|Year : 2020 | Volume
| Issue : 1 | Page : 18-23
The effect of sports on oral health in Riyadh city: A cross-sectional study
Abdulrahman Al Saffan1, Rawan Marey Alshahry2, Samar Abdulrahman Alrwissan2, Zainab Abdulatif Aljanoubi2, Raghad Abdulaziz Alswailem2
1 Preventive Department, Riyadh Elm University, Riyadh, Saudi Arabia
2 Dental Interns, Riyadh Elm University, Riyadh, Saudi Arabia
|Date of Submission||31-Dec-2018|
|Date of Decision||31-Mar-2019|
|Date of Acceptance||06-May-2019|
|Date of Web Publication||05-Feb-2020|
Dr. Abdulrahman Al Saffan
Riyadh Elm University, Riyadh
Source of Support: None, Conflict of Interest: None
Background: The global sports nutrition industry has skyrocketed regarding its total worth which has led to an enormous inflow of a variety of supplemental products. All of which are advertised to help the consumer achieve the desired body shape. The increased consumption of all sorts of protein and carbohydrates supplements have been reported to play a significant role in hastening dental decay.
Materials and Methods: A cross-sectional study was conducted by the distribution of printed questionnaires among amateur bodybuilders/powerlifters in 13 gyms and fitness centers in addition to a 4-day event entitled “Fitness, healthy living and sports investment event”. A total of 1314 men and women participated in completing the questionnaire.
Results: The majority (60.5%) of the participants were males and non-smokers (62.0%). Most of the participants reported using nutritional supplements (73.1%). Nearly, half the participants reported the use of >7 nutritional supplements per week (48.6%). A statistically significant result was found in regards to the relationship between increased consumption of dietary supplements and poor oral health. The methods of oral hygiene reported, appear to be insufficient.
Conclusion: It is evident that amateur weightlifters and bodybuilders are a new risk group for developing dental caries. Therefore, more attempts must be made to raise the awareness regarding the implications of increasing the consumption of carbohydrates, proteins and the sugary sports drinks on oral health, and the accompanied salivary dehydration during and after workouts, which may aggravate the decaying process.
Keywords: Bodybuilders, energy drinks, oral health, Riyadh
|How to cite this article:|
Al Saffan A, Alshahry RM, Alrwissan SA, Aljanoubi ZA, Alswailem RA. The effect of sports on oral health in Riyadh city: A cross-sectional study. Saudi J Oral Sci 2020;7:18-23
|How to cite this URL:|
Al Saffan A, Alshahry RM, Alrwissan SA, Aljanoubi ZA, Alswailem RA. The effect of sports on oral health in Riyadh city: A cross-sectional study. Saudi J Oral Sci [serial online] 2020 [cited 2020 Feb 28];7:18-23. Available from: http://www.saudijos.org/text.asp?2020/7/1/18/269033
| Introduction|| |
Throughout the years, there has been an observable increase in the exposure of people to various images of commercials, magazines, and social networking., Globalization has played a tremendous role in this unprecedented change concerning how people at large now view and interpret what is considered aesthetically pleasing. This man-constructed idea of beauty and being externally acceptable according to the standards of an individual's society has influenced the world of bodybuilding and fitness, forcing it to follow the trend that has been introduced by the globalized media and entertainment industry.,,
The global sports nutrition industry has skyrocketed regarding its total worth, which has led to an enormous inflow of a variety of products, all of which are advertised to help the consumer achieve the desired body shape. These products fall into several categories such as meal support, meal replacement, nitric oxide, postworkout and preworkout shakes, protein powder, and bars. The type and pattern of consumption play a substantial role in oral health status, including dental caries, periodontal disease, and dental erosion.
