Clinical Sciences 871
Authors
Y. Maeda1, T.-C. Yang2, H. Miyanaga1, Y. Tanaka1, K. Ikebe1, N. Akimoto1
Affiliations
1
Department of Prosthodontics, Gerodontolgy and Oral Rehabiliation, Osaka University Graduate School of Dentistry, Suita, Japan 2 School of Dentistry, National Taiwan University, Taipei, Taiwan
Key words ▶ mouthguard ● ▶ dental caries ● ▶ sports drinks ● ▶ exercise ●
Abstract
▼
The influence of sports drinks and mouthguards on the pH level of tooth surface was examined. A custom-made mouthguard was fabricated for each subject. The pH level was measured by electric pH meter with sensitivity of 0.01 up to 30 min. Sports drinks (pH = 3.75) containing 9.4 % sugar were used in this study. Measurements were performed on a cohort of 23 female subjects without a mouthguard (control), wearing a mouthguard only (MG), wearing a mouthguard after 30 ml sports drink intake (SD + MG), wearing a mouthguard during a 5-min jogging exercise (MG + EX) and wearing a mouthguard during jogging after sports drink intake (SD + MG + EX).
Introduction accepted after revision December 05, 2013 Bibliography DOI http://dx.doi.org/ 10.1055/s-0033-1364021 Published online: March 6, 2014 Int J Sports Med 2014; 35: 871–873 © Georg Thieme Verlag KG Stuttgart · New York ISSN 0172-4622 Correspondence Prof. Yoshinobu Maeda Department of Prosthodontics, Gerodontolgy and Oral Rehabiliation Osaka University Graduate School of Dentistry 1-8 Yamadaoka 565-0871 Suita Japan Tel.: + 81/6/6879 2954 Fax: + 81/6/6879 2957 [email protected]
▼
Intake of sports drinks with high sugar content during sporting events is recommended for preventing dehydration as well as promoting energy intake [2, 17]. However, the erosive effect of sports drinks on tooth surface has become a concern among dental health care professionals [5, 6, 8, 15]. Coombes indicated that drinking habits of sports drink and salivary production are more important determinants of dental erosion rather than consumption volume [3]. To prevent traumatic injuries during sporting events, on the other hand, the use of mouthguards should also be recommended in various contact sports such as boxing, rugby football, basketball, Tae-Kwon-Do, wrestling, etc.. For most of these sports mouthguards are either mandatory or recommended [1, 10, 20]. Athletes who wear mouthguards often consume sports drink during exercise or competition before wearing a mouthguard or with a mouthguard already in place.
For 7 male subjects, the same measurements were performed while a sports drink was taken over the mouthguard (MG + SD, MD + EX + SD). MG showed statistically higher pH level than control (p < 0.05). SD + MG exhibited a significant decrease in pH level, and SD + MG + EX exhibited even below the critical level of pH 5.5 in some subjects. When sports drinks were taken over the mouthguard, no significant differences in pH level were observed among the different conditions.Within the limitations of this study, it was suggested that wearing a mouthguard during exercise is in itself not a possible risk factor for dental caries, while wearing a mouthguard after consuming sports drinks is.
Since little is known about the influence of mouthguard use, intake of sports drinks and whole-body exercise on oral pH level, this study sought to investigate whether the use of mouthguards contributes to a decrease in pH level in the oral cavity and thereby leads to increased risk of dental caries.
Materials and Methods
▼
10 female university lacrosse players, 13 female students at a dental technology school and 7 young male dentists volunteered for this study, providing informed consent approved by the institutional ethics committee. It was also confirmed that this study meets the ethical standards and research protocol in sport and exercise science research [5]. A single-layer custom-made mouthguard was fabricated for each subject from a soft mouthguard sheet material (Erko soft; thickness, 3 mm; Erkodent, Prazwalfenweiler, Germany) using a pressure-forming machine (Erkopress 2000, Erkodent) according to the standardized design as described in our previous report [9].
Maeda Y et al. Mouthguard and Sports Drinks … Int J Sports Med 2014; 35: 871–873
This document was downloaded for personal use only. Unauthorized distribution is strictly prohibited.
