Victor Paes Dias Gonçalves*

victor.dias.paes@gmail.com

Carlos Eduardo Erthal Moraes**

carloseduardoerthal@hotmail.com

Renato André de Souza Nascimento**

renatoandrenascimento@hotmail.com

Victor Danilo de Souza Alves***

v.dan.alves@gmail.com

Carlos Maurício Fontes Vieira+

vieira@uenf.br

Henry Alonso Colorado Lopera++

henry.colorado@udea.edu.co

Felipe Perissé Duarte Lopes+++

henry.colorado@udea.edu.co

*Especialista em Cirurgia e Traumatologia Bucomaxilofacial

Mestre em Implantodontia e Doutorando em Engenharia de Materiais

Universidade Estadual do Norte Fluminense Darcy Ribeiro (UENF)

**Acadêmico de Odontologia

Universidade Salgado de Oliveira (UNIVERSO)

***Graduado em Fisioterapia pela Universidade Estácio de Sá (UNESA/Campos/RJ)

Pós-Graduado Latu Senso em Reabilitação Musculoesquelética

e Esportiva com Ênfase em Biomecânica UCB - Recreio/RJ

Pós-Graduado Latu Senso em Fisioterapia Uroginecológica

Interfisio/UniRedentor/RJ

Atualmente é mestrando em Políticas Públicas

pela Universidade Federal Fluminense (UFF)

Docente da Universidade Salgado Oliveira (UNIVERSO) Campos/RJ

+Doutorado em Engenharia e Ciência dos Materiais

pela Universidade Estadual do Norte Fluminense Darcy Ribeiro

Universidade Estadual do Norte Fluminense Darcy Ribeiro (UENF)

++Doutorado em Materials Science and Engineering

Universidade Estadual do Norte Fluminense Darcy Ribeiro (UENF)

+++Doutorado em Ciências dos Materiais pelo Instituto Militar de Engenharia

Universidade Estadual do Norte Fluminense Darcy Ribeiro (UENF)

(Brasil)

Reception: 10/16/2024 - Acceptance: 01/19/2025

1st Review: 11/29/2024 - 2nd Review: 01/16/2025

Accessible document. Law N° 26.653. WCAG 2.0

Suggested reference: Gonçalves, V.P.D., Moraes, C.E.E., Nascimento, R.A. de S., Alves, V.D. de S., Carlos Maurício Fontes Vieira, Henry Alonso Colorado Lopera y Felipe Perissé Duarte Lopes (2025). Oral Health Assessment and Hygiene Behaviors in Professional Handball Athletes. Lecturas: Educación Física y Deportes, 30(323), 60-74. https://doi.org/10.46642/efd.v30i323.7945

 

Abstract

    Statement of the problem: Athletes, particularly those in contact sports like handball, face significant oral health challenges due to their intense physical activities. Effective oral health management in these athletes is crucial to prevent dental trauma and maintain overall oral hygiene. Objective: The objective of this study is to assess the prevalence of pericoronitis in young handball athletes through an intraoral clinical examination. Materials and methods: The study was conducted with 42 professional handball athletes from the Vikings Handebol Campos club. A clinical examination was performed by a single trained observer using a disposable wooden spatula and natural light. Results: The results detailed the oral health behaviors, including the frequency of dental visits, brushing habits, use of interdental care, and fluoride product. Conclusion: This study provides valuable insights into the oral health practices of professional handball players and highlights the need for targeted oral health interventions in athletes.

    Keywords: Oral health. Handball. Clinical evaluation. Athletes.

 

Resumo

    Declaração do problema: Atletas, particularmente aqueles em esportes de contato como handebol, enfrentam desafios significativos de saúde bucal devido às suas atividades físicas intensas. O gerenciamento eficaz da saúde bucal nesses atletas é crucial para prevenir traumas dentários e manter a higiene bucal geral. Objetivo: O objetivo deste estudo é avaliar a prevalência de pericoronarite em jovens atletas de handebol por meio de um exame clínico intraoral. Materiais e métodos: O estudo foi conduzido com 42 atletas profissionais de handebol do clube Vikings Handebol Campos. Um exame clínico foi realizado por um único observador treinado usando uma espátula de madeira descartável e luz natural. Resultados: Os resultados detalharão os comportamentos de saúde bucal, incluindo frequência de visitas ao dentista, hábitos de escovação, uso de cuidados interdentais e produtos com flúor, bem como achados clínicos. Conclusão: Este estudo fornece insights valiosos sobre as práticas de saúde bucal de jogadores profissionais de handebol e destaca a necessidade de intervenções direcionadas de saúde bucal em atletas.