Sports drinks often aid the overall performance and are aimed to enhance strength and endurance as well as preventing or minimizing energy (or carbohydrate) depletion or shortage during and after the activity., A relationship between dental caries, erosions, and subsequent tooth loss, and the frequency of sweetened soft drinks including sports drink intake has been reported in children and young adults,, with evident lack of awareness of the effects of higher consumption of sports drinks.,
When taking a look at the oral conditions of both amateur bodybuilders and elite athletes, poor oral health seems to be a frequent finding in several published studies.,, These results make an astounding statement considering the preventable nature of oral diseases and their potential for impact on the overall health. Nonetheless, dental visits at the London 2012 Summer Olympic Games account for approximately 30% of all visits, immediately following visits due to musculoskeletal complaints.
The increased consumption of all sorts of protein and carbohydrates supplements has been reported to play a significant role in hastening dental decay. Dehydration during sporting activities could also increase the ramifications of carbohydrates on caries and drinks with low pH on the erosion of teeth., Consequently, this makes bodybuilders and athletes a new risk group who need to be aware of the implications of their lifestyle on their oral health, which raises the question of whether athletes and bodybuilders are aware of the association between tooth decay and increased protein/carbohydrates intake.
| Materials and Methods|| |
A cross-sectional study was conducted by the distribution of printed questionnaires among amateur bodybuilders/powerlifters in 13 gyms and fitness centers in addition to a festival and 4-day event entitled “fitness, healthy living, and sports investment event” in Riyadh city.
The samples included both female and male bodybuilders/powerlifters who go to the exercise regularly. The questionnaire included personal characteristics of the study participants (gender, smoking status, any disease conditions, and oral health status) along items in yes/No responses.
Responses were calculated and analyzed using SPSS Version 21 (IBM Corp, Armonk, NY, USA) data processing software. Univariate analysis, demographic and descriptive data for categorical variables were expressed in numbers and percentages. Bivariate analysis was used to evaluate the association between dental conditions and dietary habits. The data collection process took 6 weeks, starting from September 20, 2018.
Confidentiality of patient records and anonymity of subjects was assured as all the results were only expressed as numbers and percentages, with no possible way of identification.
| Results|| |
A total of 1314 men and women participated in completing the questionnaire. The majority (n = 795, 60.5%) of the participants were male and nonsmokers (n = 815, 62.0%). The vast majority of the participants reported that they do not have any diseases (n = 1255, 95.5%) with 39% of the respondents rating their oral health status as fair. The distribution of participants' oral health status is shown in [Table 1].
The majority (n = 781, 59.4%) of participants reported that they did not have regular dental checkups. More than half of the participants (n = 640, 56.9%) reported tooth brushing frequency as once per day, and less than half of the participants (n = 526, 46.8%) never used any mouthwashes. Among the participants, who had a regular dental check-up, 51.9% reported having a dental check-up visit twice a year. The distribution of responses in regards to dental care routines is shown in [Table 2].
[Figure 1] shows oral self-care behaviors among the study participants. The majority of the participants reported using fluoride toothpaste (93.6%), followed by teeth cleaning (85.6%), rinse (75.8%), regular checkup (39.3%), and flossing (33.6%).
Most of the participants reported using nutritional supplements (n = 960, 73.1%). Nearly, half of the participants reported the use of >7 nutritional supplements per week (n = 467, 48.6%). Most of the participants reported that nutritional supplements use decided/recommended by themselves (n = 342, 35.6%) and website (n = 309, 32.2%) [Table 3].
[Table 4] and [Figure 2] show the frequency of the type of supplement consumed/different types of nutritional supplements intake. The majority reported branched-chain amino acids (BCAAs), proteins powder, and creatine (n = 803, 83.6%).
[Table 5] shows the relationship between gender, smoking status, and supplement use. There was a statistically significant higher frequency of supplement use or protein powder among males in comparison to females [Table 5]. In contrast, females were more likely to use multivitamin gummies and energy drinks than males, which was statistically significant (all P < 0.05). The prevalence of supplement use among nonsmokers (79.1%) was statistically significant and higher than smokers (63.1%). Multivitamin gummies use was higher among nonsmokers in comparison to those who smoke. Furthermore, a statistically significant relation was found between the use of sports drinks and energy drinks with smoking status (P< 0.05). Energy and sports drinks were more prevalent among nonsmokers [Table 5].
