What if Bale, Tiago or Iniesta’s injuries started in their … mouths? Or that Cristiano Ronaldo missed a penalty or that Messi was not very active in a game was his gums fault? More cavities, fewer goals and more injuries. It is the conclusion of the first scientific studies carried out in the United Kingdom, Spain and Brazil, and published in the last five years, which indicate that when professional soccer players do not worry about the health of their teeth as they do with their knees or Quadriceps are more prone to injury and lower performance.
The latest research, conducted in 2015 by University College London with eight Premier League teams, showed that the majority of players suffer from significant oral problems : almost 40% have active cavities! 50% have dental erosion and 45% acknowledge that they feel annoyed with their mouth. Some – 7% – even say that this hurts them both in training and in games.
In 2011 another study was published, this time on the oral health of FC Barcelona players: the Barcelona footballers had no less than an average of two active cavities each! During three seasons, from 2003 to 2006, researchers from the University of Barcelona and the Bellvitge Biomedical Research Institute (IDIBELL) monitored the first team’s staff: what injuries or oral trauma they had, how was the oral hygiene they practiced or if they had gum problems or dental occlusion.
They then contrasted the data collected with the information from the club’s medical team about sports injuries. The conclusion was overwhelming: the players with the worst oral health were also those with the highest probability of injury . Apparently, when an infection occurs in the mouth, a series of chemical mediators are secreted that, through the blood, can reach the muscles and weaken them.
“You have to think that, in general, high-performance athletes are a group with a very high rate of cavities . They eat a lot of carbohydrates rich in sugar, energy bars, sugary drinks … And exercise dries out their mouth and leaves them without saliva, fluid that protects against cavities. An unhealthy mouth can have a great impact on its performance “, explains dentist Lluïsa Solé.
They found that a third of the staff suffered from bruxism: due to stress, they grinded their teeth while sleeping . And like Ronaldinho, two-thirds of the players had misaligned teeth. And that is not only an aesthetic issue: in the case of the Brazilian, it caused him certain breathing difficulties.
Solé explains that it is scientifically documented how “oral diseases, especially those related to the gums, can cause health problems in the rest of the body .” They cause from balance disorders and muscle injuries to headaches or cramps, and even aggravate diabetes and increase the risk of heart disease.
The Spanish, however, do not seem to be very aware of this. According to the data collected by the White Book on oral health in Spain, prepared in 2015 by the General Council of Colleges of Dentists and Stomatologists, only 48.3% of Spaniards had spent the last year at the dentist . Even so, “in general, we have improved a lot in a while to this part. They insisted on our parents to brush their shoes and they already told us that it was important to brush our teeth. And we have even introduced mouthwashes and dental floss, ”says Vicente Faus, president of the Spanish Society of Conservative Dentistry (SEOC).
Our oral health has a lot to do with the bacteria in our mouth: there are more than seven hundred different species, and as many microorganisms live in a milliliter of saliva as there are people in China . Most help us break down food; but others will cause us health problems if they manage to proliferate and unbalance the oral microbiota. One of the microorganisms that must be kept at bay is Streptococcus mutans, a bacteria that causes cavities.
And how is the oral microbiota kept in balance?
With good hygiene and trying to avoid risk factors, such as coming into contact with pathogenic bacteria. And this is the case even from pregnancy: if the pregnant woman has a high bacterial load, it is more likely that part of these microbes will pass into the child’s mouth; And if they cause infections, they can cause problems for you.
They are transmitted by saliva, so that, with a gesture as common as cleaning the baby’s pacifier by sucking on it, we can pass pathogenic microorganisms to the child . Couples also share very similar oral microbiomes, since bacteria are exchanged with each kiss; If some of them are undesirable, they can spread tooth decay.
Diet, and especially a high sugar intake, is key to altering the oral microbiota. And we not only refer to the lumps that we add to coffee or sweets, but also to soft drinks, industrial juices, bread, pasta, ketchup … Sugar can alter collagen and also acidifies the environment, which It affects the teeth by eroding their enamel and leaving them unprotected against the bacteria that cause cavities.
Saliva plays a fundamental protective role . It is full of phosphate and calcium ions, and fluorine, which remineralize the enamel surfaces that the acid attacks. However, at some moments in life, saliva production decreases, such as when we get older. Some professions also make us salivate less – those that require us to speak a lot in public or high-performance sports – and, therefore, these groups are considered at risk for oral diseases.