Mouthguard and Sports Drinks on Tooth Surface pH
872 Clinical Sciences
▶ Fig. 1 shows changes in pH values observed in one representa●
tive subject under 5 different conditions over 30 min. In this subject, pH values for MG and MG + EX were slightly lower than control over 30 min. For SD + MG, the pH dropped down to pH 5.5 at 5 min and stayed at that level, while SD + MG + EX exhibited a gradual decrease from pH 7.1 to 5.4 over 30 min. ▶ Fig. 2 shows the averaged difference in pH level among 23 ● female subjects between time 0 and 30 min for each condition. A statistically significant decrease in pH level was observed between control and MG, SD + MG, and SD + MG + EX and MG and SD + MG + EX (p < 0.05). ▶ Fig. 3 shows the averaged difference in pH level among 7 male ● subjects between time 0 and 30 min for each condition in which subjects took sports drink over mouthguards. The slight increase in pH was observed after wearing the mouth▶ Fig. 2. However, there was no significant guard as shown in ● difference in pH level among conditions (control, MG only, MG + SD, MG + EX and MG + EX + SD).
Discussion
▼
Since sports drink usually have acidic and erosive potential (pH ranged from 3.16 to 3.70) [16], sensible use or modification of their properties is recommended [19]. Some study reported that sports drinks have erosive effect on tooth surface. Specimens from that experimental study were immersed in various sports drinks for 24 h over 14 days [8, 15]. With regard to the relationship between erosion of tooth surface and intake of sports drink among athletes, both positive and negative relationships have been reported. Järvinen et al. [7] indicated the correlation between erosion of tooth surface and sports drink intake among athletes, while
Maeda Y et al. Mouthguard and Sports Drinks … Int J Sports Med 2014; 35: 871–873
pH value
6.5 6 5.5 5 4.5 4
0
5
10 1
2
15 (min) 3
20 4
25
30
5
Fig. 1 Changes in pH values observed in one representative subject under 5 different conditions over 30 min.
* * *
1 0.5 0
1
2
3
4
5
–0.5 –1 –1.5
(*:p< 0.05)
–2 Fig. 2 Changes in pH values observed in 23 female subjects under 5 different conditions over 30 min.
1
0.5
0
1
2
3
4
5
–0.5 (p< 0.05) –1
Fig. 3 Changes in pH values observed in 7 male subjects under 5 different conditions over 30 min. 1, Control; 2, MG only; 3, MG + SD; 4, MG + EX; 5, MG + SD + EX.
Mathew et al. [11], Milosevic et al. [13] and Sirimaharaj et al. [18] indicated the no direct correlation between these items. It is well known that pH level in the oral cavity can be easily changed by various factors such as time of day, stimulus, plaque accumulation, cavities in tooth decay, restorations, prostheses, periodontal disease, among other factors. In this study, the dif-
This document was downloaded for personal use only. Unauthorized distribution is strictly prohibited.
▼
7
Change in pH value
Results
8 7.5
Change in pH Value
Serial saliva pH measurements were conducted using an electric pH meter with a sensitivity of 0.01 (D-51; HORIBA Co, Japan) every 5 min for 30 min. Saliva samples were collected on the tooth surface using a cotton swab and diluted with distillated water (pH = 7.0). Sports drink (pH = 3.75) containing 9.4 % sugar (Morinaga Co., Japan) was used in this study. Measurements were taken from 23 female subjects under the following conditions: natural dentition (control); wearing mouthguard only (MG); wearing mouthguard immediately after 30 ml sports drink intake (SD + MG); wearing mouthguard during 5-min jogging exercise (MG + EX); wearing mouthguard immediately after 30 ml sports drink intake and 5 min jogging (SD + MG + EX). The same measurements were repeated for 7 male subjects under the following conditions: natural dentition (control); wearing mouthguard only (MG); wearing mouthguard at first and 30 ml sports drink intake after (MG + SD); wearing mouthguard during 5-min jogging exercise (MG + EX); and wearing mouthguard during 5-min jogging exercise followed by 30 ml sports drink intake after MG (MG + EX + SD). Changes in pH level were compared among the 5 conditions. Statistical analysis was performed using one-way ANOVA and multiple comparisons (post hoc test). P < 0.05 was considered statistically significant.