There was a significant difference observed in regards to the use of supplements (P = 0.000), protein powder (P = 0.098), multivitamin gummies (P = 0.003), sports drinks (P = 0.000), and energy drinks (P = 0.000) between smokers and nonsmokers. There was a significant difference observed in regards to the use of supplements (P = 0.000), protein powder (P = 0.098), multivitamin gummies (P = 0.003), sports drinks (P = 0.000), and energy drinks (P = 0.000) between smokers and nonsmokers.
[Table 6] shows the relationship between oral health status and the consumption of supplements. Participants who rated their oral health status as poor were more likely to use supplements (P< 0.001). Similarly, the use of protein powder AA, sports drinks, and energy drinks was more common in participants with poor oral health status in comparison to those with good oral health status (all P < 0.001).
| Discussion|| |
An increased worldwide proclivity for supplements intake as an adjunct addition to athletes' and bodybuilders' daily routine has been reported. This increased consumption is related to the fact that nutritional supplements do not necessitate premarketing approval. Therefore, they are easily obtained and consumed. This increased tendency to consume such supplements was found in this current study with 73.1% of the participants reporting the use of nutritional supplements and nearly half of them reporting a high frequency of use. Males appear to be high consumers of these supplements, in comparison to females, which goes in line with multiple studies published in the US, UK, and Canada.,,, However, this increased protein and carbohydrates consumption has also doubled the risks of dental health deterioration, which appears to be an unknown fact to the consumers. There seems to be a lack of knowledge of the link between increased frequency of protein and carbohydrate intake. Combined with inadequate oral hygiene and infrequent dental checkups appointments, this intensifies the magnitude of dental diseases, as found in this study with 59.4% reporting not going to the dentist on a regular basis with only 39.3% going for regular checkups. Moreover, the majority reported the reason for their last dental visit being either to continue an ongoing treatment or as an emergency to relieve pain, which has been reported to be the case in a study done on athletes participating in the 2003 Olympics.
These findings place a question mark on the full understanding of supplements consumers of the ramifications of increasing the intake of proteins and carbohydrates without improving the methods of oral hygiene.
Another factor which could play a significant role in what appears to be a lack of knowledge is the tendency of the participants to consume higher amounts of nutritional supplements based on their judgment, preference or based on the information gathered from the internet as reported in this current study. More than half of the participants reporting that they either decided to add supplements to their diets based on their judgment or based on what they have found on various websites, which again coincides with what has been reported in multiple studies.,, Therefore, this unsupervised intake puts consumers in higher risks of developing dental caries faster than the average person.
The more demanding the physical activity, the more nutritional supplements are consumed, to maximize physical performance., In addition to that, the nature of most of these nutritional supplements creates a fertile environment for dental caries to be initiated or for the progression to extend. The acidic nature of sports drinks introduces another form of damage which is teeth erosion, consumed with supplements high in carbohydrates and sugar, the ideal environment is created for the demineralization and the subsequent cavitation of teeth to occur. The dehydration occurring during and after a workout is another challenge to maintaining oral health as this slows down the required washing action of saliva and the needed pH regulation through the salivary enzymes., These aggravating factors appear to be present in 48.6% of the participants who reported an intake frequency of more than seven times/day. The vast majority of the consumed supplements were for BCAAs, protein powder, and consuming energy drinks.
Another aspect was looked into in the current study, which was the relationship between gender and smoking status with the use of supplements. When looking at the consumption rate of protein powder and sports drink, a slight male predilection was found, whereas, for multivitamin gummies and energy drinks, a higher female percentage was observed. This has been observed in a meta-analysis where male supplements consumers of certain types of supplements such as protein and creatine were more than their female counterparts.
As smoking puts an additional challenge to maintaining good oral health, the percentage of smokers was also measured, with 79.1% of supplements consumers being nonsmokers with a high tendency to consume energy and sports drinks more than any other form of supplementation.