If the community of microorganisms becomes unbalanced and pathogenic microbes proliferate, cavities or periodontal disease can develop . Although most of us think of cavities as the holes that appear in the teeth, the problem already begins with the demineralization of the piece, which leaves it without a protective layer. Luckily, it can be reversed. “We can control and avoid the pathological factors of each patient and enhance those that help us to have teeth and a microbiota compatible with good oral health,” explains Solé.
Also useful are certain professional products that are placed on the teeth at night , rich in calcium phosphate, which help to restore the mineralization of the teeth; or those with xylitol or fluoride, which also restore enamel to the teeth.
Periodontal disease is more complicated: it is infectious, inflammatory and chronic , and it also destroys the supporting tissues of the tooth: the alveolar bone. And despite the fact that the majority of the population does not know what it is, around 35% of Spaniards suffer from it, according to a 2012 study by the Ibermutuamur-SEPA Prevention Society.
The first phase is gingivitis, that is, inflammation of the gums, which is reversible . When pathogenic bacteria are eliminated or hygiene is improved, the problem disappears. However, in some cases it evolves to periodontitis and bone loss occurs. “There are some bacteria that directly affect the enamel; and others that colonize the space between the gum and the tooth and that gradually destroy the bone, until a moment comes when the tooth moves and you can lose it ”, explains Solé.
Early detection essential
If detected in the early stages, treatment allows teeth to be preserved, but if diagnosed at an advanced stage, teeth often cannot be preserved. A first clue that we may have periodontitis is that our gums bleed frequently . “They can bleed if we get injured one day or in situations like pregnancy, due to hormonal changes. But a habitual bleeding is a symptom that there is a problem ”, points out Regina Izquierdo, professor orthodontist at the University of Valencia and member of the Board of Directors of the Spanish Society of Periodontology and Osseointegration (SEPA).
Periodontal disease has two consequences. The first is local and involves the loss of teeth. The other is systemic and can be serious: the presence of a large number of pathogenic bacteria under the gum can cause them to pass into the blood and invade different tissues and organs. In fact, poor oral health has been linked to an increased risk of cardiovascular disease, premature birth, diabetes, and metabolic syndrome , among other complications.
The SEPA has several working groups in collaboration with other societies, such as those of cardiology, diabetes and gynecology, because “the health of the gums can improve or worsen certain systemic conditions which, in turn, if not controlled, can aggravate the gum problem ”, says Dr. Izquierdo. “We began to find many microorganisms present in the tartar in distant organs that have some health problem. And we see that when we eliminate these microorganisms, the prevalence of this disease decreases ”, explains Dr. Faus.
The two systemic diseases in which the greatest relationship has been found to periodontitis are diabetes and heart disease . Diabetics’ risk of periodontal disease is much higher; and also the other way around: periodontal disease, due to the chronic inflammation it generates, causes mediators of this inflammation to pass into the blood, which affects the metabolic control of sugar.
Also, when someone is diagnosed with periodontitis, the risk of heart disease increases. In fact, people who have suffered a myocardial infarction should take extreme care of their gums : a recent study by the University of Granada concluded that heart attacks were more frequent and serious among patients with untreated periodontal problems.
On the other hand, the fact that Spain is one of the countries in the world in which more implants are performed, in the words of Dr. Faus, can have a double reading: that we have excellent oral surgeons and that “in Spain they have proliferated more than in other countries in Europe or the United States a type of dental clinics that profit from their work, especially by putting implants. After all, keeping a tooth in your mouth is the most complex thing . An implant, on the other hand, is more profitable and requires less technique and time ”.
“You only have to do an implant when everything else has failed ,” says Dr. Izquierdo. “The best material for the mouth is the tooth itself. It is the most biocompatible and binds to the gums in a perfect way, protecting against the entry of bacteria ”. Implants, contrary to what is usually thought, are not for life and have a high associated risk that the person ends up developing peri-implantitis, “a disease that involves bone loss due to infection around the implant,” explains Solé . In fact, according to a SEPA study, between 28% and 56% of patients with implants have it.
Implants are usually made of titanium and, in recent years, they have evolved in terms of design, materials, surfaces and types of threads. Even also in its placement: ” Now we do computer-guided surgery . Using a CT scan of the patient’s mouth and using software, we can virtually know which is the best option to perform the implant: angulation, depth or position. exact “, emphasizes Solé.
Once decided, the information is transferred to a guide that is then placed on the gum, so that ” predictability is greatly improved, surgical times are shortened and, if the case allows it, we even avoid lifting the gum , which means greater comfort for the patient. In spite of everything, the knowledge and experience of the dentist continue to be the key to the success of these treatments, “says Solé.
