The Decaying Teeth of Endurance Athletes (Guest Blogger Dr. Larry Dunlap)

My dentist friends tell me that they are seeing notably poor dental conditions in their patients who are endurance athletes. There are no scientific studies proving this situation but there are very good scientific reasons to suspect that their observations are true. The relatively poorer teeth of Americans in general are due predominantly to the exposure of the teeth to sugar and acidic pH. The worst teeth are seen in children who are put to sleep at night with a bottle of sugar containing beverage and have frequent access to similar beverages during the day. Some of these children lose all of their baby teeth to decay before they reach school age.

There are numerous well documented medical studies that show the deleterious affect of soft drinks on dental enamel. Non-cola beverages fared worst and dental problems were greatly accelerated by both regular and dietetic drinks, though the absence of sugar lessened decay. Recently sports drinks have been added to the studies with the surprising finding that they result in enamel deterioration equal to or worse than the non-cola beverages! Several different mechanisms are at work but the main problem is that almost all of these products contain phosphoric or citric acid. Other organic acids such as malic and tartaric are often present as well. These acids are very erosive to dental enamel due to their ability to chelate calcium. They are efficient buffers and keep oral pH well below the optimal salivary pH of 6.5 to 7.5. The threshold level for the development of dental caries is below Ph 5.5. Enamel demineralization occurs with prolonged exposure to lower pH or frequent cycling between optimal pH to below the threshold value. Sugar content facilitates bacterial proliferation which, in turn, promotes plaque and potential gingival inflammation at the gum line. Sports drinks and soft drinks are just not healthy for our teeth

If Darwin were alive today he would probably comment that we evolved as omnivores with infrequent fluid intake. Nothing in our dental design could anticipate the ability to sip an acidic sweet beverage multiple times during the day as well as at meal times.

Unfortunately everything in our training manuals tells us that we need to have fluids and calories on a regular basis during endurance exercise. These practices also have been scientifically documented and most of us can personally vouch for their validity. Who hasn’t experienced “hitting the wall” when failing to take in adequate replacement nutrients and/or electrolytes. Our healthy endurance habits however prove to be very unhealthy for our teeth. We are doing exactly what mothers are told not to allow their children to do which is to frequently ingest an acidic, sugar containing beverage. We may even swish these beverages around in our dry mouths in an effort to rehydrate the oral mucosa which at the same time insures an optimal bad environment for our teeth.

So far attempts to alter energy drinks with calcium and other elements that would prevent deterioration of tooth enamel have been generally unsuccessful. We are stuck with using products that are bad for our teeth. The choice here then becomes how to use them most effectively.

It turns out there are ways to drink which are going to be helpful in avoiding this degradation of tooth enamel. We need to drink rapidly and attempt not to bathe the teeth in the process. Most importantly, we can follow ingestion of any sugar containing beverage with a rinse of normal water. Our saliva brings the teeth back to a neutral pH which is healthy for the enamel. Calories and electrolytes can also be ingested as capsules which, with adequate water, provide similar physiological resuscitation without creating a bad environment for the teeth. Lastly, of course, we can see our dentist regularly and can consider fluoride treatments or application of a polymer-based protective resin to give our dental enamel an enhanced barrier against the ravages of beverages containing acids and sugar.

Consider that you are telling your great-grandchildren about the epic physical achievements of your youth. Won’t those children be more impressed when the words come from between teeth that you don’t have to take out at night? Endurance runners with their physiological needs are put in a position where their rehydration habits can have a devastating long term affect on the teeth that may initially be subtle and not fully noticeable for 5-l0 years. To counteract these factors an endurance athlete has to be particularly good about following the rules learned in grade school. Floss frequently, brush after meals and use a fluoride containing dentifrice. Drink sugar containing beverages in a way that minimizes contact with the teeth and follow them with a cleansing rinse of tap water. Be aware of these subtle subversive processes that may be a long term threat to your chewing and your smile.

Larry Dunlap, MD

[Dr. Dunlap is a marathoner and ultramarathon volunteer who also happens to be my Dad; he will be running the Boston Marathon this April!]