I have several patients and friends who are runners and cyclists who are very healthy and their bodies are physically fit. They obviously look after themselves but when I looked in the mouth I saw a different picture. I noticed an unusually high amount of decay. One patient had fillings in nearly every tooth, many of these teeth had been root filled, and there was decay under these fillings. Another friend who runs almost every day had so much acid erosion that I could see through his teeth, and many were chipped and broken from being weakened.
What happens when you have sugar?
Cariogenic food and drinks are those that have the potential to cause tooth decay. Some foods are more cariogenic than others such as refined sugars and those that are a sticky consistency because these tend to stick to the surfaces of teeth.
Every time you eat or drink cariogenic foods, the bacteria in the mouth use the sugars for energy to produce acid. When the pH of the mouth falls below the critical pH of 5.5 minerals will start to be lost from the teeth (demineralisation). The saliva acts a buffer to neutralise the acids and contains minerals to replenishes these lost minerals (remineralisation). It normally takes the saliva around 30 mins to neutralise the acids.
The process of demineralisation and remineralisation happens several times throughout the day. When you brush your teeth, you disrupt the plaque bacteria and the fluoride in toothpaste helps to remineralise the teeth. However, if there are more periods of demineralisation than remineralisation, more minerals will be lost, the enamel will become weakened and start to decay. That is, if you are having very frequent sugar attacks during the day and / or not removing the plaque regularly then you will be at much higher risk of developing tooth decay.
What happens when you have acid foods and drinks?
Acidic foods and drinks such as citrus fruits, orange juice and fizzy drinks soften the surface of tooth enamel - the hard outer surface of your teeth. If very severe, the enamel can be completely demineralised and it may expose the underlying sensitive dentine resulting in pain and sensitivity. This dentine is softer, so further acid attack wears down the teeth a lot faster. When the tooth has been softened and weakened by acid erosion, it is more susceptible to damage and it may chip and break easy leaving unsightly uneven teeth. Even toothbrushing can cause damage to the softened enamel and dentine by abrasion.
Why is this a potential problem for runners, cyclists and other endurance athletes?
Imagine getting toothache whilst your running or cycling, or your teeth being so sensitive that every time you have have a drink to rehydrate you get shooting pains in your teeth. That is definitely not something you would want to experience at any time let alone while you are competing in a race.
Many endurance athletes use sugary sports drinks and energy gels during their races and training, which can wreak havoc on the teeth. Not only are they high in sugar, they can be quite acidic too. The physical exertion causes dehydration reducing the amount of saliva produced which would normally help to neutralise the plaque acids in the mouth. Mouth breathing during exercise also dries the mouth out reducing the protective effect of saliva. This does not mean that all endurance athletes will get decay, but they may be more susceptible to getting decay as the risk factors are increased.
If you are at increased risk of tooth decay it cannot be stressed enough how important it is to maintain excellent oral hygiene. You should brush with a high fluoride toothpaste and floss twice daily, and use alcohol free fluoride mouthwash at a different time to brushing.
What to eat and drink during training and races
I have been running on and off for about 4 years but tend to only do short runs and obstacle courses (of the muddy kind) so I just stick to water.
One of my colleagues Dr Rachel Derby is a running, cycling and swimming enthusiast and is currently training for her first Ironman, so I asked her for some tips on what to eat / drink during your training and races.
Dr Rachel Derby from Hangleton Dental Practice in Hove shares her tips with us:
Stick to water for short races
Eat real foods when possible, such as banana, homemade flapjack, peanut butter sandwich, cheese sandwich, mashed sweet potato, oat cakes
Train on real foods
Use energy gels when it gets too difficult to chew, and save these for race days only
Either drink some water after you eat or rinse the mouth out with water to dilute and neutralise the acid
Use sugar free electrolyte tablets dissolved in water such as High 5 zero
What can your dentist do to help?
Let your dentist know you are an endurance athlete
Visit the dentist regularly - visit the dentist every 3-6 months so the dentist can spot any potential problems early
Your dentist can make you some custom mouth trays which you can wear for 20 minutes daily with a high fluoride toothpaste such as Duraphat (prescription only) or Tooth Mousse