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Oral health-related behaviours reported by elite and professional athletes



Background In elite sport, the protection of an athlete's health is a priority. However, research indicates a substantial prevalence of oral disease in elite and professional athletes. The challenges to oral health from participation in sport require investigation to identify effective strategies and mitigate risk. Aim To explore athlete-reported oral health behaviours, risks and potential for behaviour change in a representative sample of elite athletes based in the UK. Method This was a cross-sectional study. We provided oral health screening for 352 elite and professional athletes from June 2015 to September 2016; 344 athletes also completed a questionnaire. Results The median age was 25 years (range 18-39) and 236 (67%) were male; 323 (94.2%) said they brush twice daily while 136 (40%) said their most recent dental attendance was within the previous six months. Ninety-seven (28%) would be assessed as high consumers of sugar in their regular diet. The use of sports nutrition products was common with 288 (80%) reporting the use of sports drinks during training or competition but were positive about behaviour changes. Conclusion Despite reporting positive oral health-related behaviours, athletes have substantial amounts of oral disease. Athletes are willing to consider behaviour change related to daily plaque removal, increased fluoride availability and regular dental visits to improve oral health.
Oral health related behaviours reported by elite and professional athletes
In elite sport, protection of an athlete’s health is a priority, however research indicates a substantial
prevalence of oral disease in elite and professional athletes. The challenges to oral health from
participation in sport require investigation to identify effective strategies and mitigate risk.
To explore athlete-reported oral health behaviours, risks and potential for behaviour change in a
representative sample of elite athletes based in the UK.
This was a cross sectional study. We provided oral health screening for 352 elite and professional
athletes from June 2015-September 2016; 344 athletes also completed a questionnaire.
Median age was 25 years (range 18 - 39) and 236 (67%) were male. 323 (94.2%) said they brush twice
daily. 136 (40%) said their most recent dental attendance was within the previous 6 months. 97 (28%)
would be assessed as high consumers of sugar in their regular diet. Use of sports nutrition products
was common; 288 (80%) reported using sports drinks during training or competition but were positive
about behaviour changes.
Despite reporting positive oral health related behaviours, athletes have substantial amounts of oral
disease. Athletes are willing to consider behaviour change related to daily plaque removal, increased
fluoride availability and regular dental visits to improve oral health.
Key Points
Oral diseases and athlete-reported negative performance impacts are common in elite and
professional athletes
Advises dentists that elite athletes are willing to adopt oral health related behaviours to
mitigate the risks to oral health associated with sport
Dentists should be aware of the need for enhanced prevention for sports people
In elite sport, protection of an athlete’s health is a priority, however dental caries, periodontal diseases
and erosive tooth wear (ETW) remain prevalent. 1-4 Furthermore, athletes with poor oral health report
negative impacts on wellbeing, quality of life, training and performance.1-4 Severe events such as acute
dental infections or oro-facial trauma, leading to time lost from training and even competition, occur
infrequently. However chronic impacts which may not lead to time loss, but rather a reduction in
quality of training, are commonly reported, and at elite level may have important consequences. 4,5
Likely challenges to oral health in sport include increased risk of dental caries due to increased and/or
inappropriate consumption of dietary carbohydrates within usual diet or sports nutrition products
such as sports drinks, and energy bars or gels. 6,7 These products are marketed with no accompanying
guidance related to oral health. Sports drinks tend to be acidic, therefore may also contribute to ETW.8
Lack of awareness or prioritisation may also be a factor in elite sport.9 The risks of oral disease may
be further increased due to alterations in saliva composition during exercise10 and immune
suppression following intense effort.11 Effective oral health promotion strategies may minimise
performance impacts from poor oral health.4 Although there is good evidence for oral health
promotion and prevention outside of sport ,12 the challenges to oral health from sport and those
related to implementation in this environment, confer unique characteristics that require
investigation to identify effective strategies and mitigate risk.13
The aim of this study was to explore athlete-reported oral health behaviours, risks to oral health and
potential for behaviour change in a representative sample of elite athletes.
Study design
This was a cross-sectional study, conducted at UK elite athlete training centres between June 2015
and August 2016. We provided oral health screening for 256 athletes on podium potential/ placement
programmes for the 2016 Rio Olympic Games and 96 professional athletes (352 in total) across 11
sports which we categorised as “endurance”, “strength and power”(events lasting less than two
minutes) or “mixed” (e.g. team sports). The methods and results are reported in a previous paper.4
The athlete-reported data presented in this paper were collected with a self-administered
questionnaire, completed at the screening appointment.
Eligibility criteria
Member of elite (Olympic or professional) training/development squad
Aged 18 years or over
Able to understand the consent process with the aid of a translator if required
Able to understand and complete the questionnaire with the aid of a translator if required
Ethical approval was received from University College London research ethics committee (Project ID
6388/001). Informed written consent was obtained. Participation in the study was entirely voluntary
and with no obligation.
Athlete-reported oral health behaviours, risks to oral health and potential for behaviour change
The questionnaire was developed with input from our advisory group which included academics,
athletes, and dentists with an interest in sport. Items to explore self-reported oral health related
behaviours were based on those used in the Adult Dental Health (ADH) Survey 2009.14 They included:
frequency of tooth brushing, use of additional oral hygiene methods, most recent dental attendance,
type of service used, most important factor when making a dental appointment and previous dental
advice received. Use of additional oral hygiene aids included electric toothbrush (ETB),fluoride
mouthwash, interdental cleaning and sugar free chewing gum (SFG). Risks to oral health included
tobacco use and consumption of sugar in usual diet. The Scientific Advisory Committee on Nutrition
(SACN) advises that the maximum free sugar consumption for the UK diet should be 5%.15 Using the
method described in ADH 2009, athletes who indicated that they consumed a serving of cakes, or
sweets, or soft drinks six or more times a week were categorised as high sugar consumers.14 We also
explored knowledge of risks to oral health of sports nutrition products (SNPs). We also asked about
athletes’ use of SNPs before, during and after training and competition. Finally, we asked which
behaviours athletes would consider adopting if it would improve their oral health. The research
advisory group reviewed the questionnaire which was piloted before use.
Statistical analysis
We used a standard statistical package (IBM SPSS Statistics for Windows, Version 22.0. Armonk, NY).
