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Nijakowski, K. Regular Physical Activity and Dental Erosion. Encyclopedia. Available online: https://encyclopedia.pub/entry/18640 (accessed on 30 July 2024).
Nijakowski K. Regular Physical Activity and Dental Erosion. Encyclopedia. Available at: https://encyclopedia.pub/entry/18640. Accessed July 30, 2024.
Nijakowski, Kacper. "Regular Physical Activity and Dental Erosion" Encyclopedia, https://encyclopedia.pub/entry/18640 (accessed July 30, 2024).
Nijakowski, K. (2022, January 21). Regular Physical Activity and Dental Erosion. In Encyclopedia. https://encyclopedia.pub/entry/18640
Nijakowski, Kacper. "Regular Physical Activity and Dental Erosion." Encyclopedia. Web. 21 January, 2022.
Regular Physical Activity and Dental Erosion
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This entry is adapted from the peer-reviewed paper 10.3390/app12031099

Dental erosion is the irreversible pathological loss of hard tissues, which are chemically dissolved by acids, especially through external means, such as diet (e.g., fruit juices, isotonic or energy drinks). Regular physical activity was associated with an increased risk of dental erosion, especially under the influence of frequent consumption of sports drinks. 

dental erosion erosive lesion physical activity sports professional swimming amateur athlete sports drinks

1. Introduction

Dental erosion is the irreversible pathological loss of enamel and dentine, which are chemically dissolved by acids with an exogenous or endogenous origin, not those produced by oral bacteria [1][2]. Tooth erosion is a condition with a multifactorial aetiology that includes chemical, biological, and behavioural factors. The erosive potential of acidic beverages depends on their chemical properties, such as the pH, titratable acidity, mineral content, adherence to the tooth surface or calcium chelation. Examples of biological factors are the salivary flow rate, acquired pellicle, and tooth structure and relation to cheeks or tongue. Moreover, behavioural factors, such as dietary habits, regular physical activity resulting in dehydration and decreased salivary flow, excessive oral hygiene, or, on the other hand, chronic addictions (e.g., alcoholism), may predispose individuals to dental erosion [3]. Sources of acid delivery to the oral cavity can be divided into two groups: intrinsic and extrinsic. Among intrinsic factors there are vomiting in anorexia or bulimia, gastroesophageal reflux, or other chronic gastrointestinal disorders. Extrinsic acids come from external means, such as diet (e.g., acidic beverages: fruit juices, isotonic or energy drinks, wine), chronic consumption of selected medication, or the occupational environment [4][5].
It can be challenging to detect initial erosion lesions because they may be imperceptible. The erosive process is much faster than caries, as frequent exposure to acids leads to permanent hard tissue loss with accompanying hypersensitivity. During the oral examination, erosion defects have a characteristic appearance—a smooth glazed enamel surface [6][7]. The fundamental principle of treatment is the reduction of acid exposure and the enhancement of remineralisation [8]. The basic prevention is mainly based on limiting the frequency of consuming low pH products [9]. Patients should also take care of their oral hygiene by using low abrasive pastes and regular application of preparations containing fluoride or casein phosphopeptide-amorphous calcium phosphate (CPP-ACP) [10][11][12]. Moreover, tooth brushing immediately after the enamel’s exposure to acidic drinks must be avoided in order to enable pH neutralisation of the oral environment and not cause more considerable losses through the mechanical action [13][14].
Physically active consumers are generally not aware of the erosive potential of sports drinks. These beverages have a low pH value and contain citric acid as an ingredient, which is an organic acid provoking a drop in salivary pH [15]. Citric acid might also induce the process of chelation, which is the dissolution of calcium ions from the structure of enamel [16]. Both of these factors play a significant role in the process of erosion. Most sports drinks’ pH values are contained within the range from 3.16 to 3.70 [17]. Although critical pH value for enamel, depending on ontogenetic tendencies, oscillate between 5.5 to 6.5 [18]. This leads to the conclusion that beverages with a pH value below 5.5 can have an adverse effect on enamel and dentine. Other aspects influenced by ontogenetic predispositions are the quantity and quality of saliva as well as the resilience of the enamel. Saliva has protective values against acids causing dental erosion [19]. Therefore, athletes with any deficits of quality or quantity of saliva may be at higher risk of dental erosion. The common consumption of sports drinks might cause a reduction in the microhardness of enamel and lead to irreversible erosive lesions [15]. The level of lesions depends on the frequency of consumption and the length of time the beverage is kept in the mouth [20]. Frequent intake of isotonic drinks might cause sensitivity, loss of dental structure, and dentine exposure. Studies showed that the temperature of consumed sports drinks influences their erosive potential. In order to reduce the damaging effects on the dental tissues, it is recommended to intake those beverages at 9 °C instead of consuming them at room temperature [15][21].

2. Regular Physical Activity and Dental Erosion

There is a relationship between the development of dental erosion and regular physical activity, especially with the accompanying consumption of sports drinks.

Buczkowska-Radlińska et al. [22] analysed the prevalence of dental erosion among competitive and recreational 14- to 16-year-old swimmers in Szczecin, Poland. The competitive swimmers were from local sports clubs—junior subgroup training for about 7 years and senior subgroups training for about 10 years. Both subgroups spent over 19 h in the swimming pool per week. The recreational swimmers were randomly selected from students at high schools who were swimming once or twice per week and no more than 2 h per week. All participants trained in closely monitored, gas-chlorinated swimming pool water. Erosive lesions were observed significantly more often in the competitive swimmers than the recreational swimmers (26% and 10%, respectively). All lesions were grade 1, according to the Lussi classification. In the competitive swimmers, the anterior teeth were affected on both labial and palatal surfaces, whereas in recreational swimmers only palatal surfaces were affected. The erosion on the labial surfaces occurred only in senior competitive swimmers, especially in men. The authors suggest that the development of tooth erosion may be influenced by the length of training sessions and the duration of competitive swimming.

