Sports Diet and Oral Health in Athletes: A Comprehensive Review

Food and fluid supply is fundamental for optimal athletic performance but can also be a risk factor for caries, dental erosion, and periodontal diseases, which in turn can impair athletic performance. Many studies have reported a high prevalence of oral diseases in elite athletes, notably dental caries 20-84%, dental erosion 42-59%, gingivitis 58-77%, and periodontal disease 15-41%, caused by frequent consumption of sugars/carbohydrates, polyunsaturated fats, or deficient protein intake. There are three possible major reasons for poor oral health in athletes which are addressed in this review: oxidative stress, sports diet, and oral hygiene. This update particularly summarizes potential sports nutritional effects on athletes' dental health. Overall, sports diet appropriately applied to deliver benefits for performance associated with oral hygiene requirements is necessary to ensure athletes' health. The overall aim is to help athletes, dentists, and nutritionists understand the tangled connections between sports diet, oral health, and oral healthcare to develop mitigation strategies to reduce the risk of dental diseases due to nutrition.

Effect of a demineralization model on the microhardness, surface roughness and topography of giomers: An in vitro study

The purpose of this study is to compare the effect of a demineralization model on the microhardness, surface roughness, and topography of giomers.Seventy-two discs of six different dental materials in three different presentations (pit and fissure sealant (PFS), flowable and restorative materials) were divided into six groups (n = 12 p/g). Three experimental groups (giomers) consisted of BeautiSealant, Beautifil Flow Plus, and Beautifil II, and three control groups (resin-based materials) were formed using ClinproTM, FiltekTM Z350 XT Flow, and Filtek™ Bulk Fill materials. Vickers microhardness, surface roughness, and topographic analysis with atomic force microscopy were measured at the beginning (0) after four (1) and 7 days (2) of immersion in a demineralizing model. Statistical analysis was performed using One-way and Repeated Measures ANOVA and Pearson's correlation coefficient (p ≤ .05). The microhardness values showed significant variations, except for the G_RM group. All the groups presented significant increases in roughness through the experiment stages, except for RB_PFS in the Ra parameter. The topographic analysis showed variations in the micromorphology, especially in the experimental group at the end of the demineralization model. Finally, there was no correlation between microhardness and surface roughness. The demineralization model decreased the microhardness, with the lowest reductions in the giomers groups. The effect of the demineralizing model on the surface roughness and topography showed an increase in specific patterns for the experimental and control groups. Therefore, their clinical use is recommended. RESEARCH HIGHLIGHTS: The demineralization model decreased the microhardness property of the evaluated materials, with better performance for the giomer groups. The effect of the demineralizing model on surface roughness showed an increase with specific patterns for the experimental and control groups. Although the materials presented changes in their microhardness, roughness, and topography, their clinical use is recommended.

Erosive Potential and Sugar Content of Popular Beverages: A Double Whammy for Dentition

Objectives

This study aims to identify the pH level and subsequently the erosive potential of beverages including their sugar content.

Materials and Methods

Beverages were purchased from a local convenience store, and some of the beverages were freshly prepared. The acidity of each beverage was identified using a calibrated pH meter. The pH was obtained in triplicate, and the results were expressed in average values with standard deviations. The pH values were then used to determine their erosive potential and the sugar content was obtained from the packaging and recorded.

Results

A total of 167 beverages were purchased and categorized. The beverages were categorized into 15 groups: milk tea, hawker drinks, instant drinks, fresh fruit juices, milk, energy drinks, designer coffee, soda, canned drinks, cultured milk, vegetable juices, cordials, bottled fruit drinks, tea, and mineral water. The pH value ranges from 2.65 to 7.85. Seven beverages (4.2%) were classified as extremely erosive, 53 beverages (31.1%) were classified as erosive, and 36 beverages (21.6%) were classified as minimally erosive. In total, 57.5% of the beverages were potentially erosive, and most of the soda and energy drinks were erosive. The highest sugar content per 100 g was BOH Teh Tarik Original (71.8 g), whereas the highest sugar content per serving was Carabao energy drink (10.8 g).