Clinical Sciences 873
Acknowledgements
▼
This study was funded by University Study Grant.
Competing interests: There are no competing interests to any company or society. No competing interests declared.
References 1 Azodo CC, Odai CD, Osazuwa-Peters N, Obuekwe ON. A survey of orofacial injuries among basketball players. Int Dent J 2011; 61: 43–46 2 Chromiak JA, Smedley B, Carpenter W, Brown R, Koh YS, Lamberth JG, Joe LA, Abadie BR, Altorfer G. Effect of a 10-week strength training program and recovery drink on body composition, muscular strength and endurance, and anaerobic power and capacity. Nutrition 2004; 20: 420–427 3 Coombes JS. Sports drinks and dental erosion. Am J Dent 2005; 18: 101–104 4 Dibdin GH, Dawes C. A mathematical model of the influence of salivary urea on the pH of fasted dental plaque and on the changes occurring during a cariogenic challenge. Caries Res 1998; 32: 70–74 5 Harriss DJ, Atkinson G. Ethical standards in sport and exercise science research: 2014 update. Int J Sports Med 2013; 34: 1025–1028 6 Hooper S, West NX, Sharif N, Smith S, North M, De’Ath J, Parker DM, Roedig-Penman A, Addy M. A comparison of enamel erosion by a new sports drink compared to two proprietary products: a controlled, crossover study in situ. J Dent 2004; 32: 541–545 7 Järvinen VK, Rytömaa II, Heinonen OP. Risk factors in dental erosion. J Dent Res 1991; 70: 942–947 8 Kitchens M, Owens BM. Effect of carbonated beverages, coffee, sports and high energy drinks, and bottled water on the in vitro erosion characteristics of dental enamel. J Clin Pediatr Dent 2007; 31: 153–159 9 Maeda Y, Machi H, Tsugawa T. Influences of palatal side design and finishing on the wearability and retention of mouthguards. Br J Sports Med 2006; 40: 1006–1008 10 Maeda Y, Kumamoto D, Yagi K, Ikebe K. Effectiveness and fabrication of mouthguards. Dent Traumatol 2009; 25: 556–564 11 Mathew T, Casamassimo PS, Hayes JR. Relationship between sports drinks and dental erosion in 304 university athletes in Columbus, Ohio, USA. Caries Res 2002; 36: 281–287 12 Meyerowitz C, Featherstone JD, Billings RJ, Eisenberg AD, Fu J, Shariati M, Zero DT. Use of an intra-oral model to evaluate 0.05 % sodium fluoride mouthrinse in radiation-induced hyposalivation. J Dent Res 1991; 70: 894–898 13 Milosevic A, Kelly MJ, McLean AN. Sports supplement drinks and dental health in competitive swimmers and cyclists. Br Dent J 1997; 182: 303–308 14 Milgrom P, Zero DT, Tanzer JM. An examination of the advances in science and technology of prevention of tooth decay in young children since the Surgeon General's Report on Oral Health. Acad Pediatr 2009; 9: 404–409 15 Owens BM, Kitchens M. The erosive potential of soft drinks on enamel surface substrate: an in vitro scanning electron microscopy investigation. J Contemp Dent Pract 2007; 8: 11–20 16 Rees J, Loyn T, McAndrew R. The acidic and erosive potential of five sports drinks. Eur J Prosthodont Restor Dent 2005; 13: 186–190 17 Rozenek R, Ward P, Long S, Garhammer J. Effects of high-calorie supplements on body composition and muscular strength following resistance training. J Sports Med Phys Fitness 2002; 42: 340–347 18 Sirimaharaj V, Brearley Messer L, Morgan MV. Acidic diet and dental erosion among athletes. Aust Dent J 2002; 47: 228–236 19 Tahmassebi JF, Duggal MS, Malik-Kotru G, Curzon ME. Soft drinks and dental health: a review of the current literature. J Dent 2006; 34: 2–11 20 Woodmansey KF. Athletic mouth guards prevent orofacial injuries: a review. Gen Dent 1999; 47: 64–69
Maeda Y et al. Mouthguard and Sports Drinks … Int J Sports Med 2014; 35: 871–873
This document was downloaded for personal use only. Unauthorized distribution is strictly prohibited.