For data analysis. Counts and percentages summarised the categorical data. This report was guided
by the STROBE statement of observational studies16.
Median age was 25 years (range 18 - 39) and 236 (67%) were male. The demographic characteristics
of the group are presented in Online table 1. There were 50 (14.2%) athletes in the strength and power
(S&P) category, 143 (40.6%) in the endurance category and 159 (45.2%) in the mixed category. Table
1 summarises the prevalence of oral disease in each category and sport. Questionnaire data were
available for up to 344 athletes (50 (14.5%) S&P, 140 (40.7%) endurance and 154 (44.8%) mixed). Eight
questionnaires were not returned due to time constraints and some athletes omitted some response
Oral health behaviours (Online Tables 2, 3 and 4)
Overall, 323 (94.2%, 95% CI 91.8-96.7) reported brushing their teeth at least twice daily. Regarding
use of additional methods for oral hygiene, 190 (55.9%, 95% CI 49.9 -60.4) said they used an ETB, 148
(43.7%, (95% CI 37.9-48.3) said they used dental floss or interdental brushes, 139 (40.9%, 95% CI 35.4-
45.6) said they used fluoride mouthwash and 120 (35.1%, 95% CI 30.32-40.3) reported using sugar
free chewing gum (SFG). Three hundred and twelve (90%, 95% CI (87.1 -93.4) athletes reported
drinking water on at least six days or more per week.
Risks to oral health (Online Tables 5, 6 and 7)
One (0.3%) athlete reported current use of smokeless tobacco. We categorised 97 (28.2%, 95% CI
23.7-33.2) of athletes as high consumers of sugar in their regular diet. Regarding the use of sports
nutrition products, 288 85.7% (95% CI 81.5-89.1) of the 336 athletes who provided this information
reported using sports drinks at least sometimes during training/competition, 198 (58.8%, 95% CI 53.4-
63.9) energy bars and 239 (70.3%, 95% CI 65.9 -75.5) energy gels.
Dental service considerations (Online Tables 8, 9, 10 and 11)
We asked how recently athletes had attended a dentist. Fewer than half (136, 39.5%, 95% CI 34.5-
44.8) of the athletes said they had attended for a dental visit within the previous 6 months. Three
quarters (262, 76.2%, 95% CI 71.4-80.4) said they recalled receiving oral hygiene advice from a dental
professional at some time and just over half (206, 59.9%, 95% CI 54.6-64.9) said they recalled receiving
advice about diet. When asked what type of dental service they used for their most recent dental visit
141 (41%, 95% CI 35.9-46.3) said an NHS dentist, 147 (45.6%, 95% CI 40.5-50.9) said a private dentist
and 34 (9.9%, 95% CI 7.13-13.52) said a private dental hygienist. Athletes were asked which single
factor was the most important when arranging a dental appointment. However, twenty indicated
more than one factor. Of the remaining 314, 195 (62.1%, 95% CI 56.6-67.3) said convenience, 85
(27.1%, 95% CI 22.5-32.3) reputation of the dentist and 34 (10.8%, 95% CI 6.9-13.2) cost.
Oral health beliefs and potential for behaviour change
The majority of athletes recognised that smoking and sugary foods and drinks including sports
nutrition products could damage oral health (Table 2). The potential for behaviour change options
and athlete responses are listed in Table 3. With the exception of reducing snacking between meals
most athletes were positive about potential for behaviour change.
Key findings
This is the first study to investigate self- reported oral health behaviour and challenges to oral health
in representative samples of elite and professional athletes from different sports. In general, athletes
report favourable oral health behaviours including toothbrushing before bed and in the morning but
fewer than half had attended a dentist within the previous six months. Overall, we categorised 28.2%
of athletes as high consumers of sugar in their regular diet, however 58.8% reported using energy bars
and 70.3% energy gels during training and competition and fewer than half (46%) athletes said they
could or probably could reduce snacking between meals. Although 85.7% reported using sports drinks
at least sometimes during training/competition, 80.4% said they could or probably could reduce
sugary drinks including sports drinks between meals. Athletes said that they would consider regular
dental visits, use of additional oral hygiene aids and increasing fluoride availability to improve oral
Strengths and limitations of the data
The strength of this study is the number of participants and completeness of the sample screened in
each sport. Conducting studies in elite sport is difficult due to the competing pressures for time on the
athletes and their support teams. However, self-reported measures can be unreliable and only serve
as a proxy measure for oral hygiene and dietary habits. The questionnaire was completed
independently and anonymously for convenience and to limit responder bias. However, it provided
limited information regarding whether the athletes used sports drinks, energy bars and gels on the
advice of coaches and/or nutritionists, or if they used them in response to marketing/ availability.
Information on the content of the snacks consumed by athletes was also limited. Use of qualitative
methods such as interviews or focus groups would have yielded a much greater depth of information
but would have required a greater time commitment from the athletes which was not possible during
this study.
Comparison with other studies
Few studies have investigated oral health behaviours and risks to oral health in this relatively young
adult group.17-19 A cautious comparison may be made with adults of a similar age in the general
population in England, Wales and Northern Ireland. 19 Elite athletes report more favourable oral health
behaviours; 94% compared to 74% say they brush morning and night and 43% compared to 18% say
they use dental floss or interdental brushes. Only one athlete reported currently using smokeless
tobacco (the proportion of smokers in the general population is around 28%) and 28.2% compared to
55% would be classed as high consumers of sugar in their general diet. The findings from this study
support those from one study of Nigerian college athletes17 and another study limited to triathletes18
which concluded by recommending raising athletes awareness of their specific increased risk for
dental caries and erosion and demonstrating how to optimize their oral hygiene and advice.
Evidence-based interventions to improve oral health
We found differences in prevalence of oral diseases between different sports. However the document
“Delivering better oral health; an evidence-based toolkit” (DBOH) recommends that everyone should
be given the benefit of advice and support to change behaviour regarding their general and dental
health, not just those thought to be ‘at risk’.12 Therefore strategies identified in this paper are
appropriate to all sports
Reducing risks to oral health from lifestyle
Athletes reported high consumption of energy gels and bars during training and competition despite
believing that they can damage oral health. However fewer than half felt they could reduce snacking.