Conclusion

High sugar content and low acidic content of beverages could have a negative impact on the dentition. An intervention is required from a public health perspective to regulate the consumption of sweetened and flavored beverages.

Evaluating the pH of Various Commercially Available Beverages in Pakistan: Impact of Highly Acidic Beverages on the Surface Hardness and Weight Loss of Human Teeth

The objectives of this study were to investigate the pH of common beverages and to evaluate the effects of common acidic beverages on the surface hardness and weight loss of human tooth specimens. A total of 106 beverages were conveniently purchased from supermarkets in Karachi, Pakistan. Prior to evaluation, beverages were refrigerated or stored at room temperature in accordance with the manufacturers’ recommendations. Beverages were categorized into six groups: ‘Sports and Energy drinks’, ‘Water’, ‘Fruit Juices and Drinks’, ‘Sodas’, ‘Milk and Flavored Milk’ and ‘Teas and Coffee’. Using a pH meter, the pH of each beverage was measured in triplicate at room temperature. In addition, the influence of five highly acidic beverages on the weight loss and surface hardness of human tooth specimens was evaluated using gravimetric analysis and the Vickers hardness tester, respectively. ‘Sports and Energy drinks’, ‘Fruits Juices and Drinks’ and ‘Sodas’ were the most acidic beverage categories, with a pH range of 3.00−5.00. A total of 33% of beverages tested in this study were highly acidic (pH less than 4.00), 29% of beverages were moderately acidic (pH 4.00−4.99) and 31% were mildly acidic (pH 5.00−6.99). Significant weight loss was observed in all immersed specimens compared to control counterparts (p < 0.05). Similarly, for surface hardness, five highly acidic beverages (Red Bull, Pepsi, Apple Cidra, Tang Mosambi and Tang Orange) significantly decreased the surface hardness of specimens (p < 0.05). The pH levels of commonly available beverages in Pakistan are highly acidic, which may encourage loss of minerals from teeth; hence, affecting their surface hardness.

Dietary Determinants of Dental Caries Prevalence and Experience in Saudi Schoolchildren: Frequency versus Quantity

Background

Sugar-added diet has been associated with increased risk of developing dental caries.

Objective

To investigate the dietary determinants of caries prevalence and experience based on the frequency versus the quantity of consumption among Saudi schoolchildren.

Methods

This is a cross-sectional study that invited 12- to 15-year-old intermediate school students (N = 3000) in four cities in the Eastern Province of Saudi Arabia. Data collection comprised a pretested questionnaire and clinical examination. Caries was diagnosed based on the World Health Organization (WHO) criteria and was recorded as a decayed, missing, filled tooth (DMFT). The questionnaire included questions regarding the consumption of different quantities and frequencies of multiple sugar-containing food items. Multiple logistic and linear regression models were used to assess the influence of sugar-containing food on the dental caries experience (DMFT) and prevalence of decayed teeth. SPSS version 20.0 was used to analyze the data at 5% significance level.

Results

Of 3000 invited students, 2262 participated with a participation rate of 75.4%. Our study found that the frequency of soft drink consumption was significantly associated with increased caries prevalence (adjusted OR = 1.33, 95% CI 1.07–1.65) and experience (adjusted B = 0.46, 95% CI 0.16–0.76). The frequency of consumption of fruit juice was statistically significantly associated with increased caries experience (adjusted B = 0.48, 95% CI 0.16–0.79). The interaction terms between the frequency and the quantity of consumption of energy drinks, soft drinks, and sweetened milk were statistically significantly related to caries experience and prevalence.

Conclusion

Although the frequency of consumption of sugar-containing drinks was more associated with caries experience and prevalence, the interaction between frequency and quantity was highly related to the prevalence and experience of dental caries.

