Scientific Programme
Sports and Exercise Medicine and Health
IS-MH04 - Why is elite athlete oral health so poor and what can we do to reverse the performance impacts?
Date: 02.07.2025, Time: 09:30 - 10:45, Session Room: Arco
Description
Athletes have been consistently shown to have poor oral health with common negative impacts on performance and psycho-social outcomes. These consequences likely result from the demands of training, nutrition, and environmental factors. While physically active individuals exhibit healthier oral microbiome profiles than their sedentary counterparts, elite athletes may experience poorer oral health due to cumulative stress, dietary choices, and dehydration. These issues are further complicated by gender-specific factors, with female athletes facing additional risks related to hormonal fluctuations and potential nutritional deficits. An emerging solution in this context is dietary nitrate, which has been shown to act as an oral health prebiotic offering a novel approach to improving the oral health of elite athletes. This session will explore research and potential strategies to address these challenges. Professor Needleman will open with a presentation on oral health challenges faced by athletes, their impact on performance, and behaviour change interventions. Dr Burleigh will discuss emerging research on how exercise affects the oral microbiome and discuss the unique challenges female athletes face. Professor Easton will conclude the session with a presentation on the potential of dietary nitrate supplementation as an oral health prebiotic. This session will interest researchers and practitioners in nutrition, sports medicine, oral health, and athlete support teams.
Chair(s)
Mia Burleigh
The University of the West of Scotland, Sport and Physical Activity Research Institute
United Kingdom
Speaker A
Ian Needleman
UCL Eastman Dental Institute, Periodontology
United Kingdom
Read CVECSS Rimini 2025: IS-MH04
Oral health, inflammation, elite athletes and performance medicine
Our studies across Olympic games, elite squads and sports federations show a remarkably consistent pattern; elite athletes have high levels of oral diseases which are higher than non-athlete populations despite being easily preventable. Importantly, we have also shown that oral health negatively affects self-reported athlete performance with new data indicating impacts on objective laboratory parameters such as VO2max. These observations are consistent with other effects of oral health such as impairment of glycaemic control. This presentation will summarise what we know about oral health in elite athletes and its determinants. It will also review what we know about the mechanisms linking oral health with systemic health and performance. Finally, the presentation will review what we know about how best to promote oral health within high performance sport including interventions developed in partnership with athletes. The topic is directly relevant to the health, daily wellbeing and performance of athletes. The target audience includes not only sports medicine clinicians and scientists but also athletes and their support staff.
Speaker B
Mia Burleigh
The University of the West of Scotland, School of Science and Sport
United Kingdom
Read CVECSS Rimini 2025: IS-MH04
Exercise, Oral Microbes, and Performance: A Complex Interplay
Emerging research demonstrates the complex relationship between exercise and the oral microbiome, revealing that exercise can influence oral health both positively and negatively. Oral health is closely tied to microbial composition and function and is an often overlooked, yet critical, component of an athlete’s performance and overall well-being. While factors such as high-carbohydrate diets, frequent energy drink consumption, dehydration, and immune suppression following intense training can compromise oral health, recent data from our laboratory, suggest that physically active individuals—those habitually meeting the minimum exercise recommendations—tend to have healthier oral microbiome profiles compared to sedentary individuals. Active individuals exhibit a balanced microbial environment, which may contribute to improved oral and systemic health. This stands in contrast to previous research that shows elite athletes, particularly those involved in high-intensity training, often suffer from poorer oral health outcomes, likely due to the cumulative effects of dietary choices, reduced salivary flow, and the heightened physical demands of their training regimens. The oral microbiome is highly sensitive to changes in diet, hydration, and immune function—all of which are influenced by exercise. Regular, moderate exercise appears to promote microbial diversity, supporting a healthier balance of bacteria in the mouth. However, in elite athletes, the stress of demanding training, coupled with other risk factors, can lead to an environment that fosters pathogenic bacteria, increasing susceptibility to oral diseases such as dental caries, gingivitis, and periodontitis. This dual impact of exercise on the oral microbiome underscores the need for a nuanced understanding of the relationship between exercise and oral health. While the focus of this lecture is on the general athlete population, female athletes present a compelling area for future research. Hormonal fluctuations related to menstruation, pregnancy, and menopause may further influence the composition and health of the oral microbiome. Female athletes, especially those at risk of relative energy deficiency in sport (RED-S), may experience compounded oral health challenges due to nutritional deficiencies and compromised immune function, warranting further investigation. This talk will detail the current understanding of how exercise affects the oral microbiome, examining both the positive and negative outcomes associated with different levels of physical activity. We will explore the implications for athlete oral health management and suggest areas for future research, particularly in understanding female-specific factors that could influence oral microbial balance. The session will be of interest to athletes, sports scientists, oral health professionals, the athlete support team and anyone involved in athlete support and well-being.
Speaker C
Chris Easton
Heriot-Watt University, Institute for Clinical Exercise and Health Science
United Kingdom
Read CVECSS Rimini 2025: IS-MH04
NO Limits? The potential of dietary nitrate supplementation to improve oral health in athletes
Nitric oxide is a key signalling molecule that regulates a multitude of physiological processes, including immune function, vascular tone, and neurotransmission. Nitric oxide is generated endogenously via nitric oxide synthase enzymes, but this process is downregulated with ageing and underpins progressive endothelial dysfunction and a range of other age-related disorders. However, circulating nitric oxide levels can be enhanced via the ingestion of nitrate-rich vegetables, including beetroot. The nitrate is converted to nitrite by certain species of bacteria in the mouth and further reduced to nitric oxide when certain physiological conditions prevail. There is now a plethora of research which demonstrates that increasing nitric oxide levels through dietary nitrate supplementation can improve cardiovascular health and exercise performance. There is also emerging evidence to suggest that nitrate supplementation can improve markers of oral health. Data from our lab, for example, has shown that nitrate-rich beetroot juice can increase the pH of saliva and significantly alter the composition of the oral microbiome in favour of oral health. We have also shown that beetroot juice attenuates the decline in salivary pH following the ingestion of sugar-rich and acidic sports supplements. Dietary nitrate, therefore, may provide athletes with both an ergogenic advantage and an effective means to protect their oral health. This presentation will discuss the role of the oral microbiome in the regulation of nitric oxide availability and will review the emerging evidence on the potential of dietary nitrate supplementation to reduce the incidence of oral health issues in athletes or treat those where oral disease is already present. This talk will be of interest to athletes, support teams, and sporting bodies with a commitment to athlete well-being in addition to academics with research interests in immune function, sport nutrition, and nitric oxide physiology.