Hydration is an important consideration in sport20 and most athletes reported using sports drinks
however, many felt that they could reduce their intake of sports drinks. The use of beverages and
supplements containing sugars should be discouraged. 7 Many rowers regularly drink sugar free
squash, however this is not associated with increased caries or ETW in this group, therefore could be
a useful alternative to proprietary sports drinks for hydration. For post-event hydration, milk could be
substituted for proprietary sports drinks, and plain water is adequate if combined with electrolyte and
carbohydrate-containing foods such as those normally eaten during the recovery period. 7,21,22 Many
athletes (83.2%) would consider the use of SFG but DBOH does not recommended it as a preventive
adjunct. There is however some evidence that it may have a potential role in caries prevention.23
Athletes reported receiving oral hygiene advice and advice about diet from a dental professional at
some time and dental professionals are well placed to identify potential lifestyle problems such as
eating disorders. 13 Sport nutrition is one of the cornerstones for athlete preparation and therefore
well placed to deliver benefits across performance, general health, oral health and wellbeing. It would
therefore make sense for strategies incorporating oral health to be jointly developed by registered
sport nutritionists, oral health experts and other athlete support team members.7
Improving oral health through oral health screening and coaching
Oral health promotion in sport is most likely to be successful if it is embedded within overall athlete
general health and performance promotion24 but most members of the athlete support team are not
expert in this area and therefore specialist input is needed. Coaches, nutritionists and those who work
with athletes should have robust training to ensure that athletes balance performance with their oral
and general health. Dental recall intervals are based on risk25 and regular attendance for dental checks
does not necessarily predict better oral health. 26 However regular checks are important, not only to
identify oral diseases at an early stage but also as an opportunity to enhance motivation towards a
high standard of oral health. 27 Most athletes said they would attend for regular dental checks if it
would improve their oral health, but convenience is an important consideration. Oral diseases such as
caries, ETW and periodontal diseases do not present with pain in their early stages and athletes may
delay a dental check or even treatment until they perceive that they have a problem. Athletes may
not be brushing effectively as most had evidence of gingival inflammation or risk factors present.
Interdental cleaning using dental floss or other methods is important for optimum oral health.12,28
Although less than half currently do this, most athletes said they would consider cleaning interdentally
if it would improve oral health. However practical instruction is required to improve oral hygiene skills.
Our high recruitment rate of athletes underlines the importance of providing screening and simple
oral health promotion/preventive advice at athletes’ training centres, preferably combined with
education and coaching in practical oral hygiene skills.
Opportunities to mitigate risk through increased fluoride availability
The most important behavioural factor affecting both caries and periodontal health is routinely
performed oral hygiene with fluoride. 29 When normal strength fluoride toothpaste (1000-1450ppm)
is used, fluoride mouthwash used at a different time to brushing can be advised30. Many athletes said
they could use a fluoride mouthwash, at a different time to brushing, therefore this could be an
opportunity to increase fluoride availability but requires a new behaviour. Where caries risk is
increased, higher strength prescription fluoride (2800ppm) is indicated31. Very high strength fluoride
toothpaste (5000ppm) may also have a protective effect against erosion32. Nearly all athletes said they
brushed in accordance with the widely recognised oral health advice of twice daily12, therefore using
prescription strength fluoride toothpaste would increase fluoride availability without requiring change
in current behaviour.
Enhancing oral health related behaviour through behaviour change techniques
To date, there is no evidence show which behaviour change technique (BCT) is best for enhancing
health behaviours related to oral health.33 However, the current dominant approach to understanding
health behaviour is the COM-B model 34 and it has been suggested that interventions based on this
behaviour change theory may be successful.35 Further research including consultation with all
stakeholders including sports nutritionists, sport and exercise medicine practitioners and dental
professionals is needed to ensure quality and relevance within elite athlete care.
Elite and professional athletes report more favourable oral health behaviours but still have similar
levels of oral disease to the general population. Athletes say they would consider simple behaviour
change including reduction in the use of sports drinks, attendance for regular screening and adoption
of additional oral hygiene methods. These findings help inform on the design of interventions to
improve/maintain oral health and reduce performance impacts.
Declaration of interests
This project was jointly funded by a grant from GSK and UCL IMPACT (award number 157871). The
authors declare no conflict of interest. The Centre for Oral Health and Performance is part of the UK
IOC Research Centre for Prevention of Injury and Protection of Athlete Health with the Institute of
Sport Exercise and Health (ISEH) and the National Centre for Sport and Exercise Medicine (NCSEM).
We wish to acknowledge the input from our advisory group, the athletes and support staff from all
the sports who so generously gave of their time to contribute to this research project. Thank you also
to Miss Sarah Needleman and Mrs Karen Wigmore for data entry and to Mrs Karen Wigmore, Mrs
Alison O’Neil and Miss Laura Wigmore for assistance during data collection. We are grateful to
Professor Susan Michie and Professor Robert West of the UCL Centre for Behaviour change for advice
regarding the design of the behaviour change elements of the questionnaire.
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... Sport disciplines show a high variety of resulting influence factors and behaviors. Differences include for example body composition and nutrition behavior [39]. The categorization in endurance, strength, contact, and team sport might provide an initial estimation. ...
... On the one hand, modified oral health behavior and physical stress have a strong impact, which will be discussed here. Moreover, the very time-consuming activity [3], increased stress [41], physical constitution [41], nutrition (mainly so-called "sports nutrition" consumed during training, such as carbohydrate gels and bars) [39,41], and repeated episodes of dry mouth (due to mouth breathing and fluid loss during training) play a role. In this context, important individual-and sports-specific differences occur. ...
... Respective deficiencies were documented, especially for elite athletes (▶table 3). Regular dental maintenance appointments [3,6,30,41] and individual oral hygiene are frequently insufficient, e. g., regarding interdental care and fluoride supply [31,39]. In addition, a dependency on the duration of training was noted: 97 % of the athletes who train up to 20 hours per week brush their teeth twice a day. ...