Nitrate-rich beetroot juice offsets salivary acidity following carbohydrate ingestion before and after endurance exercise in healthy male runners

There have been recent calls for strategies to improve oral health in athletes. High carbohydrate diets, exercise induced dehydration and transient perturbations to immune function combine to increase oral disease risk in this group. We tested whether a single dose of nitrate (NO₃^-) would offset the reduction in salivary pH following carbohydrate ingestion before and after an exercise bout designed to cause mild dehydration. Eleven trained male runners (V˙O2max 53 ± 9 ml∙kg^-1∙min^-1, age 30 ± 7 years) completed a randomised placebo-controlled study comprising four experimental trials. Participants ingested the following fluids one hour before each trial: (a) 140 ml of water (negative-control), (b) 140 ml of water (positive-control), (c) 140 ml of NO₃^- rich beetroot juice (~12.4 mmol NO₃^-) (NO₃^- trial) or (d) 140 ml NO₃^- depleted beetroot juice (placebo-trial). During the negative-control trial, participants ingested 795 ml of water in three equal aliquots: before, during, and after 90 min of submaximal running. In the other trials they received 795 ml of carbohydrate supplements in the same fashion. Venous blood was collected before and after the exercise bout and saliva was sampled before and repeatedly over the 20 min following carbohydrate or water ingestion. As expected, nitrite (NO₂^-) and NO₃^- were higher in plasma and saliva during the NO₃^- trial than all other trials (all P<0.001). Compared to the negative-control, salivary-pH was significantly reduced following the ingestion of carbohydrate in the positive-control and placebo trials (both P <0.05). Salivary-pH was similar between the negative-control and NO₃^- trials before and after exercise despite ingestion of carbohydrate in the NO₃^- trial (both P≥0.221). Ingesting NO₃^- attenuates the expected reduction in salivary-pH following carbohydrate supplements and exercise-induced dehydration. NO₃^- should be considered by athletes as a novel nutritional strategy to reduce the risk of developing acidity related oral health conditions.

Acid Resistance of Glass Ionomer Cement Restorative Materials

In view of the need for aesthetics, restorations of teeth will typically be completed using tooth colored restorative materials. With the advent of biomimetic restorative materials, such as glass ionomer cements (GIC), much greater emphasis is now being placed on how well such materials can resist the challenge of acids that are present in foods and drinks, or gastric contents that are regurgitated. This laboratory study compared the dissolution and behavior of five GIC materials (GC Fuji® VII, GC Fuji® Bulk, GC Fuji® IX Fast, Fuji® IX Extra and GC Equia® Forte Fil) when exposed to three acids (citric acid, phosphoric acid and lactic acid), versus ultrapure deionized water, which was used as a control. Discs of each material GIC were submerged in solutions and percentage weight changes over time determined. Subsequently, the GIC materials were also placed as a part of standardized Class II sandwich restorations in bovine teeth (n = 20), and submerged in the solutions, and the extent of GIC dissolution and protection of the adjacent tooth was scored. Weight loss increased with time and with acid concentration. Overall, the most soluble material was GC Fuji® IX Extra, while GC Fuji® IX Fast and GC Fuji® Bulk were less soluble, and the least soluble material was GC Equia® Forte Fil. The most destructive solution for both the discs and for GIC restorations in teeth was 10% citric acid, while the least destructive acid was 0.1% lactic acid. The more recent GIC materials GC Fuji® Bulk and GC Equia® Forte Fil showed increased acid resistance over the older GIC materials, and this further justifies their use in open sandwich Class II restorations in more hostile environments.

Evaluation of Surface Roughness and Hardness of Newer Nanoposterior Composite Resins after Immersion in Food-Simulating Liquids

Introduction:

Restorative resins during their prolonged use are exposed to variety foods and beverages are subjected to wear, degradation, and staining resulting in failure of restoration and require replacement. This study is aimed to evaluate surface roughness and hardness of five commercially available posterior resin composites following exposure to various food-simulating liquids (FSLs).

Materials and Methods:

Specimens were immersed in distilled water, ethanol, citric acid, and air and later examined using a profilometer, scanning electron microscope for the surface profiles. Hardness was measured by Vickers Hardness test.

Statistical Analysis:

Results were subjected to two-way ANOVA and Tukey's multiple Post hoc test.

