jorge.abou@hotmail.com

suzely.moimaz@unesp.br

tania.saliba@unesp.br

fernando.chiba@unesp.br

osaliba@terra.com.br

*Ph.D. student of Public Health in Dentistry

São Paulo State University (UNESP)

School of Dentistry, Araçatuba, São Paulo

**Full Professor, Department of Preventive and Restorative Dentistry

Ph.D. in Preventive and Social Dentistry

São Paulo State University (UNESP)

School of Dentistry, Araçatuba, São Paulo

***Associate Professor, Department of Preventive and Restorative Dentistry

São Paulo State University (UNESP), School of Dentistry, Araçatuba

Ph.D. in Legal Dentistry and Deontology

University of Campinas (UNICAMP), Campinas, São Paulo

****Assistant Professor, Department of Preventive and Restorative Dentistry

São Paulo State University (UNESP), School of Dentistry, Araçatuba

Ph.D. in Preventive and Social Dentistry

São Paulo State University (UNESP), School of Dentistry, Araçatuba

(Brazil)

Reception: 07/17/2020 - Acceptance: 02/07/2021

1st Review: 12/14/2020 - 2nd Review: 01/19/2021

Accessible document. Law N° 26.653. WCAG 2.0

Suggested reference: Rejaili, J.A., Moimaz, S.A.S., Saliba, T.A., Chiba, F.Y., & Saliba, O. (2021). Social Habits, Oral Hygiene Practices, and Hydration in Athletes. Lecturas: Educación Física y Deportes, 25(274), 48-63. https://doi.org/10.46642/efd.v25i274.2457

 

Abstract

    Introduction: Social habits, oral health and lifestyle are important, not only from the perspective of sport development, but also from public health. Objectives: To investigate social habits, oral hygiene practices, and hydration in athletes. Methods: A cross-sectional, descriptive, survey study was conducted of 647 athletes from different sports disciplines. The variables researched were as follows: sports practiced, consumption of soft drinks and alcoholic beverages, smoking, mouth-breathing habit, use of medicines, oral hygiene practices, and intake of water, isotonic and energy drinks. Results: Of the total athletes, 313 (48.53%) breathed through their mouths during sports practice, 381 (58.89%) did not drink soft drinks, 618 (95.52%) did not smoke, and 98 (15.15%) consumed alcoholic beverages at least twice a week. The majority (85.63%) drank only water, while 138 (21.33%) consumed energy drinks during exercise. The highest proportion of athletes trained between 3 and 5 days a week (67.08%), for 2 to 4 hours a day (76.05%). Dental floss was not used by 212 (32.77%) athletes. The use of medicines was reported by 114 athletes (17.62%), and majority of these medicines were medically prescribed. The majority of athletes reported been unaware of the fact that the medicines could be doping. Conclusions: A large portion of the athletes had mouth-breathing habit during sports practice, and although all of them performed tooth brushing, a considerable number lacked knowledge regarding the use of dental floss. The consumption of soft drinks and alcoholic beverages, use of medicines, and smoking was low.

    Keywords: Hydration. Oral health. Healthy lifestyle. Oral hygiene. Mouth breathing.

 

Resumo

    Introdução: Hábitos sociais, saúde bucal e o estilo de vida são importantes, não apenas da perspectiva do desenvolvimento esportivo, mas também da saúde pública. Objetivos: Investigar hábitos sociais, práticas de higiene bucal e hidratação em atletas. Métodos: Foi realizado um estudo transversal e descritivo de 647 atletas de diferentes disciplinas esportivas. As variáveis ​​pesquisadas foram: esportes praticados, consumo de refrigerantes, bebidas alcoólicas, tabagismo, hábito de respiração bucal, uso de medicamentos, práticas de higiene bucal e ingestão de água, isotônicos e bebidas energéticas. Resultados: Do total de atletas, 313 (48,53%) respiravam pela boca durante a prática esportiva, 381 (58,89%) não bebiam refrigerantes, 618 (95,52%) não fumavam e 98 (15,15%) consumiam bebidas alcoólicas pelo menos duas vezes por semana. A maioria (85,63%) bebia apenas água, enquanto 138 (21,33%) consumiam bebidas energéticas durante o exercício. A maior proporção de atletas treinava entre 3 e 5 dias por semana (67,08%), durante 2 a 4 horas por dia (76,05%). O fio dental não foi utilizado por 212 (32,77%) atletas. O uso de medicamentos foi relatado por 114 atletas (17,62%), e a maioria desses medicamentos foi prescrita medicamente. A maioria dos atletas relatou não ter conhecimento do fato de que os remédios poderiam ser doping. Conclusões: Grande parte dos atletas possuía hábito de respirar pela boca durante a prática esportiva e, embora todos realizem escovação dentária, um número considerável não possuía conhecimento sobre o uso do fio dental. O consumo de refrigerantes, bebidas alcoólicas, uso de medicamentos e fumo foi baixo.

