Sports Drinks and Energy Bars and Gummy Bears, Oh My!
Fueling is essential for endurance training and competition. Fueling with sugar (glucose) is the standard and comes in many forms (chews, gels, drinks, bars, candy, etc.). Many endurance athletes are concerned about the effect of sugar on their teeth, especially when they learn that endurance athletics puts them at a higher risk of dental disease. To understand your risk, you need to understand how bacteria use sugar, what this does to your teeth, and the “20-minute window.”
What is the 20-minute Window?
Bacteria in your mouth metabolize sugar to generate energy. The byproduct of this process is acid production. The sugar is metabolized by the bacteria, releasing acid and producing a lower pH on the surface of your tooth. It is this acidic environment that harms your teeth.
The lower pH causes the tooth to demineralize in the area around the bacteria (i.e., tooth structure dissolves as a result of the low pH). If left unchecked, this causes a hole in the area, also known as a cavity. However, the low pH is brought back to normal levels by saliva. Saliva buffers the acid and stops the process, which takes around 20 minutes. So, there is a “20-minute window” where your teeth are susceptible to an acid challenge from the metabolism of sugar by bacteria.
The “20-minute window” is not dependent on the amount of sugar consumed but repeats based on the frequency of sugar exposure. For example, if you eat a 1,000-calorie piece of cheesecake, there is a “20-minute window” after you eat it during which your teeth are at risk of demineralization. If you eat four 250-calorie energy bars, one per hour during a long bike ride, then there are four 20-minute windows of acid challenge and potential damage to your teeth. Hence, this greatly increases your risk of decay.
What are the Other Risk Factors?
Endurance athletes are at even greater risk due to factors like mouth breathing during exercise. Mouth breathing can cause a decrease in saliva, reducing its efficiency in buffering the acid. This leads to a longer exposure to a low pH.
Areas where gum recession exposes the root of the tooth are softer and more susceptible to acid challenges. Similarly, areas at the junction of fillings or crowns with natural teeth are more at risk because they tend to be soft as well.
Chips or fractures in your teeth expose the softer inner surface (dentin), which is more susceptible to cavities. Additionally, medicines that decrease salivary flow and cause dry mouth can also increase your risk of dental issues.
How do We Reduce Risks?
So, what can an athlete do? Fueling is essential and mandatory, but it can harm your teeth. However, underfueling can lead to a host of far worse issues. Understanding and managing your risk factors is the best strategy for maintaining your dental health.
Decreasing sugar intake is the standard answer to this problem, but that is not possible for athletes. Limiting fueling options that are gummy or tacky in nature can help, as these fuels tend to stick to the teeth and small chips or cracks, providing an ongoing fuel source for bacteria. For athletes prone to dental decay, finding sources that do not stick to the teeth is beneficial.
Likewise, limiting the ongoing or frequent use of glucose-based sports drinks, that constantly reset the 20-minute window, is beneficial while on a ride, run or hike. For example, drinking 500ml of a sports drink at the top of the hour exposes you to one 20-minute window, while sipping 500ml over the hour will expose you to many 20-minute windows.
Ensuring that your mouth is in good condition is essential. Small chips, areas of wear, or slightly worn fillings may not need attention in the general population, but for endurance athletes, these small vulnerabilities can grow quickly.
Fluoride can help strengthen the most at-risk or demineralized areas. A fluoride nightly rinse (e.g., ACT Rinse) has been shown to remineralize some areas affected by acid. Fluoride varnish applied to areas where gum recession occurs can also protect those areas. This varnish, typically applied after a cleaning, delivers a high dose of fluoride directly to the areas most in need, helping them resist the effects of sugar.
Frequent cleanings and dental check-ups are crucial for identifying and addressing small issues before they grow larger. While most people are seen every six months, every three months (or more frequently) may be necessary if you are more susceptible to decay.
Rinsing with water after fueling is another helpful tactic. If possible, rinsing your mouth after consuming a sugary snack or drink can help mechanically remove sugar from the mouth. However, unless you have multiple water bottles on hand during a bike ride, this may not always be feasible.
Maintaining your dental health while fueling properly to sustain overall health and performance is something all endurance athletes should understand and incorporate into their routine.
