Oral Care Considerations for the Endurance Athlete

Thank you for your interest in Athladent — an oral care approach developed specifically for athletes. At first glance, the concept of a toothpaste designed for endurance athletes may seem unnecessary. However, when the unique physiologic and biochemical conditions of an athlete’s oral environment are examined, clear limitations of conventional toothpastes emerge. Athladent is not a “brush once and feel the effects” product; it is a long-term strategy aimed at preserving oral condition across years of high-volume training, so that athletes’ future selves benefit from the care they practice today.

The Athlete’s Oral Environment

Endurance athletes — most commonly cyclists, runners, and triathletes, but also cross-country skiers, rowers, and other ultra-endurance competitors — experience a distinct and cyclical oral environment. During prolonged training and competition, athletes frequently enter periods of hyposalivation (dry mouth), followed by a return to normal salivary flow post-exercise. This pattern differs from the chronically xerostomic patients typically encountered in clinical practice. These repeated dry-mouth intervals, combined with frequent carbohydrate intake (glucose, fructose, sucrose, maltodextrin in gels and sports drinks), create a sustained acidic challenge to the teeth. For example, common sports drinks often have pH values around 3–4 (far below the critical pH ~5.5 where enamel dissolves), and prolonged exposure to these acids favors dental erosion. The result is an increased prevalence of dental caries (cavities), erosive tooth wear, and dentinal hypersensitivity among high-volume athletes. Indeed, studies of elite athletes report dental caries rates ranging from 20% to 84%, and dental erosion in about 42–59% of athletes, far higher than in non-athlete populations.

Compounding these risks, endurance training is associated with systemic immune modulation. Intense exercise can elevate stress hormones and temporarily depress aspects of immune function. Clinically, this manifests as chronic gingival inflammation, delayed oral wound healing, and increased susceptibility to oral infections. For example, one study found that a 2-hour intense cycling session reduced saliva flow by ~39% and salivary IgA (an important immune protein) by ~19%, resulting in weaker saliva defenses and a higher risk of enamel erosion and oral pathology. It is not uncommon for endurance athletes to experience persistent gingival irritation or recurrent mouth ulcers during heavy training blocks. Additionally, reductions in baseline salivary IgA during periods of intense training have been correlated with increased upper respiratory tract infections in athletes, underlining the close connection between oral mucosal immunity and overall health.

Consumer Toothpaste Selection: A Mismatch for Athletes

When athletes select a toothpaste in a typical retail setting, decisions are often driven by cost, flavor, or whitening claims rather than biological compatibility. Many do not realize that highly abrasive or detergent-heavy formulations may exacerbate the very problems they are experiencing — accelerating enamel loss, increasing sensitivity, and prolonging soft-tissue inflammation. In the endurance athlete’s case, a toothpaste that might be fine for the average person could be counterproductive given the frequent acid attacks and dry mouth episodes they endure.

For dental providers treating endurance athletes, toothpaste selection should be approached as a therapeutic decision rather than a purely cosmetic one. In other words, the toothpaste becomes part of the preventive equipment for the athlete, much like sunscreen is for a marathoner or cycling shorts are for a cyclist. It should protect and complement the athlete’s unique oral environment, not just polish the teeth. Below are key formulation considerations when selecting (or formulating) a toothpaste for athletes.