    Unitermos: Hidratação. Saúde bucal. Estilo de vida saudável. Higiene bucal. Respiração bucal.

 

Resumen

    Introducción: Hábitos sociales, salud bucal y estilo de vida son importantes, no solo desde la perspectiva del desarrollo deportivo, sino también desde la salud pública. Objetivos: Investigar hábitos sociales, prácticas de higiene bucal e hidratación en deportistas. Métodos: Estudio transversal, descriptivo, de 647 atletas de diferentes deportes. Se investigaron las siguientes variables: deportes practicados, consumo de refrescos y bebidas alcohólicas, tabaquismo, hábito de respirar por la boca, uso de medicamentos, prácticas de higiene oral y consumo de agua, bebidas isotónicas y energéticas. Resultados: 313 atletas (48,53%) respiran por la boca durante la práctica deportiva, 381 (58,89%) no bebieron refrescos, 618 (95,52%) no fumaron y 98 (15,15%) consumieron bebidas alcohólicas al menos dos veces a la semana. La mayoría (85,63%) bebió solo agua, mientras que 138 (21,33%) consumió bebidas energéticas durante el ejercicio. La mayor cantidad de estos deportistas entrenó entre 3 y 5 días a la semana (67,08%), durante 2 a 4 horas al día (76,05%). El hilo dental no fue utilizado por 212 atletas (32,77%). El uso de medicamentos fue reportado por 114 atletas (17,62%), y la mayoría de estos medicamentos fueron recetados médicamente. La mayoría informó desconocer el hecho de que los medicamentos podrían ser doping. Conclusiones: Una gran parte tenía el hábito de respirar por la boca durante la práctica deportiva, y aunque todos se cepillaban los dientes, un número considerable carecía de conocimiento sobre el uso del hilo dental. El consumo de refrescos y bebidas alcohólicas, uso de medicamentos y tabaquismo fueron bajos.

    Palabras clave: Hidratación. Salud bucal. Estilo de vida saludable. Higiene bucal. Respiración por la boca.

 

Lecturas: Educación Física y Deportes, Vol. 25, Núm. 274, Mar. (2021)

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Introduction 

 

    Oral health is an integral part of general health and it is known that the athletes should maintain a proper routine of tooth brushing and oral hygiene practices, to perform well in physical activity, considering the association between oral health and non-communicable diseases (Honkala et al., 2015).The oral health of athletes could be a constant concern due to the high prevalence of trauma caused by accidents and dental diseases, such as dental caries, erosion, and periodontal disease (Azodo et al., 2011; Needleman et al., 2016; Ferreira et al., 2019). Although oral conditions can have a direct impact on sports performance, the athletes tend to make dental appointments only when necessary, do not attend regular check-ups, due to negligence or even ignorance of the importance of oral health (Needleman et al., 2016; Ashley et al., 2015). The maintenance and improvement of oral health in athletes is of crucial importance to promote sports performance and maintain health. (Azodo et al., 2011)

 

    Habits and lifestyle among athletes are of great importance, not only from the perspective of sport development, but also from public health (Kokko et al., 2015). Hence, a factor to be considered is tobacco consumption, the second leading cause of death in the world and the leading cause of premature death and disability, the cause of various types of cancers, and lung, cerebrovascular, and cardiovascular diseases (Oliveira et al., 2019). Epidemiological studies have found strong and consistent association between chronic smoking and loss of the periodontal attachment, an irreversible condition of periodontal disease, characterized by inflammation and degeneration of the supporting tissues of the teeth. (Zeng et al., 2014; Korman et al., 1993; Manicone et al., 2017)

 

    Another behavior that deserves attention is the chronic abuse of alcohol that produces toxic effects on several organs, including the oral cavity (Rusyn et al., 2013). Periodontal disease, dry mouth, dental caries, loss of teeth, and oral cancer have been reported in patients affected by disorders related to alcohol abuse (Amaral et al., 2009; Wang et al., 2016).