Results:

There were significant differences in results among the composite resin tested. Inter comparison between materials after treating with FSLs, clear fill majesty (CFM) and Z350 showed better hardness values under the influence of ethanol, followed by Ever X, Tetric Evo Ceram and Sure fill SDR. None of the composites were unaffected by air compared to FSLs. Citric acid had reduced the hardness of CFM and had caused surface roughness on Sure fill SDR and Tetric Evo Ceram. Distilled water reduced hardness of CFM and SureFil SDR. EverX was not affected by any of the FSL either in hardness or surface roughness properties. All composites showed surface irregularities in all media. Ethanol and water had almost similar effect on all composites.

Conclusions:

Differences in hardness and surface roughness are due to different composition of resin matrix and different filler particles in all composite resin material tested.

EROSIVE POTENTIAL OF SPORTS BEVERAGES ON HUMAN ENAMEL “IN VITRO”

ABSTRACT Introduction: The low pH of sports drinks may cause tooth enamel demineralization. Objective: To measure Vickers hardness of human enamel exposed to sports drinks. Methods: Human molars were used to collect the enamel samples. Each sample had a test surface (exposed to the drinks) and a control surface (unexposed). The samples were exposed to isotonic drinks Gatorade and Powerade, and to maltodextrin drinks Malto Advanced and Malto Active, for 10 minutes every 12 hours over 30 days. The Vickers microhardness test was conducted with three indentations on each surface. The mean of the indentations within each group was considered in the statistical analysis. Sports drinks variables were analyzed with ANOVA/Tukey (p≤0.01). The independent t-test was used in the comparison between the control and test surfaces of each drink (p ≤ 0.05). Results: Enamel exposure to Gatorade (p = 0.000) Malto Advanced (p = 0.000) and Malto Active (p = 0.000) was seen to significantly reduce microhardness, while the isotonic drink Powerade had no significant effect on enamel (p = 0.248). Conclusion: It was concluded that with the exception of the isotonic drink Powerade, all the sports drinks tested caused a reduction in the microhardness of human enamel. Evidence Level III; Therapeutic studies - Investigating the Results of Treatment.

Food acid content and erosive potential of sugar-free confections

BACKGROUND

Dental erosion is an increasingly prevalent problem associated with frequent consumption of acidic foods and beverages. The aim of this study was to measure the food acid content and the erosive potential of a variety of sugar-free confections.

METHODS

Thirty sugar-free confections were selected and extracts analysed to determine pH, titratable acidity, chemical composition and apparent degree of saturation with respect to apatite. The effect of the sugar-free confections in artificial saliva on human enamel was determined in an in vitro dental erosion assay using change in surface microhardness.

RESULTS

The change in surface microhardness was used to categorize the confections as high, moderate or low erosive potential. Seventeen of the 30 sugar-free confections were found to contain high concentrations of food acids, exhibit low pH and high titratable acidity and have high erosive potential. Significant correlations were found between the dental erosive potential (change in enamel surface microhardness) and pH and titratable acidity of the confections. Ten of these high erosive potential confections displayed dental messages on the packaging suggesting they were safe for teeth.

CONCLUSIONS

Many sugar-free confections, even some with 'Toothfriendly' messages on the product label, contain high contents of food acids and have erosive potential.

Amazonian delicacy tucupi is as erosive as a cola-based soft drink

OBJECTIVE

Acidic diets are advocated as main risk factor for tooth erosion, which could be prevented, or at least controlled, if patients were early advised. It is important to identify, hence, if possible dietary constituents regionally consumed on large scale, such as tucupi, a low-pH yellowish-green color and strong flavor delicacy made from the juice of a bitter cassava, may explain its occurrence in specific patient groups. This cross-over in situ/ex vivo study evaluated tucupi's ability to promote erosion of bovine enamel by assessing its percentage of surface microhardness change (%SMHC), taking a cola-based soft drink and human saliva as positive and negative controls.

