eg. Tooth Mousse, Clinpro, and fluoride containing mouth rinses.

  • Brush and floss your teeth. Brushing and flossing remove bacteria. Bacteria mediate decay; without bacteria no decay can occur! There are rules though: -

  1. Brush twice a day, morning and night, and before a training session.

  2. Use a soft toothbrush and a fluoride containing toothpaste – or as previously suggested, a specialized toothpaste such as Clinpro

  3. Do not brush within an hour of training as dehydrated and acid weakened enamel is susceptible to toothbrush / toothpaste abrasion.

During race and training situations you might: -

  • Consider frequent rehydration with water only, then less frequent intake of electrolytes and sugars.

  • Use tooth friendly nutrition products eg 32Gi

  • Use a sugar free gum to stimulate saliva production, which will aid the natural defences of the mouth. If this gum contains xylitol, it has been shown to additionally down regulate the bacteria causing decay.

All these strategies revolve around maintenance of a healthy mouth, if it has been greater than 6 months since you last saw your dentist, an appointment to establish you do in fact have a healthy mouth would be wise. If you have an aching or sensitive tooth, these strategies may have arrived a little late, the sooner your dentist can review it, the better your options will be. Further reading: Bryant S et al. Elite athletes and Oral Health. Int J Sports Med 2011; 32: 720-724

Thanks to Melbourne Dentist and friend of ETPA, James Rich for this great article. if your interested in more information, James can be located: Moore Street, Moonee Ponds, Melbourne.

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