 

    The importance of nutrition in sport has been historically reported, and its role in improving health and sports performance is widely recognized (Carrillo López et al., 2020). Nutrition is one of the determining factors of oral health and can be both protective and harmful. Frequent consumption of acidic and sugary foods can trigger tooth decay and dental wear, promoting negative impacts on the athlete's performance (Needleman et al., 2018). Sports, isotonic, and energy drinks contain carbohydrates, minerals, and other components involved in the development of tooth decay. Similar to sodas, which contain phosphoric acid, these beverages, when metabolized, generate acidic products causing a drop in oral pH and consequently, dental demineralization (Broughton et al., 2016). Saliva plays an important role in the pH balance and consequently, in the process of demineralization and dental remineralization; however, during vigorous exercise, the production of saliva is decreased and therefore, a dry mouth combined with the consumption of sports drinks and mouth-breathing habit can increase dental erosion. (Silk et al., 2017)

 

    The use of doping agents in sport is a widespread problem not only among elite athletes, but also in recreational sports. There are drugs that can improve the selective aspects of physical performance; however, most doping agents have serious side effects, especially when used in combination and in high doses, and for a long period (Filho et al., 2017; Birzniece, 2015). Because the assessment of knowledge and behavior related to the athlete's health is fundamental for establishment of strategies and goals for the promotion of healthy habits, the purpose of this study was to investigate the social habits, oral hygiene practices, and hydration of athletes.

 

Methods 

 

    This is a cross-sectional, descriptive, survey research of 647 athletes from 22 different Olympic and non-Olympic sports (Rejaili, 2020). Professional and amateur athletes related to sports institutions in a municipality in the state of São Paulo, Brazil, were interviewed. All the athletes from municipal or private sports clubs and associations, who participated in official competitions, regardless of age and sex, were included in this study. Written informed consent was obtained from the athletes and those who refused to participate in the research or who did not sign the free, prior, and informed consent term, after three attempts to approach, were excluded. The results were made available to the authorities of Health and Sports Secretariat. A specific questionnaire for data collection was developed and tested in a pilot study and included the investigation of the following variables: sex, age, sports practiced, training characteristics, consumption of soft drinks and alcoholic beverages, smoking, use of medicines, oral hygiene practices, mouth-breathing habit and intake of water, isotonic, and energy drinks. The interviews were conducted individually by a single previously trained researcher, in an isolated room inside the clubs and sports associations, avoiding any interference in the data collection.

 

    The data were analyzed using descriptive statistics and the distributions of absolute frequency and percentage of the variables studied were presented through tables. Data processing were performed using the Epi Info software version 7.2.

 

    The study was approved by the Human Research Ethics Committee (CAAE: 16292219.4.0000.5420) and conducted in compliance with ethical principles, as established in the Declaration of Helsinki and in the resolution 466/2012 of the National Health Council of the Brazilian Ministry of Health.

 

Results 

 

    Table 1 shows the distribution of athletes according to the sport practiced and sex. The number of men was 2.3 times the number of women. The proportion of women was higher only in the rhythmic and artistic gymnastics modalities (Table 1).

 

Sport practiced	Sex
	Man		Woman		Total
	n	%	n	%	n	%
Basketball	45	6.95	8	1.24	53	8.19
Soccer	26	4.02	0	0	26	4.02
Handball	19	2.95	7	1.07	26	4.02
Rugby	17	2.63	10	1.54	27	4.17
Volleyball	25	3.86	16	2.48	41	6.34
Soccer	60	9.27	19	2.94	79	12.21
Futsal	15	2.32	13	2.01	28	4.33
Badminton	21	3.25	5	0.77	26	4.02
Baseball	23	3.55	0	0	23	3.55
Field tennis	23	3.55	13	2.01	36	5.56
Table tennis	16	2.47	8	1.24	24	3.71
Athletics	17	2.63	16	2.47	33	5.1
Cycling	20	3.09	6	0.93	26	4.02
Artistic Gymnastics	6	0.93	9	1.39	15	2.32
Rhythmic Gymnastics	1	0.15	15	2.32	16	2.47
Swimming	21	3.25	11	1.7	32	4.95
Triathlon	6	0.93	6	0.93	12	1.86
Boxing	21	3.25	1	0.15	22	3.4
Jiu Jitsu	24	3.71	5	0.77	29	4.48
Judo	16	2.47	11	1.7	27	4.17
Karate	14	2.16	11	1.7	25	3.86
Taekwondo	12	1.86	9	1.39	21	3.25
Total	448	69.25	199	30.75	647	100