    Unitermos: Saúde oral. Handebol. Avaliação clínica. Atletas.

 

Resumen

    Planteamiento del problema: Los deportistas, en particular los que practican deportes de contacto como el balonmano, se enfrentan a importantes retos de salud bucodental debido a su intensa actividad física. El manejo eficaz de la salud bucodental en estos deportistas es crucial para prevenir traumatismos dentales y mantener una higiene bucodental integral. Objetivo: Evaluar la prevalencia de pericoronaritis en jóvenes jugadores de balonmano mediante un examen clínico intraoral. Materiales y métodos: El estudio se realizó con 42 deportistas profesionales de balonmano del club Vikings Handebol Campos. Un único observador capacitado realizó un examen clínico utilizando una espátula de madera desechable y luz natural. Resultados: Los resultados detallaron los hábitos de salud bucodental, incluyendo la frecuencia de las visitas al dentista, los hábitos de cepillado, el uso de higiene interdental y el uso de productos con flúor. Conclusión: Este estudio proporciona información valiosa sobre las prácticas de salud bucodental de los jugadores profesionales de balonmano y destaca la necesidad de intervenciones específicas de salud bucodental en los deportistas.

    Palabras clave: Salud bucodental. Balonmano. Evaluación clínica. Deportistas.

 

Lecturas: Educación Física y Deportes, Vol. 30, Núm. 323, Abr. (2025)

---

 

Introduction 

 

    The overall health of an athlete is more demanding compared to sedentary individuals or individuals with less physically demanding lifestyles, as it directly reflects on their performance during sports activities (Teles et al., 2020). The athlete and the club invest time, effort, and money to ensure the athlete reaches their peak fitness during competition, as the high-performance standards required can only be met by a fully healthy individual. (Gay-Escoda et al., 2011; Gonçalves et al., 2017; Pedra et al., 2019; Drew et al., 2023; Amawi et al., 2024;)

Periodontal disease has gained attention due to its impact on the oral cavity, such as the loss of gingival attachment, which occurs alongside the development of an inflammatory condition, potentially releasing endotoxins into the bloodstream and bacteria present in periodontal pockets. (Abdulkareem et al., 2023)

 

    This condition affects muscle fibers, altering their physiological properties according to the stimuli received. The association between physical exercise and periodontal disease exacerbates levels of lymphocytes, neutrophils, and eosinophils, indirectly suggesting a greater muscle response to the immune response and, consequently, a decrease in muscle hypertrophy. In other words, periodontal disease has the potential to remodel inflammatory mediators. (Souza et al., 2012)

 

    Lattaro et al. (2023) and Ferradans et al. (2020) investigated how oral health affects salivary pH and other biomarkers in elite athletes. Lattaro et al. (2023) found that periodontal disease increases salivary acidity in athletes, but pH returns to neutral levels with improved oral hygiene, biofilm control, and periodontal treatment. Complementing these findings, Ferradans et al. (2020) studied 46 elite adolescent basketball players and observed that those with poor oral hygiene experienced a more significant drop in salivary pH and a greater increase in lactate levels after intense training, suggesting a higher vulnerability to dental caries when oral hygiene is inadequate, especially in conjunction with a poor diet.

 

    In young athletes, a very common condition of periodontal disorders is pericoronitis, which is defined as an inflammatory state, infectious or not, involving the soft tissue around the crown of a tooth, usually a lower third molar in the process of eruption or partially erupted (Moloney et al., 2009; Wehr et al., 2019). The accumulation of bacteria and food debris in the pericoronal region is a common cause of this pathology. This leads to inflammation, local pain, swelling, and, in more severe cases, abscess. (Cekici et al., 2014)

 

    Regarding the incidence of pericoronitis in young people, according to Nitzan et al. (1985), in their study evaluating 245 cases, 95% affected lower third molars, and only 5% other regions. The most affected age group was observed to be young people aged 20 to 29, representing 85 of the 241 cases evaluated. Recent studies highlight the oral health behaviors of elite athletes, revealing that 21–81% of athletes, including professional football players and Olympic candidates, visited the dentist in the last year (Needleman et al., 2013; Minty et al., 2018; Kragt et al., 2019). While 100% reported daily tooth brushing, 60–94% brushed at least twice a day (Bryant et al., 2011; Merle et al., 2022). However, only 44% practiced interdental care, and 41–49% used fluoride mouthwash, with fluoride gel use being even lower, with only 11% adherence (Gallagher et al., 2019; Kandelman et al., 2008). The literature also suggests that increased levels of cortisol and catecholamines induced by physical activity can worsen oral health, especially regarding periodontitis, with factors such as creatine kinase and IL-6 playing a negative role. (Solleveld et al., 2015; Olesov et al., 2021)

 

    These data underscore the importance of a more careful approach to athletes' oral health, considering potential complications arising from physical factors and stress. The main objective of this study is to assess the prevalence of pericoronitis in young handball athletes through an intraoral clinical examination. The secondary objective is to associate the prevalence of pericoronitis with a questionnaire administered to the athletes.

