The Fittest People in the World Have a Dental Problem

By Genni Burkhart, Editor

Elite athletes receive more medical supervision than perhaps any other population. Their teams include doctors, dietitians, physiotherapists, and analysts who monitor every aspect of their lives from sleep to training, recovery, and diet. Yet, with all that attention, a new study in Medscape News Europe found that 70% of elite athletes have periodontal disease and 46% have active dental caries at rates higher than those of their peers in the general population. Research from February 2026 in the British Dental Journal also confirmed this trend across different sports, competition levels, and athlete backgrounds.

The infrastructure around elite athletes is extensive, yet oral health has yet to make the cut.

Sports, the Independent Risk Factor

This research suggests that high-performance sport itself is an independent risk factor for oral disease. In many cases, athletes with the most severe oral health findings are otherwise systemically healthy.

Let's dive in.

Over time, several factors add up for athletes. Those include:

• Repeated fermentable carbohydrate consumption from gels, sports drinks, and energy bars across long training windows, delivering sugar to tooth surfaces in a pattern and duration that standard dietary screening can miss. 
• Exercise-induced salivary suppression, which strips teeth of their primary acid buffer at exactly the moment acid exposure peaks. Dehydration also worsens the effect.
• Improperly maintained mouthguards worn for extended periods, which disturb the oral microbiota and compound the already-disrupted oral environment.
• Chronic low-grade systemic inflammation from sustained high training loads, which creates favorable conditions for periodontal pathogens regardless of hygiene habits.

In fact, athletes from 20 to 35 years old, who are in their peak competitive years, have the highest rates of dental problems. In other patients, these findings would usually point to long-term neglect. However, that's clearly not the case in this population. 

Performance Costs

A February 2026 British Dental Journal review by Hollander and colleagues documented consistent associations between poor oral health and reduced objective performance metrics, including VO₂ max, power output, speed, and agility. The mechanisms are traceable, and they're specific. They include: 

• Periodontal inflammation compromises training adaptation through systemic inflammatory burden.
• Chronic pain and inflammation from active caries and periodontal disease disrupt sleep and concentration in ways that build across a season and peak around competition.
• Periodontitis is associated with higher rates of muscle and joint injuries, including among soccer athletes.
• Oral dysbiosis disrupts the nitrate-reducing bacteria responsible for nitric oxide synthesis, a compound that directly affects vascular efficiency and aerobic capacity.

Oral disease is chronic, and it slowly erodes the same systems that drive recovery, output, and performance.

That same body of research characterizes oral health as a silent determinant of sporting performance rather than a separate, isolated concern. Basically, an athlete carrying untreated periodontal disease through a full season is managing slower recovery, a higher injury risk, and reduced endurance capacity.

The Missing Variable

A 2026 British Dental Journal study by Lee-Green drew on interviews with elite athletes from endurance athletics, professional rugby, and Paralympic rowing. These athletes reported training multiple times daily, eating frequently to meet energy demands, and relying on carbohydrate-rich foods and gels throughout the day. They were aware of oral health risks in general terms, but lacked a clinical understanding of the correlation between their training habits and oral health.

For context, it's important to know that athletes at this level are precise about even the most marginal of gains. As such, they track recovery markers, sleep, power output, and nutritional timing with highly specific tools. They're also highly motivated, data-driven patients who respond to performance outcomes. Oral health affects every one of those outputs. It's just not a consistent part of their clinical conversation.

The Dental Appointment Chat

Gallagher and colleagues published clinical screening guidance alongside the February 2026 BJD literature review, noting that oral diseases are preventable for this population and that, with early detection, behavior change can occur. For these patients, a sport-specific conversation during their appointment can be the very catalyst for change. Elite athletes can have consistent hygiene habits and still present with caries or early periodontal findings. Chronic oxidative stress, low-grade inflammation, and changes to the oral microbiota from intense training are often the primary drivers. As such, treating caries and periodontal disease without helping the patient understand the underlying cause will simply lead to recurrence.

According to the research, one week of illness alone reduces an elite athlete's odds of achieving their key performance goal by 26%. In fact, oral disease is chronic and drives inflammation, impairs recovery, and reduces aerobic output throughout an entire season. No other clinician in an athlete's corner is better positioned to address that issue than their dentist. That post-appointment chat with their dentist just might be the missing piece in an otherwise complete performance picture. 

References

1. Simón, C. (2026, February 20). Dental disease may undermine elite athletic performance. Medscape News Europe. https://www.medscape.com/viewarticle/dental-disease-performance-risk-2026a10005ea

2. Needleman, I., Gallagher, J., & Ashley, P. (2026). What do we know about elite athletes' oral health? British Dental Journal, 240, 217-222. https://doi.org/10.1038/s41415-025-8909-7

3. Hollander, K., Eshkol-Yogev, I., Zech, A., Buti, J., & Needleman, I. (2026). The influence of oral health on sports performance: an interdisciplinary perspective. British Dental Journal, 240, 277-283. https://doi.org/10.1038/s41415-025-9348-1

4. Lee-Green, Z. (2026). Elite athletes and oral health: knowledge, perception, and experience of three top athletes. British Dental Journal, 240, 291-296. https://doi.org/10.1038/s41415-026-9535-8

5. Gallagher, J., Needleman, I., Ashley, P., & Fine, P. (2026). Oral health screening for sport. British Dental Journal, 240, 223-227. https://doi.org/10.1038/s41415-025-9005-8

Author: With over 16 years as a published, award-winning journalist, editor, and writer, Genni Burkhart's career has spanned politics, healthcare, law, business finance, technology, and news. She resides in Northern Colorado, where she works as the editor-in-chief of the Incisor at DOCS Education.