Source: Author's own elaboration

 

    Information on hydration, social and training habits is described in Table 2. The majority of athletes reported that they consume only water during sports, while energy drinks intake was verified in approximately one fifth of them. It was observed that most athletes did not consume soft drinks, did not smoke, and that there were almost no cases of daily consumption of alcoholic beverages. The greatest proportion of athletes trained between 3 and 5 days a week, for 2 to 4 hours a day (Table 2).

 

Variables	n	%
Hydration
Water	554	85.63
Water and isotonic	92	14.22
Isotonic	1	0.15
Total	647	100.00
Energetic drinks consumption
No	509	78.67
Yes	138	21.33
Total	647	100.00
Soft drinks consumption
No	381	58.89
One to three times a day	253	39.11
More than 3 times a day	13	2.00
Total	647	100.00
Alcohol consumption
Does not consume	342	52.86
Sporadic or once a month	108	16.68
Once a week	99	15.30
At least 2 times a week	98	15.15
Total	647	100.00
Smoking
No	618	95.52
1 to 3 times a day	21	3.24
More than 3 times a day	8	1.24
Total	647	100.00
Training days per week
1	4	0.62
2	58	8.96
3	180	27.82
4	104	16.07
5	150	23.19
6	121	18.7
7	30	4.64
Total	647	100.00
Training hours per day
1 to 1.45	133	20.55
2 to 2.30	322	49.77
3 to 4	170	26.28
5 to 8	22	3.40
Total	647	100.00

Source: Author's own elaboration

 

    Distribution of athletes according to the oral hygiene practices and mouth-breathing habit during sports practice are shown in Table 3. It was observed that approximately one third of the athletes did not use dental floss and that just slightly more than half performed tooth brushing thrice a day. Mouth-breathing habit during sports practice was verified in about half of the athletes (Table 3).

 

Variable	n	%
Dental floss
Do not use	213	32.92
Rarely	37	5.72
Once a day	218	33.69
2 times per day	129	19.94
3 times a day	50	7.73
Total	647	100.00
Tooth brushing
Once a day	41	6.34
2 times per day	243	37.56
3 times a day	363	56.10
Total	647	100.00
Mouth breathing
No	334	51.62
Yes	313	48.38
Total	647	100.00

Source: Author's own elaboration

 

    As shown in Table 4, approximately 18% of the athletes reported taking some medications, the majority of them by medical prescription. It was observed that the majority of athletes reported that they were unaware of the fact that the medicines could be doping, while about 5% admitted they had already consumed medicines considered doping (Table 4).

 

Variables	n	%
Use of medication
No	533	82.38
Yes	144	17.62
Total	647	100.00
Drug prescription
Self-medication	10	8.77
Dental surgeon	1	0.88
Doctor	97	85.09
Other professional	6	5.26
Total	114	100.00
Knowledge if the drug is doping
No	98	85.96
Yes	16	14.04
Total	114	100.00
Doping agent consumption
No	616	95.21
Yes	31	4.79
Total	647	100.00

Source: Author's own elaboration

 

Discussion 

 

    In this study on habits that can influence the health and performance of the athlete, it was observed, it was observed that there were a large number of athletes who presented with mouth-breathing habit during sports practice and who consumed isotonic and energy drinks. It was also found that the prevalence of consumption of soft drinks and alcoholic beverages, use of medicines, and smoking was low.

 

    Mouth-breathing habit, observed in approximately half of the athletes analyzed, can contribute to increase in the dental plaque levels, consequently leading to the development of dental caries and periodontal diseases. This could be related to dehydration of the dental and gingival surfaces, reduced epithelial resistance to the formation of bacterial plaque, and the absence of self-cleansing salivary action. In addition, saliva plays an important role in balancing and maintaining the pH of the oral cavity, due to its buffering action (Mummolo et al., 2018). Thus, the importance of preventive measures and oral hygiene practices in the athletes is evident, especially for those who have mouth-breathing habit.

