Interview: “Every high-intensity sport usually involves high sugar consumption”
Sports dentistry is usually considered only to deal with sports injuries and accidents. Naturally, a dental trauma that includes fractures of teeth and facial bones can impede the athlete’s ability to train and compete. As the treatment and prevention of such orofacial injuries has constituted a main pillar of the discipline, mouth guards have become a pivotal tool for athletes and sports dentists alike. However, oral diseases are just as important to consider, especially among tennis players. Dr Stephane Perez, sports dentist in Paris, explains why this is the case.
Dr Perez, when did you start specialising in sports dentistry?
I began working with athletes in 1986. For 20 years, I was responsible for the health of tennis players in France. In France, we have a special organisation: the Fédération Française de Tennis (French Tennis Federation). They take care of the health of the tennis players, which is unique to France. In other countries, such as the United States, these federations do not cover the healthcare of athletes. They have to travel alone without any financial support. In France, athletes are obliged to visit physicians including cardiologists and dentists. This has been the case for 15 years.
At the same time, tennis players and other athletes continue to complain about dental problems. Why is this the case?
Athletes are also humans: they do not want to care about their teeth unless they are in pain. The first tennis players I treated were as young as 15-years-old. I instantly recognised many caries and the reason was their consumption of energy drinks. When they joined the French Tennis Federation, we immediately tried to cure the cavities. In the first year, we cured about ten cavities in the mouth of every male player. The oral situation among females was usually better. I think that female tennis players had about five cavities, so sugar consumption seemed to be stronger among males. This is a fact I usually communicate to my colleagues at the American Tennis Federation. Many American colleagues have now recognised this problem. In all countries, sugar was never considered a problem, only traumatic treatment. However, I am right to focus on caries and cavity treatment.
Why don’t athletes get rid of sugary drinks then?
A lot of business comes from encouraging the consumption of sugary drinks among athletes. And, when I became a member of the French Olympic committee, the main companies that supported those athletes were Coca Cola, Haribo, etc. We never talked about sugar consumption. I have quit the committee so I am not aware of the situation now. Another problem we have witnessed among athletes are wisdom teeth. That is now also considered a real problem that can impact their wellbeing.
Since London 2012, the Olympic committee has realised that dental clinics during the Olympic Games have been the most visited medical institutions in the village because essentially healthcare is free. In particular, those athletes without social security frequent the clinics and are awaiting the Olympic Games just to be cured in time. In fact, the dental practice is now the most frequented clinic in the village. All of the dentists are very proud to prove to their medical colleagues that everybody needs dental care. At the same time, dental care is neglected in many athletes’ countries of origin despite the fact that oral health is fundamental for general health.
Could you tell us one story about one of your famous patients?
Yes, Andy Murray is a great example. He had a broken tooth between the quarter and semi-final of the Roland Garros tournament. It was a huge problem because he had a big cavity that was in danger of forming an abscess. He had visited another dentist six months before the start of the championship. He came to see me and I succeeded in stopping the pain, nothing else. At that time, I was not able to provide a full treatment and injections because certain medicine could be considered doping. So, I was obliged to do the best that I could. He did not lose because of me, but his broken tooth definitely contributed to his loss. At the time, he stopped the press conference because he had to go to the dentist. One journalist wrote that it was scandalous to go to a French dentist rather than an English dentist. How remarkable, right? Well, I also treat other top athletes but I cannot talk about them, of course.
Why are you so interested in tennis?
I used to play tennis. It is my favourite sport. It is also one of the main sports with cavities. Other teams have special dentists so I am not sure about those disciplines. However, fencers usually also have problems with cavities. They drink a lot of acidic drinks to maintain their concentration. Sometimes, they only have ten-minute breaks and one point can lead to losing the whole match. Every high-intensity sport usually involves high sugar consumption. As a consequence, erosion continues to be a problem.
What can you do in terms of prophylaxis?
All athletes understand the problem of bad oral health and its effect on muscular diseases. However, not everybody wants to go to the dentist despite these risks. What I do is to communicate with my colleagues and explain to them the psychology of the sportsmen. I tell them how they can explain preventive care to those athletes. The main thing I explain is the skills an athlete needs to have in order to be successful, such as discipline and an ability to concentrate.
Certainly, we could push for a lot of preventive efforts with fluoride, for example, but in France, we have the problem that prevention is not paid for. And only three sport disciplines have money: football, tennis and golf. All other athletes do not make sufficient money and therefore cannot afford preventive treatment. Interestingly, the US Olympic Committee has decided, together with the government, that dental care is tax deductible. That is a huge step forward.
What can you recommend to your dental colleagues if they treat an athlete?
I recommend they have a different attitude for each sport and learn as much as possible about the discipline. They also need to learn about sugar intake and understand the importance of protective devices such as mouth guards. In the end, these dentists should also participate in athletes’ training sessions so that they can see what the athletes are doing. The most important thing is to have empathy with the athletes. Luckily, we have many dentists who practise sports professionally or recreationally.
The most important thing during the match is to rinse the mouth with water after consuming energy drinks. This stops most of the acidic effect of the drink. You can see athletes spitting out the water after rinsing because they do not want to consume too much water.
Will good oral health lead to better performance?
Good oral health does not hurt! But I do not think that we can ameliorate the performance of an athlete. We can only secure their oral wellbeing. For this, I would be very happy if athletes visited a dentist at least once per year for a check-up. We should not only be considered technicians.