Your Teeth Might Be Slowing You Down
Modern athletes track everything. Heart rate variability, sleep stages, lactate thresholds, macros down to the gram. But there is one part of the body that rarely makes it onto the performance dashboard: the mouth.
A 2026 interdisciplinary review published in the British Dental Journal by Hollander et al. [1] pulls together evidence from systematic reviews, meta-analyses, and cross-sectional studies spanning Olympic Games, professional soccer, and national-level competition. The picture that emerges is surprising: oral health problems are strikingly common in athletes, and they are consistently associated with worse performance — not just in how athletes feel, but in what they can physically produce.
The Evidence: From Cavities to Slower Sprint Times
The scale of the issue is the first surprise. In a cross-sectional study of athletes at the London 2012 Olympic Games, Needleman et al. (2013) found that roughly 55% had untreated dental caries, 76% showed signs of gingivitis, and 45% had erosive tooth wear. A separate study of 187 UK professional footballers (Needleman et al., 2016) found gingivitis in 80% of players and active caries in 37%. These are some of the fittest people on the planet, and yet their mouths tell a different story.
The second surprise is what this seems to cost them. In a study of 352 Olympic and elite athletes, Gallagher et al. (2018) reported that 32% said oral health issues negatively affected their sporting performance. Needleman et al. (2013) found that 18% of London 2012 athletes said oral health specifically hindered their training or competition. In professional soccer, nearly 20% of players reported oral health impacting their quality of life, with a statistically significant link between active decay and self-reported performance impacts (Needleman et al., 2016). Common complaints across studies included acute dental pain, difficulty eating, and disrupted sleep — all of which cut directly into recovery.
But self-reported data only goes so far. What do the measurements say?
Merle et al. (2022) studied world-class and elite German athletes and found that those with signs of periodontitis — a severe gum infection — recorded a 5.7% lower mean V̇O2max (the gold-standard measure of aerobic capacity) compared to athletes with healthier gums: 55.9 versus 59.3 mL/min/kg (p=0.03). At the elite level, where races are decided by fractions of a percent, 5.7% is enormous. The same study found that athletes with lower gum inflammation produced higher maximal power on a cycling ergometer: 5.0 versus 4.4 W/kg (p=0.03).
The pattern holds in explosive sports too. Yapici et al. (2019) measured Turkish athletes' dental health using the DMFT index (Decayed, Missing, Filled Teeth) and tested them on agility drills and sprints. Athletes with a DMFT score below 4 consistently outperformed those scoring 4 or higher across t-drill, zig-zag, lateral change of direction, and 505 agility tests, as well as 10, 20, and 30-metre sprints. All differences were statistically significant, with low-to-moderate correlations between worse dental health and longer completion times.
An important note: these are cross-sectional associations. They show that athletes with worse oral health tend to perform worse, but they cannot prove that fixing dental problems will directly boost performance. That said, the consistency of the pattern across different sports, countries, and performance measures is hard to dismiss.
How Problems in the Mouth Reach the Rest of the Body
The association is consistent, but how would a cavity or inflamed gums actually slow someone down on the track or in the gym? Hollander et al. [1] outline five plausible pathways, and some of them are more intuitive than others.
The most compelling is systemic inflammation. Periodontitis is not just a local gum problem — it is a chronic inflammatory condition. The body responds by flooding the bloodstream with inflammatory markers like C-reactive protein (CRP), TNF-α, and interleukin-6 (IL-6). These molecules impair glycaemic control, hinder muscle repair, and accelerate fatigue. IL-6 is especially interesting here: working muscles naturally release it during exercise as a signalling molecule, but when IL-6 is chronically elevated from an oral infection, it increases skeletal muscle fatigability and disrupts mitochondrial function. In plain terms, the body recovers more slowly and tires more quickly — exactly the opposite of what any training programme is trying to achieve.
Then there is impaired nutrition. Pain from cavities, gum disease, or mouth ulcers can make eating uncomfortable enough that athletes shift away from nutrient-dense foods — nuts, raw vegetables, acidic fruits — toward softer, more processed alternatives. The result is a worse diet at exactly the time when training demands make good nutrition most important.
Perhaps the most fascinating pathway involves the oral microbiome. Certain bacteria on the tongue convert dietary nitrate — from foods like beetroot, spinach, and rocket — into nitrite, a precursor of nitric oxide (NO). NO widens blood vessels, improves oxygen delivery to muscles, and reduces the oxygen cost of exercise [2]. Research suggests that athletes carry higher levels of these nitrate-reducing bacteria and have elevated salivary nitrite, which correlates positively with aerobic fitness [1, 2]. Oral diseases like periodontitis can disrupt this microbial community. And related: antiseptic mouthwash has been shown to suppress this nitrate-to-nitrite conversion, reducing the blood-pressure-lowering effect of exercise by more than 60% within the first hour of recovery [3]. The bacteria you rinse away may be the same ones helping your cardiovascular system recover from a hard session.
The remaining two pathways are more straightforward. Psychological burden — visible dental problems like bleeding gums, missing teeth, or bad breath can chip away at self-confidence, while chronic oral pain increases anxiety and impairs decision-making in competitive settings. And altered sensorimotor control — dental pain is a powerful sensory input that can interfere with motor control and force production, potentially through mechanoreceptors in the tissues around the teeth. Jaw issues and temporomandibular disorders have also been linked to impaired postural stability.
Where the Science Stands — and Where It Is Heading
It is worth being honest about the limits of this evidence. Most studies are cross-sectional, meaning they capture a snapshot rather than tracking changes over time. Many rely on self-reported performance impacts using unvalidated questionnaires. And the athlete populations across studies vary widely in how they are defined and classified, which makes direct comparisons tricky.
What is missing — and what would be most convincing — are well-designed intervention trials. If researchers could take a group of athletes with poor oral health, treat their dental problems, and then measure whether performance improved, that would move the conversation from association to causation. The Hollander et al. review [1] calls for exactly this kind of research: interdisciplinary studies using validated outcome measures, clearly defined athlete populations, and study designs co-produced with athletes and their support teams.
One small step in that direction already exists. A feasibility study across Great Britain Cycling, Rowing, and a Premiership Rugby Union team tested a simple oral health education programme delivered to athletes and support staff. It found improvements in oral health behaviours and reductions in self-reported performance impacts. It is not a controlled performance trial, but it shows the concept is workable and that athletes respond to this kind of intervention.
In the meantime, the associations are consistent enough — and the mechanisms plausible enough — that oral health deserves a place in the conversation about athletic performance alongside nutrition, sleep, and recovery. For something so common and so treatable, it is a variable worth paying attention to.
References
- Hollander K, Eshkol-Yogev I, Zech A, Buti J, Needleman I. "The influence of oral health on sports performance: an interdisciplinary perspective", British Dental Journal 240 (2026) 277–283. doi.org/10.1038/s41415-025-9348-1
- Bryan NS, Burleigh MC, Easton C. "The oral microbiome, nitric oxide and exercise performance", Nitric Oxide 125–126 (2022) 23–30. doi.org/10.1016/j.niox.2022.05.004
- Cutler C, Kiernan M, Willis JR et al. "Post-exercise hypotension and skeletal muscle oxygenation is regulated by nitrate-reducing activity of oral bacteria", Free Radical Biology and Medicine 143 (2019) 252–259. doi.org/10.1016/j.freeradbiomed.2019.07.035