Nearly four out of 10 UK professional footballers have active tooth decay, while one in 20 has irreversible gum disease, finds a large representative study of players, published online in the British Journal of Sports Medicine.
This poor level of dental health is affecting performance and wellbeing, and the sport needs to tackle this head on as a matter of urgency, say the researchers.
There is mounting evidence to suggest that the dental health of professional/elite footballers is below average, but the impact on play has not been clear.
The researchers therefore assessed the prevalence of tooth and gum problems, and the impact on wellbeing and performance, among a representative sample of 187 professional footballers from eight clubs in England and Wales.
Five of the teams were in the Premier League; two were in the Championship; and one was in League One. The average age of the players was 24, but ranged from 18 to 39.
Six dentists comprehensively checked the tooth and gum health of every player - equivalent to more than 90% of each senior squad - and each footballer was asked about the impact of dental health on their personal and professional lives.
The check-ups revealed a high prevalence of poor dental health, most of which was preventable, despite the fact that almost three out of four players said they had had a dental check-up within the past year.
Nearly four out of 10 (37%) of the players had active tooth decay (dental caries), and dental erosion, in which the tooth structure is worn away by acid, was evident in over half (53%).
Nearly two thirds (64%) said they drank sports drinks at least three times a week, although the researchers point out that the association between sports drinks and dental erosion "remains unclear."
Eight out of 10 players also had gum disease (gingivitis); in one in 20 (5%) this was moderate to severe - and irreversible. Half the mouth was affected by gum disease in three out of four players.
Around one in six (16%) reported current pain in their mouth or teeth, while around one in four (27%) experienced dental sensitivity to hot or cold food/drink.
The footballers said that the state of their mouths did affect them. Poor tooth and gum health "bothered" almost half (45%) of them, and one in five (20%) said it undermined their quality of life. Around 7% said that it adversely affected their performance or training.
"This study provides the most reliable evidence that oral health within professional football is poor, and is consistent with research conducted in Brazil, Spain, and the USA," write the researchers. And the level of poor dental health uncovered by the study is likely to add up to a substantial need for current and future treatment, they warn.
They call for regular dental screening to be a part of routine medical care in professional football, together with an increased emphasis on simple effective preventive approaches to help athletes look after their teeth and gums.
"Successful strategies to promote oral health within professional football are urgently needed," they emphasise. "This study provides strong evidence to support oral health screening within professional football," they add.