Tooth and gum problems common among teenage footballers in England

The prevalence of tooth and gum issues among teenage (academy) professional footballers in England is high, finds research published in the open access journal BMJ Open Sport & Exercise Medicine.

Inadequate oral hygiene, poor diet, and infrequent routine visits to the dentist, are all contributory factors, the findings suggest, prompting the researchers to call for remedial action to promote good oral health.

This is essential for wellbeing, quality of life, long term health, and ultimately sporting performance, they emphasize.

Previously published research indicates high levels of tooth and gum disease among professional senior team footballers in England and Wales. The researchers therefore wanted to find out if these problems start early in young professional academy footballers, with a view to informing preventive and health promotion strategies.

They invited players (all aged 16–18) from professional academy football clubs in England to undergo a full dental health screen and to fill in questionnaires on their dental and oral hygiene routines, frequency of sports/energy and fizzy drink consumption; and the perceived effects on their wellbeing, training, and sporting performance.

In all, 160 footballers out of a total of 179 from 10 English academy football clubs took part. Most (87%;139) were young men; just over 13% (21) were young women. On average, they were 16 years old. 

Nearly 1 in 3 (31%; 50) needed fillings for tooth decay; and more than 3 out of 4 (77%;123) had inflamed gums (gingivitis). Around 1 in 4 (22.5%; 36) had irreversible periodontitis (chronic infection that damages the tissues and bone supporting the teeth). 

Twenty five (15.5%) had moderate to severe tooth wear, affecting up to at least 50% of tooth structure and requiring treatment. This was somewhat surprising given the young age of the participants, say the researchers.

Tooth wear is caused by dietary acids, stress induced tooth clenching and grinding, eating disorders (bulimia), or acid reflux, they explain. 

"This should be of concern given that in many instances these issues will go undetected until it becomes problematic to the player, affecting not just their dental health but their general health and wellbeing," they comment.

More than a third (36%; 57) had broken/chipped incisors, 1 in 10 of whom (16) actively recalled that they received either a soft tissue injury (lips or tongue) or dental trauma during training or competition at the academy. No player said they wore a mouthguard during play.

Nearly 1 in 4 (23%; 37) said they drank sports/energy drinks every day; 14 (9%) said they drank fizzy drinks daily-risk factors for both tooth decay and wear.

Three quarters of participants (just over 76%;122) said they brushed their teeth twice a day, but 18 said they did so once or a day, or when they remembered. And around 1 in 5 (21%; 34) hadn't been to the dentist for more than 2 years. 

Participants generally felt that oral health issues affected their sporting performance: 22 (14%) said they had missed training/competition due to oral health issues and/or cracked, chipped, or broken teeth.

The relatively small number of female participants is a limiting factor for the generalisability of this study, acknowledge the researchers.

But most of the tooth and gum issues identified in the dental screens can be prevented with simple, low cost, evidence based interventions, they point out, adding that poor oral health is disproportionately associated with levels of deprivation.

"The high levels of oral diseases in academy football[ers] will have long and consequential implications for these participants. In the short term, these will include impacts on life quality, confidence, and self-reported performance," they write. 

"Longer term, an additional lifelong burden of dental treatment and disadvantage can be expected, including negative effects on life quality, social mobility and risk of systemic diseases, including diabetes and cardiovascular disease."

They conclude: "Good oral health should be based on effective integrated health promotion. Knowledge alone is insufficient and behaviour change will be key. …Such health promotion can (and should be) delivered within existing academy resources. A further lynchpin should be regular dental screening to personalise preventative oral health advice based on dental need."