Full-text available
Recently, there has been intense discussion about sports dentistry and potential interactions between oral health and athletes’ performance. This narrative review aims to provide a comprehensive overview of the available literature about oral inflammation in sports. For this purpose, it presents the most common types of oral inflammation (gingivitis, periodontitis, pericoronitis, apical periodontitis), and their prevalence in athletes. Both the impact of oral inflammation on performance and causes for oral inflammation in athletes are discussed by presenting current literature. Finally, international recommendations for dental care in sports are presented. Several studies stated a high prevalence of oral inflammation in athletes, especially of gingivitis (58–97%) and periodontitis (41%). Also, many athletes report oral pain (17–30%) and a negative impact of oral health on training (3–9%). Besides this, a systemic impact of oral inflammation is discussed: In periodontitis patients, blood parameters and physical fitness are changed. In athletes, associations between muscle injuries and poor oral health are reported. There are deficits in oral health behavior. Furthermore, systemic changes due to physical stress could influence oral tissues. Overall, complex bidirectional interactions between competitive sports and oral inflammation are possible. Regular dental examinations and prevention strategies should be implemented in sports.
... Nevertheless, the root causes of poor oral health in athletes have not yet been clearly identified. Besides the physical stress itself, special nutrition habits (Gallagher et al., 2019), changes in saliva (Frese et al., 2015), changes in oral microbiome (Minty et al., 2018), and deficiencies in oral health behaviour have been detected (Gallagher et al., 2019;Gay-Escoda et al., 2011;Kragt et al., 2019;Merle et al., 2022). Additionally, mental stress (Minty et al., 2018) and weekly duration of sport have an impact on oral health. ...
... Nevertheless, the root causes of poor oral health in athletes have not yet been clearly identified. Besides the physical stress itself, special nutrition habits (Gallagher et al., 2019), changes in saliva (Frese et al., 2015), changes in oral microbiome (Minty et al., 2018), and deficiencies in oral health behaviour have been detected (Gallagher et al., 2019;Gay-Escoda et al., 2011;Kragt et al., 2019;Merle et al., 2022). Additionally, mental stress (Minty et al., 2018) and weekly duration of sport have an impact on oral health. ...
... Various studies, especially in soccer players, showed high rates of both caries and periodontitis (Botelho et al., 2021;Gay-Escoda et al., 2011;Needleman et al., 2016) and the highest odds ratio for carious teeth in comparison to different other types of sport (Gallagher et al., 2018). Again, nutrition and oral health behaviour could be a factor (Gallagher et al., 2019). Besides this, the socioeconomic factor must be mentioned. ...
This cross-sectional study aimed to compare clinical oral conditions as well as the self-reported oral health status of biathletes and cross-country skiers (A) to age- and gender-matched non-athletic controls (C). Thirty-one A and 68 C were examined in 2020 regarding caries experience (DMF-T), partially erupted wisdom teeth, non-carious tooth wear (erosion), dental plaque biofilm, gingival inflammation, periodontal screening (PSI), salivary active matrix-metalloproteinase-8 (aMMP-8) test and screening for temporomandibular disorders (TMD). Questionnaires recorded periodontal symptoms, TMD symptoms and oral health behaviour. Group A had a lower prevalence of carious teeth and positive aMMP-8 tests, but more of them had severe gingivitis and signs of periodontitis. Both groups reported similar oral health behaviour. Only in group C, associations between aMMP-8 and periodontal findings as well as clinical findings and self-reported symptoms of TMD were identified. Group A showed a high prevalence of oral inflammation and seemed to be less aware of oral symptoms. Clinical examination seems to be necessary for periodontal/TMD screening of athletes.
... At the same time, young people who play sports are receptive to health-promoting issues [5]. Elite and professional athletes in the UK are willing to consider behavior change to improve oral health [10]. On the other hand, it has been found opposite results that dental caries was significantly less prevalent among those with sufficient (19.8%) than insufficient (27.8%) physical activity among Spanish adults [11]. ...
... Different outcomes between the studies may be explained by different research settings, such as differences in the assessment of physical activity and of dental caries (selfreported vs clinical examination). In the Spanish study [10], self-reported high physical activity was associated with self-reported dental caries. However, the association disappeared in an adjusted (sex, age, marital status, education, obesity, smoking, alcohol) logistic regression model. ...
... Regular rhythm of life and healthy eating habits may be associated with physically active life and known to be good for oral health too. Gallagher et al. (2019) found that professional athletes known to be willing to consider behavior change to improve oral health [10]. Approximately, 90% of the study population consumed alcohol at least occasionally. ...
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Studies on measured physical fitness and oral health are sparse. The aim of this study was to investigate the associations between self-reported physical activity and measured physical fitness and oral health of young men. The study population consisted of 13,564 Finnish male conscripts who had mandatory clinical oral examinations and physical fitness tests at the beginning of military service in 2011. Finally, around 10,800 conscripts had physical fitness test outcomes available and a total of 8552 conscripts answered a computer-based questionnaire on background factors. Decayed Tooth (DT) and Decayed, Missing, or Filled Tooth (DMFT) indices, outcomes of surveys and fitness tests were used in analyses by cross-tabulation and multivariable logistic regression model (odds ratios [OR] with 95% confidence interval [CI]) were calculated. Regularly exercising conscripts had a reduced need for dental restorative treatment than those reporting no physical activity (p < 0.0001). The proportion of participants with sound dentition (DT = 0) increased steadily with increasing physical activity (39.0-59.4%). Good measured physical fitness was a protective factor against increased dental restorative treatment need. A low prevalence of smoking and low use of alcohol and energy drinks were associated with frequent exercise, whereas consumption of sport drinks and snuff use were common among those who exercised frequently. Good measured physical fitness and self-reported physical activity are associated with reduced caries burden. There is a need for information about the harms of tobacco products and the benefits of a healthy diet, even for the increased energy needs of the physically active.
... 20 Moreover, between 3% and 18% of athletes declared that oral health affected their training or performance. 3,4,17,18 Numerous potential risk factors for oral diseases in competitive sports have been discussed, for example, special nutrition habits (usually high carbonate, partially as a gel), 21 mental stress, 15 changes in saliva, 16,22 and oral microbiome changes. 15 Overall, oral health behaviors of athletes might also compromise oral health with irregular or even no dental check-up visits, 2,4,15,18 deficits in daily toothbrushing and missing interdental cleaning. ...
... 15 Overall, oral health behaviors of athletes might also compromise oral health with irregular or even no dental check-up visits, 2,4,15,18 deficits in daily toothbrushing and missing interdental cleaning. 21 While there have been recommendations to implement oral health screening in athletes, 23,24 this is not yet standard and the number of epidemiological studies is low. The available studies were conducted in different healthcare systems with different organization types of competitive sports. ...