ferences in weather and temperature may have affected the pH level between the male and female cohorts, since these 2 groups were measured separately at different times of the year. In this study, pH level equilibration was initially attempted among the subjects by using distilled water (pH = 7.0). Compared to control, subjects with mouthguards showed an increase in pH level of approximately 0.5. In male subjects, average pH level with MG only, MG + SD, MG + EX and MG + EX + SD were slightly higher than control although there were no significant differences. The reason for this increase may be that ammonia was generated from entrapped saliva in the closed space created by the mouthguard [4]. In 23 the female subjects, SD + MG did not change pH level significantly, which can be explained by the saliva’s buffering capability. During exercise, when the sympathetic nerve was dominant, saliva flow and buffering capability decreased, which might explain the slight decrease in pH level with SD + MG and significant decrease with MG + EX and with SD + MG + EX. Although in this study the pH level did not decrease to below 5.5 in most subjects, a decrease down to the critical level of 5.5 is possible in the absence of proper oral hygiene. Hence, dental plaque may accumulate on the tooth surface when athletes use a mouthguard. Results from male subjects in this study suggests that properly fitted custom-made mouthguards do not allow sports drink to flow onto the tooth surface. It also suggests that oral hygiene should be strongly promoted among athletes when they use mouthguards. As consuming water is recommended during sporting events, it might be preferable to recommend the intake of drinking water or sports drinks with non-cariogenic sugar such as Xylitol when wearing a mouthguard [14]. Moreover, it could even be possible to use mouthguards as anti-cariogenic drug-delivery means during sporting events [12]. Within the limitation of this study, it is concluded that consuming sports drinks prior to using a custom-made mouthguard is a possible risk factor for dental caries.
Copyright of International Journal of Sports Medicine is the property of Georg Thieme Verlag Stuttgart and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use.
Authors
Y. Maeda1, T.-C. Yang2, H. Miyanaga1, Y. Tanaka1, K. Ikebe1, N. Akimoto1
Affiliations
1
Department of Prosthodontics, Gerodontolgy and Oral Rehabiliation, Osaka University Graduate School of Dentistry, Suita, Japan 2 School of Dentistry, National Taiwan University, Taipei, Taiwan
Key words ▶ mouthguard ● ▶ dental caries ● ▶ sports drinks ● ▶ exercise ●
Abstract
▼
The influence of sports drinks and mouthguards on the pH level of tooth surface was examined. A custom-made mouthguard was fabricated for each subject. The pH level was measured by electric pH meter with sensitivity of 0.01 up to 30 min. Sports drinks (pH = 3.75) containing 9.4 % sugar were used in this study. Measurements were performed on a cohort of 23 female subjects without a mouthguard (control), wearing a mouthguard only (MG), wearing a mouthguard after 30 ml sports drink intake (SD + MG), wearing a mouthguard during a 5-min jogging exercise (MG + EX) and wearing a mouthguard during jogging after sports drink intake (SD + MG + EX).
Introduction accepted after revision December 05, 2013 Bibliography DOI http://dx.doi.org/ 10.1055/s-0033-1364021 Published online: March 6, 2014 Int J Sports Med 2014; 35: 871–873 © Georg Thieme Verlag KG Stuttgart · New York ISSN 0172-4622 Correspondence Prof. Yoshinobu Maeda Department of Prosthodontics, Gerodontolgy and Oral Rehabiliation Osaka University Graduate School of Dentistry 1-8 Yamadaoka 565-0871 Suita Japan Tel.: + 81/6/6879 2954 Fax: + 81/6/6879 2957 [email protected]
▼
Intake of sports drinks with high sugar content during sporting events is recommended for preventing dehydration as well as promoting energy intake [2, 17]. However, the erosive effect of sports drinks on tooth surface has become a concern among dental health care professionals [5, 6, 8, 15]. Coombes indicated that drinking habits of sports drink and salivary production are more important determinants of dental erosion rather than consumption volume [3]. To prevent traumatic injuries during sporting events, on the other hand, the use of mouthguards should also be recommended in various contact sports such as boxing, rugby football, basketball, Tae-Kwon-Do, wrestling, etc.. For most of these sports mouthguards are either mandatory or recommended [1, 10, 20]. Athletes who wear mouthguards often consume sports drink during exercise or competition before wearing a mouthguard or with a mouthguard already in place.