 

    Adequate hydration during sports activities contributes greatly in maintaining oral health, since long training sessions can result in decreased salivary flow, due to dehydration and mouth breathing. In this study, less than 5% of athletes trained 5 to 8 hours a day, which can be considered as a long training session. High-energy demands are often met by frequent intake of foods that contain fermentable carbohydrates and acidic sports drinks (Bryant et al., 2011; Burke et al., 2003; Sirimaharaji et al., 2002). Sports drinks are different products than energy drinks; sports drinks contain carbohydrates, minerals, electrolytes, and flavoring agents and are intended to replace water and electrolytes lost by sweating during exercise (Committee on Nutrition and the Council on Sports Medicine and Fitness, 2011). In contrast, the term “energy drink” refers to a different type of drink that contains substances that act as non-nutritive stimulants, such as caffeine, guarana, taurine, ginseng, L-carnitine, creatine, and/or glucuronolactone, with suspected ergogenic or performance-improvement effects (Sirimaharaji et al., 2002). The active ingredients in most energy drinks are caffeine, and to some extent taurine and sugars (Manchester et al., 2017). In recent years, the consumption of sports drinks in adolescents has tripled and its commercialization has been increasingly focused on children and adolescents as a healthy alternative to soft drinks (Silk et al., 2017). The benefits of sports drinks are mainly directed to individuals who perform vigorous and prolonged physical activities in hot or humid climates; however, these drinks contribute to the emergence of tooth decay due to the sugar content and acidic pH (Silk et al., 2017). Energy drinks have become an integral part of youth, athletic, and military culture. Many athletes are convinced that energy drinks improve the performance, and the military and university students, often consume energy drinks as stimulants to cope with sleep deprivation or to improve academic and athletic performance (Manchester et al., 2017). Despite the positive attributes of energy drinks, there are increasing number of reports stating that the combination of their active ingredients can generate serious and potentially fatal side effects. Recently, an increase in the use of energy drinks combined with alcoholic beverages has also been reported; however, preliminary studies show that this combination may result in important adverse effects(Manchester et al., 2017). On one hand, sports drinks benefit the athlete by replacing the water and electrolytes lost by sweating, on the other hand, if consumed frequently, they can promote tooth demineralization, due to the fermentation of the sugar contained in them. Therefore, it is of fundamental importance that sportspeople maintain proper oral hygiene practices.

 

    In this study, all the athletes performed tooth brushing often twice or thrice a day. In contrast, most participants rarely used or did not use dental floss, showing a lack of knowledge regarding this oral hygiene practice and emphasizing the importance of oral health education programs aimed at this target population. Studies conducted in Turkey on weekend athletes, and in New Zealand on elite triathletes, found that tooth brushing was performed only twice a week, demonstrating the athletes' negligence in relation to oral health (Bryant et al., 2011; Dursun et al., 2015). The dental floss is an important instrument for cleaning interdental surfaces, places inaccessible to the bristles of the brushes; therefore, its correct use should be encouraged, to avoid the accumulation of dental biofilm and consequently, the development of interproximal dental caries.

 

    It was observed that the prevalence of smoking habits and alcohol consumption among athletes was low. The relationship between sports and smoking has been contradictory, because while it is suggested that sport is a protective factor against the beginning of smoking; however, there is also a tendency to find unhealthy habits among the athletes. A recent study showed that team-sports athletes were three times likely to smoke than individual-sports athletes, suggesting that the reason is psychological, due to less pressure for sharing the credit of success with other team members. (De Nitto et al., 2020)

 

    Regarding the consumption of alcoholic beverages, it is expected that the athletes abstain from alcohol to avoid the negative impact that this habit can have on sports performance; however, athletes are not exempt from the influence that alcoholic beverages have on society, including being able to consume higher volumes of alcohol through compulsive behaviors compared to the general population. Thus, careful control should be exercised by those responsible for the athlete`s well-being, including the athlete himself, over the usual consumption of alcohol, to avoid the negative impact associated with the excessive use of alcohol. (Barnes, 2014)

 

    The prolonged use of alcohol and tobacco is widely recognized as an important risk factor for the development of cancer of the head and neck, especially in the region of the lip, oral cavity, pharynx, larynx, and esophagus (Jiang et al, 2019). In addition, the synergistic consumption of alcohol and tobacco significantly increases the chances of oral squamous cell carcinoma (Mello et al., 2019). These data reinforce the importance of public health policies aimed at the prevention and control of the consumption of alcohol and tobacco.