... The determined personal oral hygiene ( Figure 1A), as well as self-reported oral symptoms ( Figure 1B), were similar to the results of other studies. Daily toothbrushing was frequent, 18,41 but less than one-half of the participants reported performing interdental cleaning, 21 which is important to maintain periodontal health. 32 Regarding the use of professional dental services, more than 20% did not regularly attend a dentist for examinations. ...
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Purpose: This retrospective cross-sectional study aimed to evaluate oral health status (dental, periodontal and functional) and oral health behavior in young German athletes including the comparison of competitive (CA) and amateur sports (AA). Methods: Data of CA (German national teams, perspective and youth squads) and AA aged between 18 and 30 years with an available oral examination in 2019 were included. Clinical examination: caries experience (DMF-T), non-carious wear (erosion, BEWE), partially erupted wisdom teeth, gingival inflammation (PBI), plaque index, periodontal screening (PSI), and temporomandibular dysfunction (TMD) screening. Questionnaires: oral health behavior, periodontal symptoms. Results: 88 CA (w = 51 %, 20.6 ± 3.5 years) of endurance sports and 57 AA (w = 51%, 22.2 ± 2.1 years) were included. DMF-T was comparable (CA: 2.7 ± 2.2, AA: 2.3 ± 2.2; p = 0.275) with more D-T in CA (0.6 ± 1.0) than AA (0.3 ± 0.7; p = 0.046; caries prevalence: CA: 34 %, AA: 19 %; p = 0.06). Both groups had low severity of erosion (BEWE about 3.5). CA had more positive TMD screenings (43 % vs. 25 %; p = 0.014). In both groups, all athletes showed signs of gingival inflammation, but on average of low severity (PBI < 1). More CA needed complex periodontal treatment than AA (maximum PSI = 3 in 40% vs. 12%; p < 0.001). Oral health behavior was comparable (daily tooth brushing, regular dental check-ups in > 70%). Conclusions: Young German athletes (CA and AA) generally showed signs of gingival inflammation and needed to improve their oral health behavior. CA showed slightly increased oral findings (more D-T, periodontal and TMD screening findings) than AA, but similar oral health behavior. This may imply an increased dental care need in competitive sports.
... Numerous studies and systematic reviews on this topic exist, the vast majority pointing out the higher prevalence of dental caries, dental erosion, and periodontal diseases in competitive adult athletes. The main causal factors for these results were linked to modified salivary pH and flow rate, dehydration, using a mouthguard, or high sugar intake from sports supplements [32][33][34][35][36]. ...
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The benefits of physical activities conducted systematically on the harmonious development, intellectual performance, and general health of children are unanimously accepted. This study’s aim is to determine whether differences in oral health between young athletes and children not engaged in competitive sports are present. A total of 173 children aged between 6 and 17 years, 58 hockey players, 55 football players, and 60 in the control group were divided into groups according to their activity, age, and biological sex and examined for oral hygiene and dental and periodontal health, using clinically determined indices. Statistical analysis showed significant differences between the groups, with lower (better) values for athletes, regardless of age, sex, or activity. Oral hygiene showed the most relevant differences for males aged 14 to 17, as did the index for dental health. Periodontal health, on the other hand, was significantly better for females aged 6 to 13. Based on this data, the beneficial influence of regular physical activity also has an impact on oral health. Identifying the mechanisms behind this needs to be explored in depth and may be a topic for further research.
... Regarding oral health-related problems, the current study data are from dental screening findings in national and international elite sport practitioners, reinforcing the need for oral health preventive/promotion programs [12,13,34]. We also found that the use of mouthguards to prevent the incidence of orofacial or dental trauma is still limited in our sample; however, since handball is a fast and high impact sport, strategies that emphasize mouthguard importance and mouthguard use during training and competition should be implemented [36]. Integrating oral health screening as a part of general health assessment and the use of effective promotion strategies are highly valuable for minimizing performance impacts from poor oral conditions. ...
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We characterized the physical and physiological profiles of high-level female Portuguese handball players and examined the relationships between their anthropometric characteristics, general motor performance and cardiopulmonary fitness. Twenty-four high-level female handball players with an average age of 23.6 ± 5.5 years, height of 173.6 ± 5.1 cm and body mass of 72.6 ± 9.1 kg volunteered to participate. A Pearson correlation test was used to assess the relationship between variables. Direct relationships were observed between the players' height and arm span (r = 0.741), as well as between their squat jump and countermovement jump performances with regard to body mass (r = 0.448 and 0.496, respectively). The 9 m jump shot has a large relationship with the 7 m standing throw (r = 0.786) and between left hand dynamometry and body mass index (r = 0.595). The 30 m sprint has a relationship with the 7 m standing throw (r = −0.526) and the 9 m jump throw (r = −0.551). Oxygen uptake has a relationship with the players' height (r = −0.482) and time limit (r = 0.513), while the fitness index has a relation to the players' height (r = −0.488) and arm span (r = −0.422). Our results should be considered when using physical testing to plan optimal physical training regimens in elite team handball.
... En el mundo se han realizado un importante número de estudios para conocer la prevalencia, frecuencia y riesgo de enfermedad y trauma bucal en deportistas de diferentes disciplinas deportivas. (2,3,4) Desde el primer informe de los juegos olímpicos del año 1968, se reportó una salud bucodental deficiente en los deportistas de élite. Uno de los artículos científicos sobre medicina deportiva más consultado, según la clasificación establecida por la revista Bio Med Lib Journal, es un estudio realizado por Gay et al., (5) publicado en el año 2011. ...