 

Materials and methods 

 

    The clinical examination was conducted by a single trained observer to minimize inter-examiner variability. The visual examination was performed under adequate natural light conditions, using a disposable wooden spatula to assist in the evaluation. The choice of the wooden spatula was based on its practicality and effectiveness in similar examination conditions, and natural lighting was sufficient to ensure proper visualization of the clinical aspects observed.

 

    The target population of this study consisted of professional handball players from the city of Campos dos Goytacazes (RJ), Brazil. Participants were recruited by sending individualized emails to each athlete, with contact information provided by the President of the Vikings Handebol Campos Club. This club, which has a total of 44 athletes, provided the basis for the sample size calculation. Using the statistical program OpenEpi, it was determined that a sample of 42 athletes would be sufficient to ensure a confidence level of 99% and a margin of error of 1% (p ≤ 0.05). Thus, the study included 42 athletes from the club, with the formal consent of the club's responsible party, confirmed by the signing of a Letter of Consent.

 

    The questionnaire administered to the athletes took approximately 5 minutes to complete, and the clinical examination lasted about 7 minutes, totaling an evaluation time of 12 minutes. The inclusion criteria for the study were a minimum age of 18 years. Athletes below this age or those participating in different sports modalities were excluded from the study.

 

    This research project was submitted to the Plataforma Brasil for approval and was authorized by the Research Ethics Committee (CAAE: 38575720.4.0000.5583). All participants were duly informed about the research objectives and provided written informed consent before participating in the study.

 

Results 

 

    A total of 44 athletes were evaluated, with a mean age of 22 years (SD: 2.1), all male, and all with completed high school education and ongoing higher education courses. The presence of pericoronitis was observed in 47.22% of the athletes, indicating the existence of infection in the pericoronal flap. Conversely, 52.78% did not present with this infection.

 

Source: Research data

 

    The majority of athletes assess their general health as "Excellent" (48.72%) or "Good" (38.46%), indicating a positive perception of their health status. Only 2.56% consider their health as "Poor," with no evaluations of "Very Poor," suggesting that the studied population is relatively healthy. Most athletes rate their general health care practices as "Excellent" (51.28%) or "Good" (38.46%). There are no reports of "Poor" or "Very Poor" care, indicating a general awareness and practice of health care among the athletes.

 

    In comparison, oral health is rated less favorably than general health, with only 30.77% evaluating it as "Excellent." The majority consider it "Good" (43.59%), but a significant number report it as "Fair" (23.08%), suggesting that there is a perception that oral health could be improved. While 42.50% believe they take "Excellent" care of their oral health, there is greater variation in responses compared to general health care. 22.50% rate their oral care as "Fair" and 2.50% as "Very Poor," indicating potential gaps in oral hygiene practices.

 

Question	Excellent	Good	Average	Fair	Very Poor
What do you think about your overall health?	48.72%	38.46%	10.26%	2.56%	0.00%
Would you say that the health of your mouth is:	30.77%	43.59%	23.08%	2.56%	0.00%
How much care do you think you have taken with your health in general?	51.28%	38.46%	10.26%	0.00%	0.00%
How much care do you think you have taken with the health of your mouth?	42.50%	32.50%	22.50%	0.00%	2.50%

Source: Research data

 

    Regarding the impact of their mouth, teeth, or gums on their quality of life over the past 12 months, the responses were as follows: 2.78% reported "Very Little" impact; 2.78% reported "Little" impact; 11.11% reported a "Moderate" impact; 16.67% reported a "Fair" impact, and 66.67% reported a "Significant" impact.

 

Source: Research data

 

    Regarding the impact of their mouth, teeth, or gums on their athletic performance or training over the past 12 months (such as experiencing tooth pain during training and competition) on a scale of 0 to 5. The results were as follows: 8.33% reported "Very Little" impact; 11.11% reported "Little" impact; 22.22% reported a "Moderate" impact; 27.78% reported a "Fair" impact, and 30.56% reported a "Significant" impact.