 

    The fight against doping in sports began because of the death of a Danish cyclist during the Olympic Games in Rome in 1960. The International Olympic Committee (IOC) established a Medical Commission that was given the responsibility of designing a strategy to combat drug misuse in Olympic sports (Catlin et al., 2008). The World Anti-Doping Agency (WADA) was created in joint action by the Olympic movement and public authorities in 1999 to harmonize the wide variety of rules that had been developed both in sports organizations and at the domestic levels to promote anti-doping activity. Currently, WADA is carrying out the struggle supported by the universally accepted Wada Code and an International Anti-Doping Convention with the United Nations Educational, Scientific and Cultural Organization (Ljungqvist, 2017). There is evidence that the use of doping agents such as androgenic anabolic steroids, growth hormone and other anabolic agents, erythropoietin, and stimulants exposes the user to several health complications, such as cardiovascular disease, diabetes, cancer, mental health problems, virilization in women, suppression of natural androgen production in men, among others (Bird et al., 2016). The extent of the long-term health consequences is difficult to predict, but probably substantial, especially when considering “genetic doping”. The term refers to the non-therapeutic use of genes, genetic elements, and/or cells that have the ability to improve sports performance (Birzniece, 2015). In this study, it was found that almost 5% of the athletes had already ingested some type of substance considered doping. Importantly, the majority of athletes who ingested these types of medications were unaware whether the medication could be considered doping.

 

    The athletes are exposed to a set of challenges, including bruises, finances, travel and training, dehydration, sports drinks, and diets rich in carbohydrates, which can compromise their oral health (Piccininni et al., 2017). Reduced performance due to oral health problems is unacceptable, considering that many of them can be avoided. The effect of poor oral health on adult athletes' lives is not yet fully elucidated, but it is likely to cause considerable impacts, including a high need for treatment due to tooth loss, reduced oral function, and negative psychological effects (Locker et al., 2011). The absence of clinical examination to assess the oral health condition and the fact that in survey researches the report may not be considered reliable, are limitations of this study. According to the Olympic Charter, the International Olympic Committee and International Sports Federations have an obligation to "encourage and support measures to protect the health of athletes" (Mountjoy et al., 2013). Health professionals, technical staff, and public authorities must pay attention to the athletes' health, encouraging them to undergo periodic examinations and carrying out educational practices to encourage them to adopt healthy habits.

 

Conclusion 

 

    A large proportion of the athletes had mouth-breathing habit during sports practice, and although all of them performed tooth brushing, a considerable number lacked knowledge regarding the use of dental floss. The consumption of soft drinks and alcoholic beverages, use of medicines, and smoking was low.

 

References 

 

Amaral, C.S., Vettore, M.V., & Leão, A. (2009). The relationship of alcohol dependence and alcohol consumption with periodontitis: a systematic review. Journal of Dentistry, 37, 643-51. https://doi.org/10.1016/j.jdent.2009.04.011

 

Ashley, P., Di Iorio, A., Cole, E., Tanday, A., & Needleman, I. (2015). Oral health of elite athletes and association with performance: a systematic review. British Journal of Sports Medicine, 49, 14–9. https://doi.org/10.1136/bjsports-2014-093617

 

Azodo, C.C., Odai, C.D., Osazuwa-Peters, N., & Obuekwe, O.N. (2011). A survey of orofacial injuries among basketball players. International Dental Journal, 61, 43-6. https://doi.org/10.1111/j.1875-595X.2011.00009.x

 

Barnes, M.J. (2014). Alcohol: impact on sports performance and recovery in male athletes. Sports Medicine, 44, 909-19. https://doi.org/10.1007/s40279-014-0192-8

Bird, S.R., Goebel, C., Burke, L.M., & Greaves, R.F. (2016). Doping in sport and exercise: anabolic, ergogenic, health and clinical issues. Annals of Clinical Biochemistry, 53, 196-221. https://doi.org/10.1177/0004563215609952

Birzniece, V. (2015). Doping in sport: effects, harm and misconceptions. Internal Medicine Journal, 45, 239-48. https://doi.org/10.1111/imj.12629

 

Broughton, D., Fairchild, R.M., & Morgan, M.Z. (2016). A survey of sports drinks consumption among adolescents. British Dental Journal, 220, 639-43. https://doi.org/10.1038/sj.bdj.2016.449

 

Bryant, S., McLaughlin, K., Morgaine, K., & Drummond, B. (2011). Elite athletes and oral health. International Journal of Sports Medicine, 32, 720-4. https://doi.org/10.1055/s-0031-1277192