As all the mentioned variables were studied, a statistically significant result was found in regards to the relationship between increased consumption of dietary supplements and poor oral health. Participants who rated their oral health as poor were also regular dietary supplements users with 81.7%. This sheds light on the particular connection of athletes/bodybuilders with poor oral health which could be considered as an unexpected finding as individuals who put additional efforts into managing their physique are somewhat presumed to have good oral health as well. The findings in this current study do not differ from what has been found in multiple studies which unveiled the unanticipated high prevalence of poor oral health among athletes and bodybuilders using supplements.,,,
| Conclusion|| |
It is evident that amateur weightlifters and bodybuilders are a new risk group for developing dental caries. Therefore, more attempts must be made to raise the awareness regarding the implications of increasing the consumption of carbohydrates, proteins and the sugary sports drinks on oral health, and the accompanied salivary dehydration during and after workouts, which may aggravate the decaying process.
The authors would like to thank the questionnaire respondents for the time spent in filling the questionnaires.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Opree SJ, van Reijmersdal EA, Valkenburg PM, Buijzen M. Children's advertising exposure, advertised product desire, and materialism: A longitudinal study. Commun Res 2019;41:717-35.
Powell LM, Wada R, Khan T, Emery SL. Food and beverage television advertising exposure and youth consumption, body mass index and adiposity outcomes. Can J Econ 2017;50:345-64.
Flew T. Post-globalisation. Javnost 2019;25:102-9.
Allen MS, Walter EE. Personality and body image: A systematic review. Body Image 2016;19:79-88.
Bąk-Sosnowska M, Anna U. Body image in women practicing yoga or other forms of fitness. Arch Psychiatry Psychother 2017;19:58-68.
Craike M, Young JA, Symons CM, Pain MD, Harvey JT, Eime RM, et al.
Trends in body image of adolescent females in metropolitan and non-metropolitan regions: A longitudinal study. BMC Public Health 2016;16:1143.
Global Sports Nutrition Market: Industry Analysis and Outlook 2017-2021 – Increase in Gym Club Membership to Keep Demand High for Sports Nutrition – Research and Markets. NewsRX LLC; 2017.
Gallagher J, Ashley P, Petrie A, Needleman I. Oral health and performance impacts in elite and professional athletes. Community Dent Oral Epidemiol 2018;46:563-8.
Guäă AB, Zippenfening H, Zippenfening S, Popa Z, Rusu AM, Stoia S, et al.
Dietary supplements and exercise capacity in professional rugby players. Timisoara Phys Educ Rehabil J 2018;11:34-40.
Oosthuyse T, Millen AM. Comparison of energy supplements during prolonged exercise for maintenance of cardiac function: Carbohydrate only versus carbohydrate plus whey or casein hydrolysate. Appl Physiol Nutr Metab 2016;41:674-83.
Kim S, Park S, Lin M. Permanent tooth loss and sugar-sweetened beverage intake in U.S. young adults. J Public Health Dent 2017;77:148-54.
Smith M. Sports Drinks 'Fuel Tooth Decay Epidemic' in Kids. Cardiff (UK): MGN Ltd.; 2017.
Broughton D, Fairchild RM, Morgan MZ. A survey of sports drinks consumption among adolescents. Br Dent J 2016;220:639-43.
Fairchild RM, Broughton D, Morgan MZ. Knowledge of and attitudes to sports drinks of adolescents living in South Wales, UK. Br Dent J 2017;222:931-5.
Knight A, Alsaey M, Farooq A, Wilson MG. Alarmingly poor oral health in international athletes competing in the middle east. Br J Sports Med 2018. pii: bjsports-2017-098770.
Needleman I, Ashley P, Weiler R, McNally S. Oral health screening should be routine in professional football: A call to action for sports and exercise medicine (SEM) clinicians. Br J Sports Med 2016;50:1295-6.
Article S. Tooth Decay a Preventable Global Problem, Infomart, a Division. Lethbridge, Alta: Postmedia Network Inc.; 2018.
Vanhegan IS, Palmer-Green D, Soligard T, Steffen K, O'Connor P, Bethapudi S, et al.
The London 2012 summer olympic games: An analysis of usage of the olympic village 'polyclinic' by competing athletes. Br J Sports Med 2013;47:415-9.