 

Source: Research data

 

Discussion 

 

    Sports dentistry has as one of its core principles the treatment and prevention of oral traumas and diseases associated with sports activities (Gonçalves et al., 2018; Nahmias et al., 2022), which can directly affect athletic performance. The oral cavity, serving as either a gateway or barrier to overall health, is crucial for individual well-being and, in the case of athletes, for athletic performance (Siqueira, 2005; Alves et al., 2017). Recent studies highlight that unfavorable oral conditions can lead to an increase in inflammatory markers such as TNF-α and IL-6, which are known to impair muscle recovery and increase the risk of injuries. (Gay-Escoda et al., 2011; Drew et al., 2023; Needleman et al., 2016; Olesov et al., 2021)

 

    The results of this study showed that 47.22% of the evaluated athletes presented pericoronitis, a significant percentage that requires attention as this condition can be debilitating. The prevalence of oral diseases, such as pericoronitis, aligns with data found in previous studies, such as Needleman et al. (2016), who reported a high prevalence of adverse oral conditions among Olympic athletes, highlighting the lack of attention to oral health in this population. Self-reported issues with wisdom teeth occur in 14–23% of elite athletes in Great Britain (Bryant et al., 2011; Needleman et al., 2016). Acute pericoronitis is found in 1–3% of these athletes (Bryant et al., 2011; Needleman et al., 2016). The recommendation for the removal of at least one wisdom tooth is 22% among Dutch candidates for the 2016 Olympic Games. (Kragt et al., 2019).

 

    Additionally, athletes’ perceptions of their general health were positive, with 87.18% rating it as "Excellent" or "Good". However, oral health was less valued, with only 30.77% considering it "Excellent," suggesting a disconnect between the perception of general health and oral health. This is concerning as inadequate oral health is associated with negative impacts on quality of life and performance, as evidenced by Kandelman et al. (2008), who highlighted the relationship between oral diseases and reduced quality of life and athletic performance.

 

    When asked about the impact of oral conditions on their lives, 66.67% of athletes reported that oral problems had a "Significant" impact on their quality of life over the past 12 months. This is consistent with the literature, where Solleveld et al. (2015) indicated that oral pain and discomfort can have a profound impact on athletes' quality of life, affecting both their well-being and performance. Moreover, 30.56% of athletes reported that oral problems had a "Significant" impact on their athletic performance, aligning with studies indicating that adverse oral conditions, such as caries and periodontitis, can lead to reduced physical performance due to pain, discomfort, and increased systemic inflammatory response. (Kandelman, 2008; Solleveld et al., 2015)

 

    The lack of awareness about the importance of oral health among high-performance athletes, as observed in this study, is also highlighted by Rodrigues (2005), who noted the low frequency of brushing and inadequate flossing among athletes, behaviors that contribute to the high prevalence of oral diseases. This lack of preventive care can, as indicated by Needleman et al. (2016), compromise not only oral health but also the longevity of the athletic career.

 

    Currently, most research in Sports Dentistry is focused on the use of mouthguards and their functions (Gonçalves et al., 2021; Gonçalves et al., 2024; Nassani et al., 2024; Bhadule et al., 2024; Ahmed et al., 2024; Gezer et al., 2024; Ntovas et al., 2024). Although it is a concept established by several authors, its use is low (Costa et al., 2023; Udayamalee et al., 2024; Acosta-Figueroa, & Sanches Alfaro 2024). In addition, in the present study, the findings highlight the need for greater awareness and preventive actions regarding oral health among athletes as well. The presence of dentists in training centers and competitions is crucial to ensure that athletes maintain a balance between oral and general health. (Needleman et al., 2016, Khan et al., 2022; Tokas et al., 2022; Biagi et al., 2024)

 

    With the data obtained in the research, it is possible to find a common denominator to carry out preventive measures and curative actions through the multidisciplinary team, to promote a decrease in the prevalence of injuries and increasingly increase the prevalence of dentists in health teams[.

 

Conclusion 

 

    The presence of pericoronitis is evidenced in the results from a group of young athletes with an average age of 21 years. The data suggest that although athletes generally perceive their general health positively, oral health requires greater attention. Implementing educational programs, improving access to dental care, and adopting a multidisciplinary approach are essential to promote oral health and, consequently, improve the quality of life and athletic performance of athletes.

 

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Lecturas: Educación Física y Deportes, Vol. 30, Núm. 323, Abr. (2025)