 

Burke, L.M., Slater, G., Broad, E.M., Haukka, J., Modulon, S., & Hopkins, W.G. (2003). Eating patterns and meal frequency of elite Australian athletes. International Journal of Sport Nutrition and Exercise Metabolism, 13, 521-38. https://doi.org/10.1123/ijsnem.13.4.521

 

Carrillo López, P. J., García Perujo, M., García Cantó, E., & Rosa Guillamón, A. (2020). Eating Habits and their Relationship with Physical-Healthy Parameters. Lecturas: Educación Física y Deportes, 25, 62-75. https://doi.org/10.46642/efd.v25i264.1983

 

Catlin, D.H., Fitch, K.D., & Ljungqvist, A. (2008). Medicine and science in the fight against doping in sport. Journal of Internal Medicine, 264, 99-114. https://doi.org/10.1111/j.1365-2796.2008.01993.x

 

Committee on Nutrition and the Council on Sports Medicine and Fitness. (2011). Sports drinks and energy drinks for children and adolescents: are they appropriate? Pediatrics, 127, 1182–9. https://doi.org/10.1542/peds.2011-0965

 

De Nitto, S., Stefanizzi, P., Bianchi, FP, Castellana, M., Acatigno, L., Notarnicola, A., & Tafuri, S. (2020). Prevalence of cigarette smoking: a cross-sectional survey between individual and team sport athletes. Annali di igiene: medicina preventiva e di comunita, 32, 132-40. https://doi.org/10.7416/ai.2020.2337

 

Dursun, E., Ilarslan, Y.D., Ozgul, O., & Donmez, G. (2015). Prevalence of dental trauma and mouthguard awareness among weekend warrior soccer players. Journal of Oral Science, 57, 191-4. https://doi.org/10.2334/josnusd.57.191

 

Ferreira, GB, Guimarães, LS, Fernandes, CP, Dias, RB, Coto, NP, Antunes, LAA, & Antunes, LS (2019). Is there enough evidence that mouthguards do not affect athletic performance? A systematic literature review. International Dental Journal, 69, 25-34. https://doi.org/10.1111/idj.12406

 

Filho, J.N. da S., & Melluzzi, M.D. (2017). Efeitos do uso de esteroides anabolizantes por mulheres [Effects of the use of anabolizing steroids by women]. Lecturas: Educación Física y Deportes, 22, 65-70. https://www.efdeportes.com/efdeportes/index.php/EFDeportes/article/view/49

 

Honkala, S., Vereecken, C., Niclasen, B., & Honkala, E. (2015). Trends in toothbrushing in 20 countries/regions from 1994 to 2010. European Journal of Public Health, 25, 20–3. https://doi.org/10.1093/eurpub/ckv013

 

Jiang, H., Livingston, M., Room, R., Gan, Y., English, D., & Chenhall, R. (2019). Can public health policies on alcohol and tobacco reduce a cancer epidemic? Australia's experience. BMC Medicine, 17, 213. https://doi.org/10.1186/s12916-019-1453-z

 

Kokko, S., Villberg, J., & Kannas, L. (2015). Health promotion in sport coaching: coaches and young male athletes evaluations on the health promotion activity of coaches. International Journal of Sports Science & Coaching, 10, 339-52. https://doi.org/10.1260/1747-9541.10.2-3.339

 

Korman, K.S., & Loe, H. (1993). The role of local factors in the periodontal disease. Periodontology 2000, 2, 83-97. https://doi.org/10.1111/j.1600-0757.1993.tb00222.x

 

Ljungqvist, A. (2017). Brief history of anti-doping. Medicine and Sport Science, 62, 1-10. https://doi.org/10.1159/000460680

 

Locker, D., & Quinonez, C. (2011). To what extent do oral disorders compromise the quality of life? Community Dentistry and Oral Epidemiology, 39, 3–11. https://doi.org/10.1111/j.1600-0528.2010.00597.x

 

Manchester, J., Eshel, I., & Marion, D.W. (2017). The benefits and risks of energy drinks in young adults and military service members. Military Medicine, 182, e1726-e1733. https://doi.org/10.7205/MILMED-D-16-00339

 

