Dental Issues in Athletes: Why It Happens and What To Do About It

One sunny Saturday, I was sitting at a café when it hit.

A searing pain shot through the left bottom side of my jaw. My head jerked back, and for a minute, it was as if the rest of the world switched off. No sound, no taste. Just searing pain and the splotchy orangey-red canvas of my eyelids.

I stumbled to the nearest pharmacy and bought the most hardcore painkillers I could find. Even after swigging them down, sharp shocks of pain kept randomly firing through my jaw. I couldn’t think straight. My mum said, “You need to see a dentist. Now.”

I called Michaela, my dentist, expecting to get her voicemail. It was the weekend, and she had only just returned from a holiday in Fiji. But she told me to meet her outside the clinic.

She saw me slumped at the clinic door and quickly got me inside and onto the chair. She tapped one of my back teeth. The world shut down again. That was enough. She numbed me up, then drilled into the tooth to release the pressure. I gripped the arms of the dental chair, tears rolling down my cheeks, nodding rapidly every time she stopped to check if I was okay. I wanted her to keep going, to make the hell end faster.

That day was the start of a chain of dental dramas that plagued me for the next five years. And it wasn’t a coincidence. My dentist and I eventually connected the dots between these issues and the years of increased endurance training and long-distance events I’d been doing.

If you’re active and think dental problems are only for people who don’t brush enough, I get it. I used to think that too. But the way we train and fuel can quietly be setting us up for expensive, painful dental work down the track.

This article isn’t short. But if it can save you the pain and expense of what I’ve gone through, then it will be a great investment of your time (and I’ll consider it an act of community service on my part).

Dental Issues in Athletes: More Common Than You Think

Dental issues aren’t just an elite athlete problem. Studies have shown a high prevalence of oral diseases in athletes of all levels. One review found rates of dental caries between 20–84%, dental erosion 42–59%, gingivitis 58–77%, and periodontal disease 15–41% in athletes, often linked to frequent consumption of sugars, carbohydrates, certain fats, or inadequate protein intake¹.

At the London 2012 Olympics, a study of 302 athletes found:

• 55% had dental caries (holes, caused by acids from bacteria wearing away at tooth enamel)
• 45% had dental erosion (loss of enamel from acids e.g. from soft drinks, sports drinks)
• 76% had gingivitis (early gum disease)
• 15% had periodontitis (advanced bone and gum loss where infection damages the tissue and bone that holds teeth in place)
  More than 40% were bothered by their oral health, with 28% reporting an impact on quality of life and 18% saying it affected training and performance². Nearly half hadn’t seen a dentist in the previous year.

Endurance athletes are particularly at risk because we consume high-carb foods and drinks during training. Swimmers face another hazard — prolonged exposure to chlorinated water, especially if the pool’s pH isn’t optimal. 

The Stephan Curve: Why Your Long Run Might Be a Cavity Factory

Back in the 1940s, Dr. Robert Stephan studied how the pH of dental plaque changes after we eat or drink fermentable carbohydrates (this includes gels, sports drinks, energy bars). Normally, the mouth’s pH sits around neutral (7.0). But within minutes of eating carbohydrates, plaque bacteria ferment them into acids, dropping the pH below a critical level (about 5.5 for enamel).

Below that point, calcium and phosphate are drawn out of the tooth structure. This is called demineralisation. Your teeth become softer and more vulnerable to decay. Saliva helps to reverse this by remineralising teeth (yes, saliva contains calcium and phosphate), but the process takes 20–60 minutes, depending on saliva flow.

Here’s the kicker:
If you fuel every 20–40 minutes during a long run or ride, your pH never recovers. Add in a dry mouth and less saliva due to mild dehydration and mouth breathing, plus sticky gels that cling to teeth, and you’ve got the perfect recipe for dental trouble. Even “sugar-free” electrolyte drinks can be highly acidic as they all contain citric or malic acid. 

This graph illustrates the change in pH in your dental plaque after consuming meals and snacks. The pH drops 5-20 minutes after you consume food or drink, and takes 20 to 60 minutes to recover.

 

How the pH in your mouth may look in a 4-hour bike ride, where you’re consuming sports gels at the recommended dose (15 minutes before exercise, and every 35-45 minutes thereafter). Your mouth doesn’t have time to return to a higher pH, and as the ride progresses, the pH continues to drop below the critical level.

 

Practical Ways to Protect Your Teeth

After many hours in the dental chair (and many dollars spent), here’s what I wish I’d known sooner:

During Training:

• Neutralise the pH. My endodontist’s unexpected tip: eat a small piece of cheese mid-session. Cheese is alkaline and helps balance mouth pH. The Ile de France mini brie wheels are deluxe.
• Consider gentler fuels. Compared to acidic gels and energy drinks, Energy Nut Butter is lower in sugar and less acidic.
• Water rinse. Swish a little water after all food, sports gels and drinks. Our soft flasks are great for keeping topped up with water.

Post-Training:

• Brush as soon as you can. Keep a travel toothbrush and water bottle in the car so you can clean off acids and sugars before they linger.
• Chewing gum or xylitol mints. Chewing stimulates saliva flow, which buffers acids and helps deliver calcium and phosphate back to enamel. Xylitol also inhibits the growth and acid production of streptococcus mutans, a cavity-causing bacteria.
• GC Tooth Mousse. Apply after training or at night before bed when saliva flow is low. It delivers calcium and phosphate to replenish enamel and should be left on for at least 30 minutes without eating or drinking. You can buy it for ~$30 from your dentist or Chemist Warehouse

Daily Habits:

• Batch eating/drinking. Every time you eat or drink (other than water), pH drops. Grouping intake gives your teeth recovery time. Even carbonated water and diet sodas are acidic. Carbonation forms carbonic acid, lowering pH, so it’s best to consume them with meals, rather than sipping on them throughout the day.
• Electric toothbrush. Oscillating or sonic brushes remove plaque more effectively and have timers to ensure you brush long enough.
• Floss + interdental brushes. These reach surfaces your toothbrush can’t, helping to prevent gum disease and cavities between teeth.
  

The Bigger Picture

We train hard to protect our muscles, joints, and hearts, but our teeth are part of the system too. They’re small, but when they hurt, they can take you out of life faster than a pulled hamstring. A few small, consistent habits could save you pain, a lot of money, and training days.

And I really hope you won’t be gripping the arms of a dental chair any time soon.

 

References

¹ PMC10890155, PMID: 38399605

² PubMed 24068332 - DOI: 10.1136/bjsports-2013-092891

³ https://www.rdhmag.com/patient-care/article/14302977/game-changers-many-factors-put-athletes-at-increased-risk-for-oral-health-complications