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RESUMEN Introducción: El control de la salud bucodental de los deportistas es uno de los aspectos menos atendidos en lo referente a su salud integral, lo que demuestra la necesidad de fortalecer los programas de promoción de salud y prevención de afecciones bucales en este ámbito. Objetivo: Proponer un sistema de acciones educativas sobre salud bucodental en los adolescentes que practican deportes de combate. Métodos: Se realizó un estudio descriptivo en el macrociclo 2019-2020 con una muestra no probabi-lística de 43 deportistas; utilizándose la observación y la encuesta. Se diseñó un sistema de acciones educativas, el cual fue valorado por criterio de especialistas. Resultados: El nivel de conocimientos sobre salud bucodental que predominó en los adolescentes que practican deportes de combate fue inadecuado con un 53,5 %. El sistema de acciones educativas propuesto consta de siete encuentros: uno introductorio, cinco de estudio y uno para las conclusiones. Los temas tratados son: la actividad física y su relación con la salud bucodental, la higiene bucal en la prevención de la caries dental y la enfermedad periodontal, los protectores bucales en el deporte, traumatismos dentales en el deporte, tabaquismo y alcoholismo, su efecto en la actividad física y la salud bucodental. Conclusiones: El diseño del sistema de acciones educativas actividad física y salud bucodental en la adolescencia resulta pertinente para su aplicación en el contexto deportivo, según la valoración de los especialistas. DeCS: EDUCACIÓN EN SALUD DENTAL; HIGIENE BUCAL; EVALUACIÓN DE RESULTADOS DE ACCIONES PREVENTIVAS; DEPORTES; PROMOCIÓN DE LA SALUD
... Due to the psychological effects and highstakes environment in certain occupations, people may also develop bruxism (e.g., athletes, and paramedics). Likewise, masseter muscle hypertrophy has also been described in weight-lifters or "strongmen" [11]. In addition to hypersensitivity reactions, toxic exposure to metals (e.g., nickel ) through dust or direct contact may also lead to a variety of disease presentations and symptoms, both in the oral cavity and for systemic health [12]. ...
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Work-related exposures affecting oral health are important factors of morbidity and decreased quality of life, which may emerge from numerous physical, chemical, or mental occupational exposures. Copper (Cu) is an important trace element, however, it may also cause allergies, depose and accumulate in the body, leading to acute and chronic toxicity. In the present report, we describe a rare phenomenon found during the examination of two professional brass players, after incidentally noting an artefact during magnetic resonance imaging (MRI) scans, which were performed to monitor bone healing after bone augmentation procedures in an unrelated clinical study. During a detailed workup of patient characteristics, data on medical history, lifestyle, professional habits related to playing the instrument, and oral health status were collected. Overall, both patients presented with similar histories, and the differences from the context of this study were not relevant; however, both brass players were using an uncoated Cu mouthpiece for over 15 years. Based on the imaging findings (a shadow in the area of the lips on the MRI images) and the organoleptic evaluation of the lips and mucosa of the individuals (temporary faint green discoloration), it is most likely that the brass players were affected by oxidized Cu accumulation in the lip. In contrast to several professions, musicians are usually not required by law to attend obligatory occupational health check-ups, which may facilitate the occurrence of such exposures in musicians. Clinicians should be on the lookout for brass players involved in the profession for a long time, who may have used the mouthpieces for an extended period of time, in addition to musicians affected by Wilson’s disease. In patients affected by this phenomenon, diagnostics of oral cancer and prosthodontic procedures may be cumbersome, due to the detrimental impact on the utility of MRI imaging from artefact-formation and scattering.
... This is an unexpected finding since these athletes are considered to be at the peak of health and performance, and for the fact that oral diseases are largely preventable. However, some behaviors of athletes (such as using smokeless tobacco, consuming high quantities of sports drinks, energy bars, etc.) could contribute to poor oral health [6]. Additionally, Gallagher et al., found that fewer than half of 344 elite Olympic athletes studied had visited the dentist within the previous 6-month period and almost half of this cohort presented with dental caries [7]. ...
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Objectives: Professional athletes have a high prevalence of dental pathology, a low rate of routine dental visits, and a poor understanding of how these factors can affect athletic performance. The purpose of this study is to assess perceptions and behaviors of professional baseball players, specifically minor league professional baseball players (MLPB), in taking care of their oral health. Methods: Spring Training physicals were performed for MLPB players; a dental screening examination component was included. Following the dental screening, each MLPB player was asked to complete a 9-question survey anonymously and voluntarily. These questions included: (1) demographics, (2) attitude/history regarding dental exams and cleanings, and (3) the player’s perception of the dental screening program. An oral health prevention component was also incorporated, in which MLPB players were given plaque disclosing tablets, educated verbally and provided a written explanation on their purpose and usage. Data were analyzed using descriptive statistics and Chi-square tests. Results: A total of 80 MLPB players received dental screening examinations and 42 completed the survey. Players completing the survey were equally represented between Hispanic and non-Hispanic. A significant relationship existed between whether the spring training physical was the main dentist visit and the length of time since last dental exam. Whether the spring training physical was the main dentist visit was also significantly associated with the length of time since last dental cleaning. A significant relationship existed between Hispanic players and Non-Hispanic players as to a belief that preventive education was a beneficial part of the pre-participation dental screening examination. Additionally, a significant relationship was found between Hispanic players and Non-Hispanic players as to having received dental disclosing tablets for take home use (a preventive measure) following a pre-participation dental screening examination. Conclusion: The results of this study suggest that oral health professionals and professional baseball organizations should consider implementing practices whereby they can modify perceptions and activities that contribute to good oral health, especially among Hispanic minor league professional baseball players. One sentence summary: Oral disease prevention education is important for professional athletes, especially among Hispanic minor league professional baseball players.
The human microbiome comprises ∼10¹³–10¹⁴ microbial cells which form a symbiotic relationship with the host and play a critical role in the regulation of human metabolism. In the oral cavity, several species of bacteria are capable of reducing nitrate to nitrite; a key precursor of the signaling molecule nitric oxide. Nitric oxide has myriad physiological functions, which include the maintenance of cardiovascular homeostasis and the regulation of acute and chronic responses to exercise. This article provides a brief narrative review of the research that has explored how diversity and plasticity of the oral microbiome influences nitric oxide bioavailability and related physiological outcomes. There is unequivocal evidence that dysbiosis (e.g. through disease) or disruption (e.g. by use of antiseptic mouthwash or antibiotics) of the oral microbiota will suppress nitric oxide production via the nitrate-nitrite-nitric oxide pathway and negatively impact blood pressure. Conversely, there is preliminary evidence to suggest that proliferation of nitrate-reducing bacteria via the diet or targeted probiotics can augment nitric oxide production and improve markers of oral health. Despite this, it is yet to be established whether purposefully altering the oral microbiome can have a meaningful impact on exercise performance. Future research should determine whether alterations to the composition and metabolic activity of bacteria in the mouth influence the acute responses to exercise and the physiological adaptations to exercise training.
