Elite athletes have poor oral health despite brushing twice daily

Elite athletes have high rates of oral disease despite brushing their teeth more frequently than most people, finds a new UCL study.
The findings, published in the British Dental Journal, highlight potential for improvement as most of the athletes expressed an interest in changing their oral hygiene behaviour to improve their oral health.
The UCL Eastman Dental Institute research team surveyed 352 Olympic and professional athletes across 11 sports, including cycling, swimming, rugby, football, rowing, hockey, sailing and athletics, when they provided dental check-ups for male and female athletes measuring tooth decay, gum health and acid erosion.
The researchers also asked athletes what they did to keep their mouth, teeth and gums healthy.
The dental check-ups revealed substantial amounts of oral disease as reported in a 2018 paper, finding that nearly half (49.1%) had untreated tooth decay, the large majority showed early signs of gum inflammation, and almost a third (32%) reported that their oral health had a negative impact on their training and performance.*
Elite athletes have poor oral health despite their efforts to care for their teeth: this new study found that 94% reported brushing their teeth at least twice a day, and 44% reported regularly cleaning between their teeth (flossing) - substantially higher figures than for the general population (75% for twice-daily brushing and 21% for flossing**).
The researchers found that the athletes regularly use sports drinks (87%), energy bars (59%) and energy gels (70%), which are known to damage teeth.
"We found that a majority of the athletes in our survey already have good oral health related habits in as much as they brush their teeth twice a day, visit the dentist regularly, don't smoke and have a healthy general diet," said researcher Dr Julie Gallagher (UCL Eastman Dental Institute Centre for Oral Health and Performance).
"However, they use sports drinks, energy gels and bars frequently during training and competition; the sugar in these products increases the risk of tooth decay and the acidity of them increases the risk of erosion. This could be contributing to the high levels of tooth decay and acid erosion we saw during the dental check-ups."
The study builds on research carried out by the Centre since the London 2012 Olympics, led by Professor Ian Needleman. Previous findings have suggested that elite athletes may also face an elevated risk of oral disease from a dry mouth during intensive training.
Encouragingly, the surveyed athletes said they would consider adopting even better oral hygiene habits to tackle this and an intervention study has already been piloted.***
Dr Gallagher said: "Athletes were willing to consider behaviour changes such as additional fluoride use from mouthwash, more frequent dental visits, and reducing their intake of sports drinks, to improve oral health."
"We subsequently asked some of them and support team members to help us design an oral health intervention study, based on contemporary behaviour change theory and we will publish the results soon."

Gastroesophageal reflux associated with chronic pain in temporomandibular joint

Gastroesophageal reflux (GERD) is associated with chronic, painful temporomandibular disorder -- pain in the temporomandibular joint -- and anxiety and poor sleep contribute to this association, according to a study in CMAJ (Canadian Medical Association Journal) http://www.cmaj.ca/lookup/doi/10.1503/cmaj.181535.
Pain from temporomandibular disorder (TMD) affects about 13% of Canada's population. Reflux is an uncomfortable condition in which stomach contents are regurgitated into the throat. Evidence indicates that anxiety, somatization and depression are linked to GERD.
Researchers from China and the United States looked at data on 1522 patients with chronic TMD, of whom 69% (1048) were women, to understand the relationship between chronic TMD and GERD and to determine if anxiety, somatization and depression influence the association. They found symptomatic GERD was a risk factor for TMD, and people with a longer history of GERD had a higher risk of TMD than those with a shorter history.
"The interactions between chronic musculoskeletal diseases, gastrointestinal diseases, mental disorders and sleep problems are complicated," writes Dr. Jihua Chen, The Dental College of Georgia, Augusta, Georgia, and The Fourth Military Medical University, Xi'an, China, with coauthors. "There is evidence to support the bidirectional nature of the associations among these comorbidities, and patients may be stuck in a cycle in which undermined sleep, somatization and anxiety exacerbate the pain, with the pain also leading to sleep problems and mental disorders."
The authors suggest physicians need to be aware of the association and consider multidisciplinary management programs to help patients with TMD and chronic pain.
"Physicians and patients may overlook the association between chronic musculoskeletal disease and gastrointestinal symptoms," write the authors. "Patients with both chronic TMD and reflux symptoms may be underdiagnosed, resulting in deferred effective treatment and a prolonged disease course."
"Associations among gastroesophageal reflux disease, mental disorders, sleep and chronic temporomandibular disorder: a case-control study" is published August 19, 2019.

