The Margin: One reason some athletes may have bad teeth no matter how much they brush

These common products could be responsible for “substantial” dental problems in sports pros, new research finds. Read More...

This may be tough news for athletes to swallow.

The sports drinks, gels and bars that many jocks use to fuel their workouts may also be wrecking their teeth, according to a new study published in the British Dental Journal. And that can hurt their performance.

University College London researchers looked into why so many high-level competitors suffer so many dental problems. About half of elite U.K. athletes have signs of tooth decay compared to one-third of adults the same age in the general population. And almost four in 10 players on eight professional soccer clubs for England and Wales had cavities, according to a 2015 study. What’s more, 45% of them said they were “bothered” by the state of their teeth, and 7% said it affected their ability to train or play.

So the UCL team surveyed 352 elite and professional athletes about how often they brushed and flossed; how much sugar they consumed; whether they smoked; if they chewed gum; as well as the last time they visited a dentist. The athletes represented 11 different sports (including swimming, cycling, soccer, rowing, hockey and sailing), and 256 of them were training for the 2016 Rio Olympics.

And while these elites practiced better oral hygiene than the average person (94% brushed twice a day, and 44% flossed regularly), and they were less likely to smoke and more likely to follow a healthy diet, the researchers reported that the athletes had a “substantial” amount of dental problems. About half (49.1%) had untreated tooth decay, and almost a third (32%) reported that their oral health had a negative impact on their training and performance. And the researchers blamed these issues on sugary supplements: 87% of them sipped sports drinks; 70% used energy gels; and 59% chewed nutrition bars.

“The sugar in these products increases the risk of tooth decay and the acidity of them increases the risk of erosion,” wrote Dr. Julie Gallagher from the UCL Eastman Dental Institute Centre for Oral Health and Performance, in a news release accompanying the report. “This could be contributing to the high levels of tooth decay and acid erosion we saw during the dental check-ups.”

This builds on findings carried out by the same Centre since the London 2012 Olympics, which also previously suggested that elite athletes have a greater risk of oral diseases because of the dry mouth that many experience during intensive training. Saliva plays an important role in neutralizing acids in the mouth, as well as killing germs and protecting tooth enamel, and breathing less during intense exercise means that there is less saliva providing all of these health benefits. So you combine less spit with a high volume of sugary and acidic drinks and supplements, and athletes’ teeth and gums could be facing a world of pain.

Indeed, the FDI World Dental Federation warned about sports drinks and certain foods and supplements with added sugars and acidic ingredients during a June PSA about athletes and oral health, noting that consuming these things “can cause cavities and increase the risk of gum disease and tooth erosion.” It also warned that sports-related stress can lead to dehydration, dry mouth and teeth-grinding.

But the solution is not as simple as athletes switching from Gatorade PEP, +2.18%, Powerade KO, +1.13% and Gu gels to just drinking water. There’s a reason these products are often packed with sugar and sodium; these carbohydrates and electrolytes help with hydration and athletic performance, particularly in long or intense workouts. And this had fueled a sports drink industry expected to hit $28.5 billion globally by 2023. So what is an athlete to do?

“I’m not advocating that we eliminate these sort of things — especially for elite athletes, because they have different needs than kids playing soccer … or a weekend marathoner,” Dr. Matt Messina, a spokesman for the American Dental Association, told MarketWatch. “It comes back to everything in moderation. If we reduce the amount of sugar and acidity being consumed in sports drinks or gels, and increase the amount of cleaning of the teeth and good oral hygiene, I think we can fight this to a standstill.”

Some sports and energy drink makers are already cutting back on the added sugars. Monster Beverage launched its zero-sugar and zero-calorie Reign “body fuel” beverage line in March, and Amazon AMZN, +0.84% has rolled out its own sugar-free sports drinks under its Solimo brand.

The FDI also recommends that athletes rinse their mouths with water after sipping a sweetened drink or consuming a sports gel or nutrition bar, and to remain hydrated during the day to keep their mouths from getting too dry. They should also continue to brush their teeth twice a day for two minutes at a time with a fluoride toothpaste, as well as visiting a dentist at least once a year.

“Just because people are athletic, it doesn’t mean they’re not prone to diseases of mortals,” said Dr. Jordan Metzl, a sports medicine physician at the Hospital for Special Surgery in Manhattan. “This study shows that even if you have a six-pack, you still need to practice effective oral hygiene.”

But the average person or weekend warrior playing in a local sports league or training for a race can probably cut down on how many of these sports drinks and products that they use, since they are not performing at such a high level. “More water is better,” said Dr. Messina. “Alternate a bottle of plain water or fluoridated water with a sports drink, so you cut [the sports drinks] in half.” He suggests swishing a fluoride rinse in the mouth once or twice a day to further wash away any sugar or bacteria. Some research has also suggested that eating a piece of whole fruit, like a banana packed with potassium, is as beneficial as gulping a sports drink.

Dr. Nammy Patel, who operates a San Francisco dental practice, also recommends that athletes sip sports drink through a straw so that the substance bypasses the teeth. “Chew a xylitol based gum to keep the mouth moist. Cut down on the frequency of drinks or drinking more water. Get more frequent teeth cleanings. Use a toothpaste with fluoride and make sure you’re getting enough calcium,” she added.

And Dr. Messina also recommends that athletes of all levels check in with their dentist regularly to customize a healthy routine that works for them and their performance needs. “I can offer suggestions with a broad brush,” he said. “But if you see a dentist on regular basis, they can spot problems and offer individualized suggestions for your situation.”