For 7 male subjects, the same measurements were performed while a sports drink was taken over the mouthguard (MG + SD, MD + EX + SD). MG showed statistically higher pH level than control (p < 0.05). SD + MG exhibited a significant decrease in pH level, and SD + MG + EX exhibited even below the critical level of pH 5.5 in some subjects. When sports drinks were taken over the mouthguard, no significant differences in pH level were observed among the different conditions.Within the limitations of this study, it was suggested that wearing a mouthguard during exercise is in itself not a possible risk factor for dental caries, while wearing a mouthguard after consuming sports drinks is.
Since little is known about the influence of mouthguard use, intake of sports drinks and whole-body exercise on oral pH level, this study sought to investigate whether the use of mouthguards contributes to a decrease in pH level in the oral cavity and thereby leads to increased risk of dental caries.
Materials and Methods
▼
10 female university lacrosse players, 13 female students at a dental technology school and 7 young male dentists volunteered for this study, providing informed consent approved by the institutional ethics committee. It was also confirmed that this study meets the ethical standards and research protocol in sport and exercise science research [5]. A single-layer custom-made mouthguard was fabricated for each subject from a soft mouthguard sheet material (Erko soft; thickness, 3 mm; Erkodent, Prazwalfenweiler, Germany) using a pressure-forming machine (Erkopress 2000, Erkodent) according to the standardized design as described in our previous report [9].
Maeda Y et al. Mouthguard and Sports Drinks … Int J Sports Med 2014; 35: 871–873
This document was downloaded for personal use only. Unauthorized distribution is strictly prohibited.
Mouthguard and Sports Drinks on Tooth Surface pH
872 Clinical Sciences
▶ Fig. 1 shows changes in pH values observed in one representa●
tive subject under 5 different conditions over 30 min. In this subject, pH values for MG and MG + EX were slightly lower than control over 30 min. For SD + MG, the pH dropped down to pH 5.5 at 5 min and stayed at that level, while SD + MG + EX exhibited a gradual decrease from pH 7.1 to 5.4 over 30 min. ▶ Fig. 2 shows the averaged difference in pH level among 23 ● female subjects between time 0 and 30 min for each condition. A statistically significant decrease in pH level was observed between control and MG, SD + MG, and SD + MG + EX and MG and SD + MG + EX (p < 0.05). ▶ Fig. 3 shows the averaged difference in pH level among 7 male ● subjects between time 0 and 30 min for each condition in which subjects took sports drink over mouthguards. The slight increase in pH was observed after wearing the mouth▶ Fig. 2. However, there was no significant guard as shown in ● difference in pH level among conditions (control, MG only, MG + SD, MG + EX and MG + EX + SD).
Discussion
▼
Since sports drink usually have acidic and erosive potential (pH ranged from 3.16 to 3.70) [16], sensible use or modification of their properties is recommended [19]. Some study reported that sports drinks have erosive effect on tooth surface. Specimens from that experimental study were immersed in various sports drinks for 24 h over 14 days [8, 15]. With regard to the relationship between erosion of tooth surface and intake of sports drink among athletes, both positive and negative relationships have been reported. Järvinen et al. [7] indicated the correlation between erosion of tooth surface and sports drink intake among athletes, while
Maeda Y et al. Mouthguard and Sports Drinks … Int J Sports Med 2014; 35: 871–873
pH value
6.5 6 5.5 5 4.5 4
0
5
10 1
2
15 (min) 3
20 4
25
30
5
Fig. 1 Changes in pH values observed in one representative subject under 5 different conditions over 30 min.