Ali MS, Batley H, Ahmed F. Bodybuilding supplementation and tooth decay. Br Dent J 2015;219:35-9.
Aral K, Berdeli E, Aral CA, Berdeli A, Atan M. Effects of bodybuilding and protein supplements in saliva, gingival crevicular fluid, and serum. J Oral Sci 2017;59:121-30.
Needleman I, Ashley P, Fine P, Haddad F, Loosemore M, de Medici A. Consensus statement: Oral health and elite sport performance. Br Dent J 2014;217:587-90.
Cohen PA. Hazards of hindsight – Monitoring the safety of nutritional supplements. N
Engl J Med 2014;370:1277-80.
Petróczi A, Naughton DP, Pearce G, Bailey R, Bloodworth A, McNamee M. Nutritional supplement use by elite young UK athletes: Fallacies of advice regarding efficacy. J Int Soc Sports Nutr 2008;5:22.
Tscholl P, Alonso JM, Dollé G, Junge A, Dvorak J. The use of drugs and nutritional supplements in top-level track and field athletes. Am J Sports Med 2010;38:133-40.
Diehl K, Thiel A, Zipfel S, Mayer J, Schnell A, Schneider S, et al.
Elite adolescent athletes' use of dietary supplements: Characteristics, opinions, and sources of supply and information. Int J Sport Nutr Exerc Metab 2012;22:165-74.
Wiens K, Erdman KA, Stadnyk M, Parnell JA. Dietary supplement usage, motivation, and education in young, Canadian athletes. Int J Sport Nutr Exerc Metab 2014;24:613-22.
Reid BC, Chenette R, Macek MD. Prevalence and predictors of untreated caries and oral pain among special olympic athletes. Spec Care Dentist 2003;23:139-42.
Moynihan PJ, Kelly SA. Effect on caries of restricting sugars intake: Systematic review to inform WHO guidelines. J Dent Res 2014;93:8-18.
Hoyte CO, Albert D, Heard KJ. The use of energy drinks, dietary supplements, and prescription medications by United States college students to enhance athletic performance. J Community Health 2013;38:575-80.
Kobayashi E, Sato Y, Umegaki K, Chiba T. The prevalence of dietary supplement use among college students: A nationwide survey in Japan. Nutrients 2017;9. pii: E1250.
Locquet M, Beaudart C, Larbuisson R, Leclercq V, Buckinx F, Kaux JF, et al.
Self-administration of medicines and dietary supplements among female amateur runners: A Cross-sectional analysis. Adv Ther 2017;33:2257-68.
Cermak NM, Res PT, de Groot LC, Saris WH, van Loon LJ. Protein supplementation augments the adaptive response of skeletal muscle to resistance-type exercise training: A meta-analysis. Am J Clin Nutr 2012;96:1454-64.
Morton RW, Murphy KT, McKellar SR, Schoenfeld BJ, Henselmans M, Helms E, et al.
Asystematic review, meta-analysis and meta-regression of the effect of protein supplementation on resistance training-induced gains in muscle mass and strength in healthy adults. Br J Sports Med 2018;52:376-84.
Frese C, Wohlrab T, Sheng L, Kieser M, Krisam J, Frese F, et al.
Clinical management and prevention of dental caries in athletes: A four-year randomized controlled clinical trial. Sci Rep 2018;8:16991.
Knapik JJ, Steelman RA, Hoedebecke SS, Austin KG, Farina EK, Lieberman HR. Prevalence of dietary supplement use by athletes: Systematic review and meta-analysis. Sports Med 2016;46:103-23.
Bakri NN, Tsakos G, Masood M. Smoking status and oral health-related quality of life among adults in the United Kingdom. Br Dent J 2018;225:153-8.
Mulic A, Tveit AB, Songe D, Sivertsen H, Skaare AB. Dental erosive wear and salivary flow rate in physically active young adults. BMC Oral Health 2012;12:8.
[Figure 1], [Figure 2]
[Table 1], [Table 2], [Table 3], [Table 4], [Table 5], [Table 6]