Diet and Oral Health of Elite Athletes in Ireland

Abstract

Introduction: Previous research has indicated a high prevalence of untreated dental disease among elite athletes. Multiple factors may predispose athletes to a high-risk profile including frequent carbohydrate consumption, high energy requirements, exercise-induced immune suppression, decreased saliva production and poor oral health-related behaviours. The aim of this study was to assess the diet and oral health of elite athletes in Ireland and to determine associations between potentially cariogenic foods and dental caries prevalence based on cluster analysis. A secondary aim of this study was to design a digital template for form building, data collection and data management for use with elite athletes and future oral health surveys. Methods: This cross-sectional study involved an oral health and dietary assessment of a convenience sample of elite athletes in Ireland. Oral examinations were performed at national training centres (Sports Institute Ireland and the National Rowing Centre) using calibrated examiners and validated indices. A web-based open-source platform, KoBoToolbox, was used to create customised dental charts and a customised questionnaire. Athletes also completed multiple 24-hour dietary recalls using an online platform, Foodbook24. Clustering, profiling of clusters and a generalized linear model (GLM) were used to determine associations between dental caries prevalence and potentially cariogenic food groups or nutrients. Results: A digital data collection (DDC) form was designed for use in oral health surveys. A total of 88 athletes from 7 different sports participated. The mean age was 25.6 years old (range 19-53), and 63% were male. The prevalence of untreated dental caries using the international caries detection and assessment system (ICDAS) score of ≥ 3, was 90% at an individual level and 13% at tooth level. The mean dietary energy intake was 2678±1352 kcals/day and mean carbohydrate intake was 324±189g/day. Cluster analysis identified two distinct groups based on ‘caries prevalence’, diet, age, gender and ethnicity. Binary logistic regression revealed a significant association between cariogenic starch intake during snacks and cluster membership. Conclusions: The study found a high prevalence of untreated dental caries in this cohort, exceeding previously reported levels for elite athletes. Using cluster analysis, we identified two distinct groups of athletes based on their ‘caries prevalence’, diet, age, gender and ethnicity. Surprisingly, the only statistically significant predictor of cluster membership was the consumption of cariogenic starch during snacks. These findings highlight two crucial points: first, there is an urgent need for targeted caries prevention strategies specifically designed for elite athletes; and second, further research is necessary to investigate the potential negative impacts of sports-specific diets on oral health. Our results suggest that the relationship between athletic diets and dental health is complex and warrants more detailed examination to ensure that performance nutrition does not come at the cost of oral health. The design of a versatile form and oral health questionnaire template using digital tools customised for elite athletes was useful for efficient, comprehensive field data collection. DDC tools are convenient for data form design, collection, and storage. This template can be easily modified for use by other researchers planning oral health surveys.