Similarly, Rao et al. [23] investigated the prevalence of oral health symptoms (such as dentinal hypersensitivity, dental erosion, and dental caries) among competitive swimmers from two training centres in Kottayam, India, and found that 69.6% of the included swimmers manifested dentinal hypersensitivity, 48.2% dental erosion and 39.3% dental caries. Among the athletes complaining of dentin hypersensitivity, 61% had accompanying erosive defects. Dental erosion was observed more frequently on the palatal surface of the maxillary anterior teeth followed by the mandibular anterior teeth. In the study group, the incidence of erosion increased with the years of regular training at the pool. The odds of developing dental erosion in swimmers training for more than 3 years was 5.3 times higher compared to the rest. Furthermore, swimmers training for more than 2 h during a training session were more likely to be marked with erosive losses. Although almost two-thirds of them consumed acidic beverages, no correlation was found between the frequency of drinking and the presence of tooth erosion. The authors confirmed that dental erosion is an occupational risk for professional swimmers.

Another group of studies focused mainly on the potential impact of sports drink consumption accompanying the training of professional athletes. Silva et al. [24] analysed if the consumption of acidic beverages, including energy drinks, could be associated with dental erosion in Portuguese athletes. In the cross-sectional study, the included participants were divided into four groups: swimmers who consumed or did not consume energy drinks, and non-swimmers (bodybuilders, football players, boxers, volleyball players, and runners) who consumed or did not consume energy drinks. Of the participants, 70% had been regularly involved in the sport for more than 2 years. Among them, 39 subjects consumed energy drinks, one-third of them during each training session. As many as 83.6% of the athletes in the study group had at least one erosion lesion. The teeth in the second and fifth sextants were the most frequently affected by erosive defects (69.1% and 59.1%, respectively). According to the BEWE index scoring, 43.6% of athletes demonstrated no risk of erosion, 49.1% low risk, 6.4% medium risk and 0.9% high risk. The authors evaluated the risk factors to be “at least low risk” of dental erosion, while considering the non-swimmers who did not use energy drinks as the control group. In the multivariate logistic analysis, the most statistically significant factor was the consumption of energy drinks in swimmers—the odds of erosion were more than 15 times higher than in the control group and more than 2 times higher than in the non-swimmers consuming energy drinks group. The findings suggested a complex influence of swimming as a sport and the habit of consuming energisers on the development of erosive defects, requiring regular dental check-ups.

Some studies also identified and compared the incidence of tooth erosion in team sports. Needleman et al. [25] evaluated oral health in a representative group of professional football players in the UK. The cross-sectional study was performed in eight football clubs: five Premier League, two Championship, and one League One. One hundred eighty-seven footballers were recruited and represented above 90% of each senior team. Although almost three-quarters of them declared a previous dental check-up within the past 12 months, the oral health status was poor. A total of 36.9% of the players demonstrated active dental caries, 53.1% dental erosion, and 5% at least moderate periodontal disease. The most advanced erosion defects (grades 2–3 according to BEWE) were observed on the anterior teeth in about 20% of the cases, and a similar amount were on posterior teeth. Only 7.1% of the football players reported drinking sports beverages less than once a week. In contrast, 23.1% consumed isotonic drinks more than six times a week. The authors found no correlation between the sports drink consumption frequency and the occurrence or severity of dental erosion.

3. Conclusions

Regular physical activity is associated with an increased risk of erosive lesions, especially under the influence of the frequent consumption of sports drinks. Based on our review, approximately half of the studied athletes manifested dental erosion. However, it is difficult to establish transparent quantitative relationships due to the heterogeneity of the included studies (different age groups, various sports disciplines).

References

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  3. Lussi, A.; Jaeggi, T. Erosion-Diagnosis and Risk Factors. Clin. Oral Investig. 2008, 12 (Suppl. 1), S5–S13.
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  13. West, N.X.; Hooper, S.M.; O’Sullivan, D.; Hughes, N.; North, M.; Macdonald, E.L.; Davies, M.; Claydon, N.C.A. In Situ Randomised Trial Investigating Abrasive Effects of Two Desensitising Toothpastes on Dentine with Acidic Challenge Prior to Brushing. J. Dent. 2012, 40, 77–85.
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  22. Buczkowska-Radlińska, J.; Łagocka, R.; Kaczmarek, W.; Górski, M.; Nowicka, A. Prevalence of Dental Erosion in Adolescent Competitive Swimmers Exposed to Gas-Chlorinated Swimming Pool Water. Clin. Oral Investig. 2013, 17, 579–583.
  23. Rao, K.A.; Thomas, S.; Kumar, J.K.; Narayan, V. Prevalence of Dentinal Hypersensitivity and Dental Erosion among Competitive Swimmers, Kerala, India. Indian J. Community Med. Off. Publ. Indian Assoc. Prev. Soc. Med. 2019, 44, 390–393.
  24. Silva, M.-R.G.; Chetti, M.-A.; Neves, H.; Manso, M.-C. Is the Consumption of Beverages and Food Associated to Dental Erosion? A Cross-Sectional Study in Portuguese Athletes. Sci. Sports 2021, 36, 477.e1–477.e11.
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