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Objectives: To measure dental caries, erosive tooth wear (ETW), periodontal health, self-reported oral health problems and performance impacts in a representative sample of UK elite athletes from different sports using standardized conditions clearly defined clinical indices and a measure of impact on performance with evidence of validity in sport. Methods: Cross-sectional study, with single, calibrated examiner, conducted in the local facilities of elite and professional UK athletes (UCL ethics number 6388/001). Main oral measures: dental caries (ICDAS), erosive tooth wear (BEWE), periodontal health (BPE) and athlete-reported performance impacts. Results: We recruited 352 athletes from eleven sports. The mean age was 25 years (range 18-39), and 67.0% were male. We found caries (ICDAS code ≥3) in 49.1% of athletes, ETW (BEWE score of ≥7) in 41.4%, gingival bleeding on probing/presence of calculus (BPE score 1 or 2) in 77.0% and pocket probing depths of at least 4 mm (BPE score 3 or 4) in a further 21.6%. One in five athletes reported previous wisdom teeth problems. The odds of having caries were 2.4 times greater in team sport than endurance sport (95% CI 1.3-3.2). The odds of having erosion were 2.0 times greater in team sport than endurance sport (95% CI 1.3-3.1). Overall, 32.0% athletes reported an oral health-related impact on sport performance: oral pain (29.9%), difficulty participating in normal training and competition (9.0%), performance affected (5.8%) and reduction in training volume (3.8%). Other impacts were difficulty with eating (34.6%), relaxing (15.1%) and smiling (17.2%). Several oral health problems were associated with performance impacts. Conclusions: This is the first large representative sample study of oral health in athletes from different sports at elite level. Although experience of oral disease differs by sport, the prevalence, in UK elite and professional athletes, is substantial, with common self-reported performance impacts. Regular screening and use of effective oral health promotion strategies may minimize performance impacts from poor oral health.
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Background: The non-communicable diseases dental caries and periodontal diseases pose an enormous burden on mankind. The dental biofilm is a major biological determinant common to the development of both diseases, and they share common risk factors and social determinants, important for their prevention and control. The remit of this working group was to review the current state of knowledge on epidemiology, socio-behavioural aspects as well as plaque control with regard to dental caries and periodontal diseases. Methods: Discussions were informed by three systematic reviews on (i) the global burden of dental caries and periodontitis; (ii) socio-behavioural aspects in the prevention and control of dental caries and periodontal diseases at an individual and population level; and (iii) mechanical and chemical plaque control in the simultaneous management of gingivitis and dental caries. This consensus report is based on the outcomes of these systematic reviews and on expert opinion of the participants. Results: Key findings included the following: (i) prevalence and experience of dental caries has decreased in many regions in all age groups over the last three decades; however, not all societal groups have benefitted equally from this decline; (ii) although some studies have indicated a possible decline in periodontitis prevalence, there is insufficient evidence to conclude that prevalence has changed over recent decades; (iii) because of global population growth and increased tooth retention, the number of people affected by dental caries and periodontitis has grown substantially, increasing the total burden of these diseases globally (by 37% for untreated caries and by 67% for severe periodontitis) as estimated between 1990 and 2013, with high global economic impact; (iv) there is robust evidence for an association of low socio-economic status with a higher risk of having dental caries/caries experience and also with higher prevalence of periodontitis; (v) the most important behavioural factor, affecting both dental caries and periodontal diseases, is routinely performed oral hygiene with fluoride; (vi) population-based interventions address behavioural factors to control dental caries and periodontitis through legislation (antismoking, reduced sugar content in foods and drinks), restrictions (taxes on sugar and tobacco) guidelines and campaigns; however, their efficacy remains to be evaluated; (vii) psychological approaches aimed at changing behaviour may improve the effectiveness of oral health education; (viii) different preventive strategies have proven to be effective during the course of life; (ix) management of both dental caries and gingivitis relies heavily on efficient self-performed oral hygiene, that is toothbrushing with a fluoride-containing toothpaste and interdental cleaning; (x) professional tooth cleaning, oral hygiene instruction and motivation, dietary advice and fluoride application are effective in managing dental caries and gingivitis. Conclusion: The prevention and control of dental caries and periodontal diseases and the prevention of ultimate tooth loss is a lifelong commitment employing population- and individual-based interventions.