DESIGN

For three 7-days spaced out legs of 7 days each, nine volunteers wore palatal devices with three bovine enamel blocks, which were challenged with one of the following solutions: TUC-tucupi (n=27); COL-cola-based soft drink (n=27); SAL-saliva (n=27). Erosive challenges were performed extra-orally (4×/day) by dropping TUC or COL at room temperature on specimens. After 5min, palatal devices were replaced into the mouth. SAL permanently acted as the negative control while volunteers solely wore the device. One-way ANOVA followed by Tukey's post-hoc tests (α=0.05) were applied.

RESULTS

TUC promoted an enamel %SMHC (-21.56±10.08(a)) similar than that promoted by COL (-18.19±12.99(a); p=0.275), which were both significantly higher than that promoted by SAL (-1.86±13.65(b); p<0.0001).

CONCLUSIONS

Besides the most worldwide appreciated cola-based soft drink, the greatly consumed Amazonian delicacy tucupi can be considered a potential risk factor for tooth erosion.

Possible ways of reducing dental erosive potential of acidic beverages

Frequent consumption of acidic beverages is related to excessive tooth wear, namely dental erosion. Preventive measures may involve reduction or elimination of acidic drink consumption. However, the success of this approach is difficult to achieve as it is highly dependent on patient compliance. Therefore, a practical way of minimizing the erosive potential of popular acidic drinks may be their chemical modification. The aim of this article was to review the different methods of modification and their shortcomings. The available literature demonstrates that the erosive potential of most acidic beverages could be reduced. To date, the effectiveness of soluble calcium salts supplementation is the best established. However, modification can reduce the sensorial quality of the drink and shorten its shelf-life. There is also a need to evaluate the lowest effective and safe dose of the additive.

Fluoride content of tank water in Australia

BACKGROUND

The aims of this study were to: (1) analyse the fluoride content of tank water; (2) determine whether the method of water collection or storage influenced fluoride content; and (3) survey participant attitudes towards water fluoridation.

METHODS

Plastic tubes and a questionnaire were distributed through dentists to households with water tanks in Victoria. A midstream tank water sample was collected and fluoride analysed in triplicate using ion chromatography

RESULTS

All samples (n = 123) contained negligible amounts of fluoride, with a mean fluoride concentration of <0.01 ppm (range: <0.01-0.18 ppm). No statistically significant association was found between fluoride content and variables investigated such as tank material, tank age, roof material and gutter material. Most people did not know whether their tank water contained fluoride and 40.8% preferred to have access to fluoridated water. The majority thought fluoride was safe and more than half of the respondents supported fluoridation. Fluoride content of tank water was well below the optimal levels for caries prevention.

CONCLUSIONS

People who rely solely on tank water for drinking may require additional exposure to fluoride for optimal caries prevention.

Effect of energy drinks on the surface texture of nanoflled composite resin

OBJECTIVE

To study the effect of three energy drinks on the surface roughness of nanoflled composite resins after different periods of aging time.

MATERIALS AND METHODS

Composite resin disks, 6 mm diameter, 3 mm thickness were prepared from Filtec Z350 XT, Tetric EvoCeram and Filtec Z250 XT. Specimens fr/8om each material were tested after aging with Red Bull, Bison and Power Horse energy drinks and distilled water as a control. Specimens were stored at 37°C in dark containers for 1, 3 and 6 months. Surface roughness Ra was assessed using a surface scanning interferometry before and after each storage period. Surface roughness differences ΔRa and Ra among specimens were measured. Mean values were statistically analyzed using multiple repeated measured (ANOVA), variance and multiple comparisons of the mean values were done with Bonferroni test, with p < 0.05 as signifcance level.

RESULTS

The surface roughness degradation change ΔRa and Ra value before and after occurred by Red Bull, Bison and Power Horse energy drinks was signifcantly different for all tested materials at all three times p < 0.05. All specimens showed increase in surface roughness changes after aging periods of 1, 3 and 6 months. The highest total surface roughness difference ΔRa and Ra was found in the Red Bull group after 6 months.

CONCLUSION

Energy drinks used in this study had surface degradation effect on the tested composite resin materials. The surface roughness increased with aging time however, it was clinically acceptable in all test groups after 6 months. The effect of energy drinks solutions on the surface roughness parameter of resin composites depends on type of solution and its acidity contents.