Enhancing athletic performance: the critical role of oral health in sports.

A COMMENTARY ON

Ferreira R O, Frazão D R, Ferreira M K M et al. Periodontal disease and sports performance: a systematic review and meta-analysis. Res Sports Med. 2024; https://doi.org/10.1080/15438627.2023.2235048 .

DATA SOURCES

A comprehensive search was conducted across PubMed, Scopus, Web of Science, Cochrane Library, and LILACS, supplemented by gray literature searches using OpenGrey and Google Scholar. The search strategy combined MeSH terms and free-text keywords related to "athletes" or "exercise," and "periodontitis," "periodontal disease," or "gingivitis," along with "sports performance," adjusted for each database's syntax References were managed using EndNote X9, with duplicates removed. Eligibility screening excluded opinion papers, technical articles, guidelines, and animal studies. Full texts of relevant articles were reviewed, and additional articles were identified through citation tracking. Two reviewers independently performed the selection, with disagreements resolved by a third examiner.

STUDY SELECTION

The study selection in this systematic review involved identifying observational studies that compared professional athletes with periodontal disease (the case group) to those with a healthy periodontium (the control group). The studies included in the review were required to focus on the effects of periodontal disease on sports performance, with no restrictions on the type of sport. Specifically, the researchers developed a PECO statement and conducted searches in online databases for relevant studies published until April 2022, eventually including cross-sectional, case-control, and cohort studies that met their eligibility criteria.

DATA EXTRACTION AND SYNTHESIS

For each selected publication, data was collected on various characteristics, including publication year, study design, participant demographics (source and sample size), participants' ages, periodontal assessment methods, sports performance assessment, and outcomes. If necessary, study authors were contacted via email to obtain missing data.

QUALITY ASSESSMENT

The methodological quality of the studies was evaluated using the Joanna Briggs Institute's checklist for prevalence studies. Each study was assessed based on criteria such as the clarity of sample inclusion criteria, detailed descriptions of study subjects and settings, validity and reliability of exposure measurements, identification of confounding factors, and appropriateness of statistical analyses. Data analysis for this study was conducted using RevMan software to determine the relationship between periodontal disease and self-perceived sports performance, measured through Oral Impact on Daily Performance (OIDP) questionnaires; a meta-analysis was conducted using odds ratios (OR) with 95% confidence intervals (CI), comparing the presence of periodontal disease in performance-affected (case) and unaffected (control) groups. A random-effects model was applied when methodological heterogeneity existed, and heterogeneity was assessed via the I² index along with sensitivity analyses to evaluate the impact of individual studies on the overall findings. A funnel plot was generated where appropriate to assess publication bias. Sensitivity analyses were conducted to validate the influence of individual studies or groups of studies on the pooled results. The overall evidence quality was evaluated using the GRADE approach, which considered factors such as risk of bias, inconsistency, and indirectness.

RESULTS

Out of 793 references identified, 14 were selected for full-text evaluation following the application of eligibility criteria, leading to eight articles being included in the meta-analysis. The studies predominantly included cross-sectional designs and involved athletes whose ages ranged from 16 to 47 years. Various sports were represented, including track and field, boxing, and soccer. Six studies indicated a significant relationship between periodontal disease and self-perceived sports performance, while two studies found no association. The meta-analysis showed a 1.5-fold increased risk of sports performance decline associated with periodontal disease, as measured by the OIDP questionnaire. Specifically, the odds ratio was 1.55 (95% CI: 1.04 to 2.31), indicating with moderate certainty that athletes with periodontal disease are more likely to report a decline in performance.

CONCLUSIONS

It can be concluded from this systematic review and meta-analysis that there is a significant association between periodontal disease and reduced self-perceived sports performance in athletes. The findings underscore the importance of maintaining good oral health. Athletes should prioritize periodontal health by engaging in effective oral hygiene practices and seeking timely treatment for periodontal issues to optimize their performance.