Key Considerations for Selecting a Toothpaste for Athletes

Low Abrasivity to Protect Vulnerable Enamel – One of the most critical features for an athlete’s toothpaste is low abrasiveness. After an acid exposure (from, say, a sports drink or energy gel), enamel enters a transient demineralized, softened state. Saliva will gradually restore mineral content over the next 2–4 hours, but full re-hardening of enamel can take up to 24 hours. Brushing during this vulnerable window with a high-abrasive toothpaste significantly increases the risk of mechanically wearing away enamel. “Whitening” toothpastes, in particular, can be detrimental in this scenario — they often contain strong abrasives that strip the softened enamel, eventually exposing the underlying dentin. This effect is most pronounced in the cervical third of the tooth (near the gumline), where enamel is thinnest (often <1 mm) and where athletes commonly report sensitivity. A low Relative Dentin Abrasivity (RDA) toothpaste is therefore essential to minimize irreversible enamel wear during these repeated acid demineralization–remineralization cycles. By using a gentle polishing agent, the toothpaste can clean the teeth of stains and plaque without excessively eroding the enamel that an athlete works hard to preserve.
Gentle Formulation for Gum and Mucosal Comfort – Chronic inflammation is a well-documented consequence of sustained high training loads. Salivary biomarkers such as IgA, IL-6, IL-8 and other cytokines fluctuate in response to training stress, with reductions in mucosal immunity and prolonged healing times commonly observed. Clinically, athletes have an increased prevalence of periodontal inflammation (gingivitis), delayed gingival tissue repair, and frequent or recurrent aphthous ulcers (canker sores). Notably, heavy exercise has been linked to reduced salivary flow and protective factors, creating an oral environment prone to irritation. In this context, sodium lauryl sulfate (SLS) — a common foaming detergent in toothpaste — can exacerbate problems. As a surfactant, SLS disrupts lipid membranes and can irritate or slough the delicate oral mucosa, including newly forming gingival epithelial cells. In athletes who already experience delayed tissue repair, this additional insult can further prolong ulcer healing and inflammation. Studies have shown that switching to an SLS-free dentifrice significantly reduces the frequency, duration, and pain of recurrent mouth ulcers. For this reason, an SLS-free toothpaste is highly recommended for endurance athletes. A gentle, detergent-free formulation helps maintain periodontal and mucosal comfort, allowing soft tissues to recover normally between training sessions without chemical irritation.
Biomimetic Enamel Care with Nano-Hydroxyapatite – Enamel support is central to managing an athlete’s enamel over the long term. Fluoride is the traditional go-to ingredient for strengthening enamel and preventing caries. Instead of using fluoride, Athladent incorporates nano-hydroxyapatite (nHAp) as the functional ingredient. Nano-hydroxyapatite is a biocompatible form of calcium phosphate that closely resembles the natural mineral of human enamel (hydroxyapatite makes up ~97% of enamel by weight). By using this “biomimetic” ingredient, the formulation provides the building blocks of tooth mineral directly to the tooth surface. Unlike fluoride, which relies on saliva to facilitate remineralization (by forming fluorapatite crystals from available calcium/phosphate in saliva), nHAp does not depend solely on salivary chemistry. The nano-sized particles can diffuse into microscopic porosities in demineralized enamel, physically filling in tiny voids and integrating with the enamel structure. This helps to restore a smoother, more uniform surface to areas of the tooth that have been softened by acid. In essence, nHAp supplies a reservoir of calcium and phosphate right where it’s needed. This may be especially advantageous during exercise-induced dry mouth, when salivary mineral content and flow are low. By choosing a nHAp-rich formulation, athletes get enamel-friendly mineral support. (Note: While emerging studies are very promising regarding nHAp’s ability to improve enamel hardness and reduce sensitivity, Athladent as a cosmetic product does not claim to treat or prevent cavities. Instead, it leverages the science of nHAp to complement the mouth’s natural remineralization processes.)
Acid Buffering and Salivary Pellicle Preservation – Neutralizing acids is an important, though often overlooked, component of protecting enamel in an endurance context. Ingredients such as calcium carbonate can help buffer the oral pH, offsetting some of the acidity from frequent sports drink and gel use. Even a mild buffering effect can reduce the time that enamel spends in an acidic, demineralizing state. Equally important is the preservation of the acquired salivary pellicle (ASP) — the protein-rich film that naturally forms on tooth surfaces and serves as a protective barrier during periods of dryness. During long training sessions, the salivary pellicle is often the primary defense separating enamel from an otherwise harsh environment of acids and bacteria. Toothpastes with high abrasivity or harsh detergents can easily strip away this delicate layer with each brushing. Therefore, a formulation that minimizes pellicle disruption is ideal. Athladent’s approach is to use low-abrasion cleaners and no SLS, which together result in a low Pellicle Cleaning Ratio (PCR) — meaning the pellicle is left largely intact after brushing. Additionally, incorporating ingredients like calcium compounds or certain enzymes can support the pellicle’s integrity and even contribute beneficial ions (like calcium) to the oral environment. By protecting the acquired pellicle and buffering acids, the toothpaste helps maintain a balanced oral environment, so enamel spends less time under acid attack and more time in a neutral or remineralizing state.
Flavor, Mouthfeel, and Athlete Compliance – Even the most biologically optimized toothpaste can only benefit the athlete if it is used consistently. Thus, practical considerations of flavor and mouthfeel are key for compliance. Endurance athletes often brush early in the morning before training, and sometimes on-the-go during events or travel. A strong, burning mint flavor or lingering aftertaste can discourage thorough brushing or make the next meal/drink taste off. Athladent’s formulation uses a mild, palate-friendly flavor that is refreshing but not overpowering. The foam profile is low and gentle (thanks to being SLS-free), so there isn’t an urge to spit and rinse immediately. This encourages athletes to brush for the full two minutes and even allows a bit of residue to remain for prolonged effect. By not overwhelming the taste buds, athletes can brush before a workout without dread and without the toothpaste flavor spoiling their sports drink, energy bar, or coffee flavor during training or recovery. These seemingly small factors — pleasant taste, gentle foaming, and no flavor interference with food — meaningfully influence adherence to a regular oral hygiene routine. The goal is to make daily use feel natural and compatible with an athlete’s lifestyle, so that protective oral care becomes as habitual as the workouts themselves.

Conclusion

When the oral environment and lifestyle of endurance athletes are fully considered, it becomes clear that conventional toothpastes are often poorly suited to their needs. Athladent was developed with these specific challenges in mind — addressing prolonged acid exposure, transient dry mouth, enamel vulnerability, and real-world compliance issues. By aligning formulation science with the realities of endurance training, Athladent provides athletes with a sustainable, science-driven approach to long-term oral care. The aim is to help offset the unique dental challenges athletes face, keeping their teeth as strong and resilient as their commitment to training. Ultimately, the best oral care strategy for an endurance athlete is one that protects their smile for the miles ahead, so that their future selves can truly benefit from the care they practice today.

Sources:

Schulze, A., & Busse, M. Sports Diet and Oral Health in Athletes: A Comprehensive Review. Medicina 60(2):319 (2024) – High prevalence of caries (20–84%) and erosion (42–59%) in elite athletes; nutritional and salivary factors in athletes’ oral health.
UT Health San Antonio News (2023) – Research on “artificial enamel” nano-hydroxyapatite showing it composes ~97% of tooth enamel and can integrate into demineralized enamel.
Alli, B.Y. et al., J. Oral Pathol. Med. 48(5):358-364 (2019) – SLS-free vs. SLS toothpaste study, showing SLS-free significantly reduced frequency and duration of recurrent ulcers.