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Background: Fluoride mouthrinses have been used extensively as a caries-preventive intervention in school-based programmes and by individuals at home. This is an update of the Cochrane review of fluoride mouthrinses for preventing dental caries in children and adolescents that was first published in 2003. Objectives: The primary objective is to determine the effectiveness and safety of fluoride mouthrinses in preventing dental caries in the child and adolescent population.The secondary objective is to examine whether the effect of fluoride rinses is influenced by:• initial level of caries severity;• background exposure to fluoride in water (or salt), toothpastes or reported fluoride sources other than the study option(s); or• fluoride concentration (ppm F) or frequency of use (times per year). Search methods: We searched the following electronic databases: Cochrane Oral Health's Trials Register (whole database, to 22 April 2016), the Cochrane Central Register of Controlled Trials (CENTRAL) (the Cochrane Library, 2016, Issue 3), MEDLINE Ovid (1946 to 22 April 2016), Embase Ovid (1980 to 22 April 2016), CINAHL EBSCO (the Cumulative Index to Nursing and Allied Health Literature, 1937 to 22 April 2016), LILACS BIREME (Latin American and Caribbean Health Science Information Database, 1982 to 22 April 2016), BBO BIREME (Bibliografia Brasileira de Odontologia; from 1986 to 22 April 2016), Proquest Dissertations and Theses (1861 to 22 April 2016) and Web of Science Conference Proceedings (1990 to 22 April 2016). We undertook a search for ongoing trials on the US National Institutes of Health Trials Register ( and the World Health Organization International Clinical Trials Registry Platform. We placed no restrictions on language or date of publication when searching electronic databases. We also searched reference lists of articles and contacted selected authors and manufacturers. Selection criteria: Randomised or quasi-randomised controlled trials where blind outcome assessment was stated or indicated, comparing fluoride mouthrinse with placebo or no treatment in children up to 16 years of age. Study duration had to be at least one year. The main outcome was caries increment measured by the change in decayed, missing and filled tooth surfaces in permanent teeth (D(M)FS). Data collection and analysis: At least two review authors independently performed study selection, data extraction and risk of bias assessment. We contacted study authors for additional information when required. The primary measure of effect was the prevented fraction (PF), that is, the difference in mean caries increments between treatment and control groups expressed as a percentage of the mean increment in the control group. We conducted random-effects meta-analyses where data could be pooled. We examined potential sources of heterogeneity in random-effects metaregression analyses. We collected adverse effects information from the included trials. Main results: In this review, we included 37 trials involving 15,813 children and adolescents. All trials tested supervised use of fluoride mouthrinse in schools, with two studies also including home use. Almost all children received a fluoride rinse formulated with sodium fluoride (NaF), mostly on either a daily or weekly/fortnightly basis and at two main strengths, 230 or 900 ppm F, respectively. Most studies (28) were at high risk of bias, and nine were at unclear risk of bias.From the 35 trials (15,305 participants) that contributed data on permanent tooth surface for meta-analysis, the D(M)FS pooled PF was 27% (95% confidence interval (CI), 23% to 30%; I(2) = 42%) (moderate quality evidence). We found no significant association between estimates of D(M)FS prevented fractions and baseline caries severity, background exposure to fluorides, rinsing frequency or fluoride concentration in metaregression analyses. A funnel plot of the 35 studies in the D(M)FS PF meta-analysis indicated no relationship between prevented fraction and study precision (no evidence of reporting bias). The pooled estimate of D(M)FT PF was 23% (95% CI, 18% to 29%; I² = 54%), from the 13 trials that contributed data for the permanent teeth meta-analysis (moderate quality evidence).We found limited information concerning possible adverse effects or acceptability of the treatment regimen in the included trials. Three trials incompletely reported data on tooth staining, and one trial incompletely reported information on mucosal irritation/allergic reaction. None of the trials reported on acute adverse symptoms during treatment. Authors' conclusions: This review found that supervised regular use of fluoride mouthrinse by children and adolescents is associated with a large reduction in caries increment in permanent teeth. We are moderately certain of the size of the effect. Most of the evidence evaluated use of fluoride mouthrinse supervised in a school setting, but the findings may be applicable to children in other settings with supervised or unsupervised rinsing, although the size of the caries-preventive effect is less clear. Any future research on fluoride mouthrinses should focus on head-to-head comparisons between different fluoride rinse features or fluoride rinses against other preventive strategies, and should evaluate adverse effects and acceptability.
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The purpose of this review is to present the available evidence to support the use of dentifrices with high (>1,500 ppm) concentrations of fluoride to help in the prevention and treatment of caries in high-risk children and adolescents. Recent evidence from high-quality systematic reviews supports the dose-response relationship between caries prevention and fluoride levels, and there is good evidence from randomised clinical trials to support the use of high fluoride dentifrices. Such products are typically prescribed oral pharmaceuticals that require thorough risk assessment by the clinician and restricting use in those less than 6 years old to cases where the risk of severe morbidity caused by caries is greater than that of aesthetically objectionable fluorosis and which should mitigate the risk of fluorosis. Further research is required on the use of population- or community-based interventions using such products and currently, the evidence for dentifrices containing more than 2,900 ppm is weaker than for those containing 2,800 ppm or less.
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In the January 2016 issue of BJSM, we showed that professional footballers in the UK have poor oral health and this is associated with negative self-reported impacts on training, performance and well-being. 1 Since more than 90% of each senior squad participated in the study, we can be confident that the results represent a true picture. These findings are also consistent with data we collected during the London 2012 Olympic Games and a recent systematic review. 2 The emerging picture is of poor oral health in elite sport with important self-reported impacts on self-reported performance. In this call to action for oral health screening in professional football we: (1) place players' oral health alongside UK norms, (2) make the case that footballers are at high risk of poor oral health and (3) set out the case for screening and how this could lead to improved oral health in professional football. HOW GOOD IS FOOTBALLERS' ORAL HEALTH? Oral health is not simply absence of disease. It should positively contribute to the well-being and functioning of individuals (and societies) including performance of elite athletes. A side-by-side comparison of the most recent UK oral health data 3 with professional footballers for age 16–24 years shows worse oral health: dental caries 30% vs 38%, moderate tooth wear (loss of enamel and dentine without caries) 4% vs 20% and gingivitis 50% vs 82%. If compared only with those attending the dentist regularly, the gulf would be much greater. Twenty per cent of footballers report negative impact of their oral health on quality of life and 7% consider it impairs their performance.
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Background: The few studies that have assessed oral health in professional/elite football suggest poor oral health with minimal data on impact on performance. The aim of this research was to determine oral health in a representative sample of professional footballers in the UK and investigate possible determinants of oral health and self-reported impact on well-being, training and performance. Methods: Clinical oral health examination of senior squad players using standard methods and outcomes carried out at club training facilities. Questionnaire data were also collected. 8 teams were included, 5 Premier League, 2 Championship and 1 League One. Results: 6 dentists examined 187 players who represented >90% of each senior squad. Oral health was poor: 37% players had active dental caries, 53% dental erosion and 5% moderate-severe irreversible periodontal disease. 45% were bothered by their oral health, 20% reported an impact on their quality of life and 7% on training or performance. Despite attendance for dental check-ups, oral health deteriorated with age. Conclusions: This is the first large, representative sample study in professional football. Oral health of professional footballers is poor, and this impacts on well-being and performance. Successful strategies to promote oral health within professional football are urgently needed, and research should investigate models based on best evidence for behaviour change and implementation science. Furthermore, this study provides strong evidence to support oral health screening within professional football.
Enhancing patients' oral health related behaviour is a critical component of the preventive approach which is central to the practice of minimally invasive dentistry. The first step in the process of behaviour change is creating capability to change behaviour through the provision of information and guidance. The second step involves enhancing the motivation to change through emphasising the benefits of behaviour change and emphasising the individual patients' susceptibility or risk of oral disease. The third step seeks to put motivation into action through creating opportunities to practice oral health behaviour. Planning interventions are one approach to achieving this. This article outlines the techniques for carrying out these steps in practice.