Young footballers have significantly worse oral health and disease than others of a similar age, finds a new study of elite English football academies led by UCL researchers.
The study, published in the BMJ Open Sport and Exercise Medicine, found higher levels of oral disease in both male and female players, with causal factors including poor oral hygiene (brushing/flossing), sugary sports and fizzy drink consumption, and stress (possibly due to a high-performance environment) that can cause teeth grinding and lead to decay.
Researchers, based at UCL Eastman Dental Institute, are now calling for better oral health support and education within football academies and other sporting institutions.
Good oral health can help to prevent lifelong health consequences of oral disease, such as cavities, extractions and increased risk of health issues such as heart disease and high blood pressure. In the short-term, research has also shown that better oral health can improve sporting performance.
The observational study is the first to investigate oral health among football players aged 16 to 18, and the first to include female players of any age.
The cohort included 160 academy players representing 10 English football clubs from the Premier League, Championship and Women's Super League1, who answered a questionnaire about their oral health experiences and its impact on sporting performance, alongside a clinical assessment by a dentist.
Over three quarters (76.8%) of the players in the study had gingivitis (inflammation of the gums), compared to just 40% of 15-year-olds in England, with 22.5% of the players showing signs of irreversible periodontitis (gum disease)2.
Visible decay that required treatment was present in 31.2% of players, compared to 24% in the comparable national age group of 15-year-olds in England.
Moderate to severe levels of tooth wear was seen in 15.5% of participants, meaning their teeth had begun to wear through the enamel and into the underlying dentine (the tissue that forms the bulk of the tooth).
Alongside negative health effects, poor oral health has also been shown to affect athletic performance as players struggle to train and perform to their full potential due to tooth pain, infection and time taken off for treatment.
The presence of oral health problems such as those described above may be exacerbated by the lack of access to or inclination to visit the dentist, with one in five (19.9%) of the players included in the study having not attended the dentist in over two years.
Dr Saul Konviser, first author of the study from UCL Eastman Dental Institute, said: "Academies play a key role in shaping young footballers' lives and we believe there's an opportunity for them to help promote healthy attitudes towards oral health from an early age. This includes emphasizing preventative measures like limiting sugar and acid intake, establishing good oral health routines such as with high-fluoride toothpastes and rinses, and encouraging regular dental check-ups beyond just pre-season screenings. These steps can help to prevent or even reverse poor oral health and avoid lifelong consequences."
The findings correspond to high levels of oral disease in senior players identified in a previous UCL-led study in 20163, which found that football players' oral health was 10% worse than average for men of the same age, suggesting that disadvantage starts early and continues into adulthood.
The study also shed light on some of the factors that may be influencing poor oral health among academy players.
Only 76% of players confirmed that they brush their teeth twice a day, compared to 81% of 15-year-olds in England, which would help to explain the high rate of gum inflammation that was identified.
Similarly, only 5% of the players reported flossing on a daily basis, contrary to the national guidance that recommends flossing to help avoid gingivitis, gum disease and decay developing between the teeth.
Nine out of 10 players reported consuming sports drinks, with 23% doing so daily, and 53.1% also reported consuming fizzy drinks. Many of these drinks, which are high in acids and sugars, can lead to acid erosion of the teeth and increased risk of tooth decay.
Some cases of tooth wear were possibly related to gastric acids, with the dental screenings revealing patterns similar to those from acid reflux and even those seen in eating disorders like bulimia.
Professor Peter Fine, an author of the study from UCL Eastman Dental Institute, said: "Dentistry and oral health are often siloed from the rest of medicine, which is also true in English football academies. Despite some improvements at the senior level, oral health remains outside of athletic medical care, with players often sourcing their own dental care.
"Under-18 academy players should have access to free NHS dentistry, but they aren't always directed to it, and preventative oral health messaging isn't routinely integrated into player welfare. Providing care and fostering good oral health habits early could be a gamechanger, but there's also a question of who else, beyond medical teams and clubs, has a duty of care, such as the Football Association and the government."
Previous research has established that poor oral health is associated with individuals from lower income backgrounds. The authors say that although they did not ask about players socioeconomic backgrounds in this study, it is possible that a higher proportion of academy players come from these backgrounds and so are already at an oral health disadvantage.
Further research is needed to identify any correlation between footballer socioeconomic status and their oral and general health and if so, to help develop potential preventative strategies.
With more evidence emerging of the association between oral health, general health and sporting performance, the authors of this study are calling for a greater integration of oral health prevention and management strategies across football academies and sport in general.