Manicone, C., Tarli, A., Mirijello, L., Raffaelli, L., Vassallo, GA, Antonelli, M., Rando MM, Mosoni, C., Cossari, A., Lavorgna, L., Caputo, F., D'Addona, A., Gasbarrini, A., & Addolorato, G. (2017). Dental health in patients affected by alcohol use disorders: a cross-sectional study. European Review for Medical and Pharmacological Sciences, 21, 5021-7. https://doi.org/10.26355/eurrev_201711_13811

 

Mello, F.W., Melo, G., Pasetto, J.J., Silva, C.A.B., Warnakulasuriya, S., & Rivero, E.R.C. (2019). The synergistic effect of tobacco and alcohol consumption on oral squamous cell carcinoma: a systematic review and meta-analysis. Clinical Oral Investigations, 23, 2849-59. https://doi.org/10.1007/s00784-019-02958-1

 

Mountjoy, M., & Junge, A. (2013). The role of International Sport Federations in the protection of the athlete’s health and promotion of sport for health of the general population. British Journal of Sports Medicine, 47, 1023–7. https://doi.org/10.1136/bjsports-2013-092999

 

Mummolo, S., Nota, A., Caruso, S., Quinzi, V., Marchetti, E., & Marzo, G. (2018). Salivary markers and microbial flora in mouth breathing late adolescents. BioMed Research International, 8687608. https://doi.org/10.1155/2018/8687608

 

Needleman, I., Ashley, P., Meehan, L., Petrie, A., Weiler, R., McNally, S., Ayer, C., Hanna, R., Hunt, I., Kell, S., Ridgewell, P., & Taylor, R. (2016). Poor oral health active caries in 187 UK professional male football players clinical dental examination performed by dentists. British Journal of Sports Medicine, 50, 41-4. https://doi.org/10.1136/bjsports-2015-094953

 

Needleman, I., Rankin, A., Fairbrother, T., Fine, P., Gallagher, J., Kings, D., Maughan, RJ, Melin, AK, & Naylor, M. (2018). Nutrition and oral health in sport: time for action. British Journal of Sports Medicine, 52, 1483-84. https://doi.org/10.1136/bjsports-2017-098919

 

Oliveira, GMM, Mendes, M., Dutra, OP, Achutti, A., Fernandes, M., Correia, VA, Ferreira, MBSCS, Coelho, AS, Soares, MBPC, Évora, MABL, Mariotto, MG, & Morais, JCA (2019). 2019 Recommendations for reducing tobacco consumption in the portuguese-speaking countries. Revista Portuguesa de Cardiologia, 38, 233-44. https://doi.org/10.1016/j.repc.2019.04.003

 

Piccininni, P., Clough, A., Padilla, R., & Piccininni, G. (2017). Dental and orofacial injuries. Clinics in Sports Medicine, 36, 369-405. https://doi.org/10.1016/j.csm.2016.12.001

 

Rejaili, J. A. (2020). O esportista e a prevalência de trauma bucomaxilofacial.Conhecimento e uso de protetor bucal, hábitos e respiração na prática esportiva [Dissertação de mestrado. Universidade Estadual Paulista (UNESP), Faculdade de Odontologia, Araçatuba, Brasil]. https://repositorio.unesp.br/handle/11449/192535

 

Rusyn, I., & Bataller, R. (2013). Alcohol and toxicity. Journal of Hepatology, 59, 387–8. https://doi.org/10.1016/j.jhep.2013.01.035

 

Silk, H., & Kwok, A.(2017). Addressing adolescent oral health: a review. Pediatrics in Review, 38, 61-8. https://doi.org/10.1542/pir.2016-0134

 

Sirimaharaji, V., Brearley Messer, L., & Morgan, M.V. (2002). Acidic diet and dental erosion among athletes. Australian Dental Journal, 4, 228-36. https://doi.org/10.1111/j.1834-7819.2002.tb00334.x

 

Wang, J., Lv, J., Wang, W., & Jiang, X. (2016). Alcohol consumption and risk of periodontitis: a meta-analysis. Journal of Clinical Periodontology, 43, 572-83. https://doi.org/10.1111/jcpe.12556

 

Zeng, J., Williams, SM, Fletcher, DJ., Cameron, CM, Broadbent, JM, Shearer, DM, & Thomson, WM (2014). Reexamining the association between smoking and periodontitis in the Dunedin study with an enhanced analytical approach. Journal of Periodontology, 85, 1390-7. https://doi.org/10.1902/jop.2014.130577

Lecturas: Educación Física y Deportes, Vol. 25, Núm. 274, Mar. (2021)