* * *
1 0.5 0
1
2
3
4
5
–0.5 –1 –1.5
(*:p< 0.05)
–2 Fig. 2 Changes in pH values observed in 23 female subjects under 5 different conditions over 30 min.
1
0.5
0
1
2
3
4
5
–0.5 (p< 0.05) –1
Fig. 3 Changes in pH values observed in 7 male subjects under 5 different conditions over 30 min. 1, Control; 2, MG only; 3, MG + SD; 4, MG + EX; 5, MG + SD + EX.
Mathew et al. [11], Milosevic et al. [13] and Sirimaharaj et al. [18] indicated the no direct correlation between these items. It is well known that pH level in the oral cavity can be easily changed by various factors such as time of day, stimulus, plaque accumulation, cavities in tooth decay, restorations, prostheses, periodontal disease, among other factors. In this study, the dif-
This document was downloaded for personal use only. Unauthorized distribution is strictly prohibited.
▼
7
Change in pH value
Results
8 7.5
Change in pH Value
Serial saliva pH measurements were conducted using an electric pH meter with a sensitivity of 0.01 (D-51; HORIBA Co, Japan) every 5 min for 30 min. Saliva samples were collected on the tooth surface using a cotton swab and diluted with distillated water (pH = 7.0). Sports drink (pH = 3.75) containing 9.4 % sugar (Morinaga Co., Japan) was used in this study. Measurements were taken from 23 female subjects under the following conditions: natural dentition (control); wearing mouthguard only (MG); wearing mouthguard immediately after 30 ml sports drink intake (SD + MG); wearing mouthguard during 5-min jogging exercise (MG + EX); wearing mouthguard immediately after 30 ml sports drink intake and 5 min jogging (SD + MG + EX). The same measurements were repeated for 7 male subjects under the following conditions: natural dentition (control); wearing mouthguard only (MG); wearing mouthguard at first and 30 ml sports drink intake after (MG + SD); wearing mouthguard during 5-min jogging exercise (MG + EX); and wearing mouthguard during 5-min jogging exercise followed by 30 ml sports drink intake after MG (MG + EX + SD). Changes in pH level were compared among the 5 conditions. Statistical analysis was performed using one-way ANOVA and multiple comparisons (post hoc test). P < 0.05 was considered statistically significant.
Clinical Sciences 873
Acknowledgements
▼
This study was funded by University Study Grant.
Competing interests: There are no competing interests to any company or society. No competing interests declared.
References 1 Azodo CC, Odai CD, Osazuwa-Peters N, Obuekwe ON. A survey of orofacial injuries among basketball players. Int Dent J 2011; 61: 43–46 2 Chromiak JA, Smedley B, Carpenter W, Brown R, Koh YS, Lamberth JG, Joe LA, Abadie BR, Altorfer G. Effect of a 10-week strength training program and recovery drink on body composition, muscular strength and endurance, and anaerobic power and capacity. Nutrition 2004; 20: 420–427 3 Coombes JS. Sports drinks and dental erosion. Am J Dent 2005; 18: 101–104 4 Dibdin GH, Dawes C. A mathematical model of the influence of salivary urea on the pH of fasted dental plaque and on the changes occurring during a cariogenic challenge. Caries Res 1998; 32: 70–74 5 Harriss DJ, Atkinson G. Ethical standards in sport and exercise science research: 2014 update. Int J Sports Med 2013; 34: 1025–1028 6 Hooper S, West NX, Sharif N, Smith S, North M, De’Ath J, Parker DM, Roedig-Penman A, Addy M. A comparison of enamel erosion by a new sports drink compared to two proprietary products: a controlled, crossover study in situ. J Dent 2004; 32: 541–545 7 Järvinen VK, Rytömaa II, Heinonen OP. Risk factors in dental erosion. J Dent Res 1991; 70: 942–947 8 Kitchens M, Owens BM. Effect of carbonated beverages, coffee, sports and high energy drinks, and bottled water on the in vitro erosion characteristics of dental enamel. J Clin Pediatr Dent 2007; 31: 153–159 9 Maeda Y, Machi H, Tsugawa T. Influences of palatal side design and finishing on the wearability and retention of mouthguards. Br J Sports Med 2006; 40: 1006–1008 10 Maeda Y, Kumamoto D, Yagi K, Ikebe K. Effectiveness and fabrication of mouthguards. Dent Traumatol 2009; 25: 