In December 2017, the European College of Sports and Exercise Physicians (ECOSEP) held its 5th annual congress, in association with FIFA, at the Mohammed bin Rashid University of Medicine and Health Sciences here in Dubai. For me, it was is a milestone conference. It was the first FIFA conference which hosted a session on Sports Dentistry. I had the great honour of joining some real experts in the field in delivering an oral presentation during that session.

So, what is Sports Dentistry, and why is it important? The apparent first element of Sports Dentistry is the prevention and treatment of oro-facial injuries. Oral protection is vital and indeed, compulsory in many contact sports. From rugby to ice hockey, gridiron to field hockey, you can see athletes wearing mouth guards. However, many non-contact sports recognize the need for protection from a stray elbow or flying hand. Basketball, for example, is increasingly seeing players wearing oral protection and a recent handball conference in the Middle East dedicated a full afternoon to oro-facial injury.

But there is now much more to Sports Dentistry. Over the last few years, we have been proving what we call Oral-Systemic links; direct links between oral disease and conditions that affect the body. For example, we now know that people with gum disease and diabetes, the two conditions can make each other worse. Therefore by controlling gum disease, it can be a crucial part of improving diabetic control. Another case is heart disease. Men between the ages of 25 and 54 with active gum disease are twice as likely to die of a heart attack. Fact. Makes you want to pick up the phone and book that check-up, doesn’t it? The link in all of this is inflammation.

So why is this important for the elite athlete? To simplify, the elite athlete is continuously looking for the edge that will find them that 100th of a second, extra half a centimetre, 1% of endurance, etc. Make an elite athlete orally fit, their performance improves. A study of athletes at the London Olympics in 2012 revealed “high levels of poor oral health including dental caries (decay) (55% athletes), dental erosion (45% athletes) and periodontal disease (gum disease) (gingivitis 76% athletes, periodontitis 15% athletes). More than 40% of athletes were ‘bothered’ by their oral health, with 28% reporting an impact on the quality of life and 18% on training and performance.”

Almost a fifth of athletes at the London Olympics had dental conditions directly impacting on performance. Staggering.

A recent study of Premier League footballers led by Professor Ian Needleman of UCL revealed that nearly four out of ten professional footballers have ongoing tooth decay, 57% had tooth erosion, while eight out of ten had gum disease which in some cases was irreversible. Professor Needleman describes an ‘urgent’ need to tackle reduced levels of dental hygiene in football.  Though at some clubs there has been a positive shift. Though he once joked that a dentist was responsible for a growing list of injuries, Arsene Wenger had built a culture at Arsenal which looked at players as a whole and improving dental health.  He even had players such as Cesc Fabregas, and Robin van Persie assessed to see if removing their wisdom teeth would help. Van Persie said at the time “My osteopaths think there may be a connection between my teeth and the muscle injuries I suffer. Something like that is challenging to prove. But if the operation makes just one percent difference, it’ll be worth it. It could influence the recovery time my body needs after an injury”.  It has now been proven that the inflammation caused by impacted wisdom teeth can indeed have significant reaching effects on the body. The subsequent improvement also saw Steven Gerrard and Florent Malouda to name, but two more do the same.

Poor oral health has also been the central issue in problematic transfers. Former Aston Villa and Liverpool defender Aly Cissokho’s transfer to AC Milan fell through. The reason, explained, the player himself was, “Milan said there was some problem with my body, which was linked to my teeth.” West Ham had to pay around 130000 AED to repair wild child midfielder Ravel Morrison’s decayed and missing teeth before a loan deal to Lazio could go through. Italy, it seems, is well ahead of the game here.

Something that footballers don’t do very often wears a mouthguard, much to my despair. You may have at one time seen Cristiano Ronaldo wear one, but you’d be surprised to learn this wasn’t for protection. Canadian tennis star, Milos Raonic, wears a similar device, a specific type of mouthguard known as a ‘Mandibular Orthopaedic Repositioning Appliance (MORA).’  It increases the strength of the upper body and back muscle contractions, causing an increase in power. The mechanism theorized is that wearing a MORA aligns your temporomandibular joint (jaw joint) optimally which has a knock-on effect to the proximal muscles down the body core.

You can start to get an idea just what new ground is being broken. By treating an athlete as a whole rather than just the sum of their parts, we can see improvements in their performance and endurance, fewer injuries, and quicker recovery.