Remove false teeth before general anesthetic, doctors warn

False teeth need to be taken out before a general anaesthetic, doctors warn in the journal BMJ Case Reports after a 72 year old's dentures got stuck in his throat during surgery to remove a harmless lump in his abdominal wall, and weren't discovered for eight days.
Aside from experiencing considerable pain, bleeding, and swallowing difficulties, the oversight led to repeated hospital visits, additional invasive tests, blood transfusions, and eventually more surgery for the man.
The doctors describe how six days after abdominal surgery, the man turned up at A&E complaining of blood in the mouth and swallowing difficulties and pain, which had prevented him from eating solid food ever since.
Nothing in his test results prompted doctors to consider anything other than a respiratory infection and the side effects of having had a tube down his throat during his operation.He was therefore prescribed mouthwash, antibiotics and steroids, and sent home.
Two days later he returned with worsening symptoms. He had been unable to swallow any of the medicine he had been prescribed. He was admitted to hospital with suspected aspiration pneumonia--a severe chest infection usually caused by inhaling food or stomach acid or saliva into the lungs.
During this hospital stay, a diagnostic procedure to look at his throat and voice box revealed a semi-circular object lying across his vocal cords, which had clearly caused internal swelling and blistering.
When this was explained to him, the man revealed that his dentures, which consisted of a metal roof plate and three false teeth, had been lost during his previous hospital stay.
He then had emergency surgery to remove the dentures and was discharged after six days. But six days later a bout of bleeding prompted his return. As tests revealed the bleeding had stopped, he was sent home, only to reappear 10 days later with the same problem.
After a couple of days he was again discharged, but returned six days later because of further bleeding. Tests revealed that he had internal wound tissue around the site of the blistering which was cauterised to prevent further bleeding. Because he had lost so much blood, he also required a blood transfusion.
He was discharged after two days, but returned again nine days later with further bleeding, which required emergency surgery as the source of the bleed was a torn artery in the wound.
A check-up a week after this procedure showed that the tissue was healing well, and six weeks later he had not needed further emergency care and his blood count was back to normal.
The authors note that this isn't the first documented case of dentures being inhaled while anaesthetic is being infused.
"There are no set national guidelines on how dentures should be managed during anaesthesia, but it is known that leaving dentures in during bag-mask ventilation allows for a better seal during induction [when the anaesthetic is being infused], and therefore many hospitals allow dentures to be removed immediately before intubation [when a tube is inserted into the airway to assist breathing]," write the authors.
The presence of any false teeth or dental plates should be clearly documented before and after any surgical procedure, with all members of the surgical team made aware of what is to be done with them, they add.

New method of tooth repair? Scientists uncover mechanisms that could help dental treatment

Researchers from TU Dresden's Biotechnology Center teamed up with international scientists that led to the discovery of a new stem cell population in the front teeth of mice

Technische Universität Dresden

IMAGE: The image shows a group of mesenchymal (green) stem cells migrating in a tooth to further regenerate tissues. view more 

Credit: Source: Media and Communications | University of Plymouth

Stem cells hold the key for tissue engineering, as they develop into specialised cell types throughout the body including in teeth. An international team of researchers, including scientists from the Biotechnology Center of the TU Dresden (BIOTEC), has found a new mechanism that could offer a potential new solution to tooth repair. They discovered a new population of mesenchymal stromal cells in a continuously growing mouse incisor model. They have shown that these cells contribute to the formation of dentin, the hard tissue that covers the main body of a tooth. Importantly, the work showed that when these stem cells are activated, they send signals back to the mother cells of the tissue to control the number of cells produced, through a molecular gene called Dlk1. This study is the first to show that Dlk1 is vital for this process to work. In the same study, the researchers also demonstrated that Dlk1 can enhance stem cell activation and tissue regeneration in a wound healing model. This mechanism could provide an innovative solution for tooth repair, addressing problems such as tooth decay, crumbling and trauma treatment. Further studies are needed to validate the results for clinical applications to determine the appropriate duration and dose of treatment.
The study was led by Dr Bing Hu of the Peninsula Dental School of the University of Plymouth, UK. Co-authors were research group leader Dr. Denis Corbeil and his colleague Dr. Jana Karbanová from BIOTEC. "The discovery of this new population of stromal cells was very exciting and has enormous potential in regenerative medicine," says Dr. Denis Corbeil.