Education and evaluation of nutrition of the dental patient is one of the principal roles of the clever dentist and is of prime importance to young athletes. Optimal nutrition is particularly essential for fueling the young athlete during participation in sports and for achieving maximal growth and development. Moreover, the quality of teeth development is determined by the nutritional adequacy of the diet of children. On the other hand, their maintenance and resistance to dental diseases are affected by body metabolism.  

Carbohydrates Content in athletes diet and sports dentistry view:

      Generally, carbohydrates are considered the ideal energy source for athletes. Unfortunately, carbohydrates provide oral bacteria, an essential energy source for metabolism. Fermentable carbohydrates are metabolized by bacteria that are normally inhibited in the oral cavity to produce acids. These acids demineralize the tooth surface and cause dental decay. It is now well established that the total amount of carbohydrate does not determine the cariogenic potential of the diet but the form and frequency of consumption is the main factor that should be considered.

·    Sports Drinks

•      Consumption of sports drinks is increasing among athletes.

•      Common uses for sports drinks include fluid replacement, carbohydrate loading, and nutrient supplementation.

•      From the dental point of view, frequent intake of sports drinks increases the potential for erosion (progressive loss of the enamel of the tooth by a chemical process that does not involve bacterial action) and creates a favorable environment for cariogenic bacteria growth.

             Sports dentists’ efforts should be directed towards attaining better oral hygiene, enhancing salivary function by giving instructions of using sugar free gums, and appropriate use of fluoride and sealants, rather than the reduction of carbohydrates from the diets.

·    Sugar-free gum

         The drop in plaque pH that occurs after eating is effectively neutralized by the buffering capacity of saliva.

        The use of chewing gum after meals as a means of stimulating salivary flow to prevent the formation of dental caries. Studies have shown a tremendous reduction in the acidogenicity of plaque when chewing sugar-free gum after food consumption. Chewing gum after meals enhances remineralization and prevents demineralization. The sugar-free gum is to be chewed within 5 minutes of eating and is to be chewed for 20 minutes after each meal. The chewing of sugar-free gum after eating carbohydrate-containing snacks before exercise or events is an alternative to tooth brushing in formulating dietary and oral hygiene recommendations but should not replace tooth brushing.

EATING DISORDERS:

         The manifestations could be associated by either: weight losing or weight gaining

I. Weight Losing:

a.  Anorexia Athletica:

        Athletes in appearance-conscious sports (e.g. figure skating, ballet, swimming, diving and gymnastics) as well as weight-criteria sports (e.g. karate, boxing, wrestling) may be more prone to disordered eating patterns. These athletes may try to lose excess body weight to reach the required weight according to the sports’ rules. Fasting, meal skipping, and eliminating foods and food groups can seriously compromise health and negatively affect athletic performance. The occasional binge or skipped meal is not of concern, but the athlete who skips meals on somewhat regular basis is not able to meet his or her additional caloric needs. Moreover, during history taking, the dentist should ask athletes if they have or are currently using any supplements, including pyruvate, chromium, or fat burners. These supplements can be harmful and have a deleterious effect on exercise performance. The character­istics of anorexia athletica may include:

• Intense fear of gaining weight or becoming fat in a person who is already lean

• Reduction in food intake and increase in exercise

• Energy intake below that recommended to maintain energy requirements of training

• Common binge eating

• Common use of Laxatives &/or diuretics

• Delayed puberty

• Menstrual dysfunction

• Gastro-intestinal complaintes

• Dehydration

• Excessive fatigue

• Anxiety

     These signs should be taken seriously, and the athlete pres­enting with these symptoms needs to be evaluated by an eating disor­ders specialist. Effective treatment involves the athlete, the parents, trainer, coach, and health professionals.

b. Anorexia nervosa and bulimia:

          Any sports dentist should be aware of the oral manifestations of anorexia nervosa and bulimia. These manifestations are not uncommon with female athletes as in gymnastics, hockey, volleyball, and basketball. The decrease in buffering capacity of saliva caused by electrolyte imbalance and medications results in increased susceptibility of the teeth to acid attacks either from dental plaque or recurrent vomiting.

       As a matter of fact, the anorexic athlete’s diet is characterized by periods of low or absence carbohydrate intake interspersed with bouts of high carbohydrate consumption. Even though the over­eating is transient, it may have an adverse effect on the athlete’s dentition.

 Moreover, anorexic athletes show great tendency towards low-calorie foods, particularly raw citrus fruits, such as lemons, oranges, and grapefruits. Because of their lower pH of these fruits, excessive consumption may affect the teeth. Enamel loss is mostly seen on the facial aspects of the incisors.

 On the other hand, loss of enamel and dentin on the lingual surfaces of teeth may occur in anorexic and bulimic athletes as a result chemically by regurgitation of gastric contents and aggravated mechanically by the movement of the tongue. Additionally, there may be rounding of the teeth margins and eventually the dentin is exposed, resulting in hypersensitivity.

In early and less severe cases of anorexia nervosa, the dentist should try to instruct the athlete that permanent effects occur if the vomiting is not discontinued. This anorexic athlete should be given frequent prophylaxis and oral hygiene instruction as recommending immediate brushing of the teeth or water rinses after vomiting to dilute the acid and reduce the adverse effects.

In more severe cases, fluoride mouth rinses and varnishes may be helpful to reduce the sensitivity of the exposed dentin and increase caries resistance.

Continuous consultation with the team’s physician should be performed until the physician reports that vomiting is no longer a problem. Dental restorative treatment should be mainly preventive and palliative and should be delayed till the bulimia is discontinued otherwise many of the restorations may have to be remade later.

Additionally, frequent vomiting may cause xeros­tomia (dry mouth) leading to sore tongue, inflamed gingival tissues and rampant caries. In some cases, parotid gland swelling could be seen.

     Systemically, Hypotension and bradycardia may be observed in the anorexic athlete.

II. Weight Gaining:

On the contrary, for the athlete who wants to gain weight, it is important to assess baseline eating habits. The recommendations are to add extra calories per day to allow for weight gain. As the increase in calories should come primarily from carbohydrates, it may lead to caries promoting, especially if there is constant nibbling or snacking of foods and beverages.