556–564 11 Mathew T, Casamassimo PS, Hayes JR. Relationship between sports drinks and dental erosion in 304 university athletes in Columbus, Ohio, USA. Caries Res 2002; 36: 281–287 12 Meyerowitz C, Featherstone JD, Billings RJ, Eisenberg AD, Fu J, Shariati M, Zero DT. Use of an intra-oral model to evaluate 0.05 % sodium fluoride mouthrinse in radiation-induced hyposalivation. J Dent Res 1991; 70: 894–898 13 Milosevic A, Kelly MJ, McLean AN. Sports supplement drinks and dental health in competitive swimmers and cyclists. Br Dent J 1997; 182: 303–308 14 Milgrom P, Zero DT, Tanzer JM. An examination of the advances in science and technology of prevention of tooth decay in young children since the Surgeon General's Report on Oral Health. Acad Pediatr 2009; 9: 404–409 15 Owens BM, Kitchens M. The erosive potential of soft drinks on enamel surface substrate: an in vitro scanning electron microscopy investigation. J Contemp Dent Pract 2007; 8: 11–20 16 Rees J, Loyn T, McAndrew R. The acidic and erosive potential of five sports drinks. Eur J Prosthodont Restor Dent 2005; 13: 186–190 17 Rozenek R, Ward P, Long S, Garhammer J. Effects of high-calorie supplements on body composition and muscular strength following resistance training. J Sports Med Phys Fitness 2002; 42: 340–347 18 Sirimaharaj V, Brearley Messer L, Morgan MV. Acidic diet and dental erosion among athletes. Aust Dent J 2002; 47: 228–236 19 Tahmassebi JF, Duggal MS, Malik-Kotru G, Curzon ME. Soft drinks and dental health: a review of the current literature. J Dent 2006; 34: 2–11 20 Woodmansey KF. Athletic mouth guards prevent orofacial injuries: a review. Gen Dent 1999; 47: 64–69
Maeda Y et al. Mouthguard and Sports Drinks … Int J Sports Med 2014; 35: 871–873
This document was downloaded for personal use only. Unauthorized distribution is strictly prohibited.
ferences in weather and temperature may have affected the pH level between the male and female cohorts, since these 2 groups were measured separately at different times of the year. In this study, pH level equilibration was initially attempted among the subjects by using distilled water (pH = 7.0). Compared to control, subjects with mouthguards showed an increase in pH level of approximately 0.5. In male subjects, average pH level with MG only, MG + SD, MG + EX and MG + EX + SD were slightly higher than control although there were no significant differences. The reason for this increase may be that ammonia was generated from entrapped saliva in the closed space created by the mouthguard [4]. In 23 the female subjects, SD + MG did not change pH level significantly, which can be explained by the saliva’s buffering capability. During exercise, when the sympathetic nerve was dominant, saliva flow and buffering capability decreased, which might explain the slight decrease in pH level with SD + MG and significant decrease with MG + EX and with SD + MG + EX. Although in this study the pH level did not decrease to below 5.5 in most subjects, a decrease down to the critical level of 5.5 is possible in the absence of proper oral hygiene. Hence, dental plaque may accumulate on the tooth surface when athletes use a mouthguard. Results from male subjects in this study suggests that properly fitted custom-made mouthguards do not allow sports drink to flow onto the tooth surface. It also suggests that oral hygiene should be strongly promoted among athletes when they use mouthguards. As consuming water is recommended during sporting events, it might be preferable to recommend the intake of drinking water or sports drinks with non-cariogenic sugar such as Xylitol when wearing a mouthguard [14]. Moreover, it could even be possible to use mouthguards as anti-cariogenic drug-delivery means during sporting events [12]. Within the limitation of this study, it is concluded that consuming sports drinks prior to using a custom-made mouthguard is a possible risk factor for dental caries.
Copyright of International Journal of Sports Medicine is the property of Georg Thieme Verlag Stuttgart and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use.
