ABSTRACT
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The effect of sw im m ing on oral healt h st at us:
com pet it ive versus non- com pet it ive at hlet es
Simonetta D’ERCOLE, Marco TIERI, Diego MARTINELLI, Domenico TRIPODI
Department of Medical, Oral, and Biotechnological Sciences, University “G. D’Annunzio” of Chieti-Pescara, Chieti, Italy
Corresponding Address: Simonetta D’Ercole - University “G. d’Annunzio” Chieti- Pescara - Via dei Vestini - 31 66100 - Chieti - Italy - Phone +3908713554809 - Fax +3908713554392 - e-mail: simonetta.dercole@virgilio.it
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oung sw im m ers are part icularly suscept ible t o t he onset of oral diseases. Obj ect ive: Toevaluat e t he oral healt h st at us in young com pet it ive and non- com pet it ive sw im m ers, inv olv in g an assessm en t of saliv ar y car iogen ic bact er ia an d secr et or y I gA ( S- I gA) concent rat ion. Mat erial and Met hods: Before t raining sessions ( T1) , 54 com pet it ive and 69 non- com pet it ive swim m ers had t he following param et ers assessed: decayed, m issing, and
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sessions ( T2) , st im ulat ed saliva was collect ed and m icr obiological and im m unological analyses were perform ed. Result s: Com pet it ive swim m ers t rained 2.02± 0.09 hours 5 t im es a week, while non- com pet it ive swim m ers t rained 2.03± 0.18 hours a week. A t ot al of 14.7% of com pet it ive sw im m ers suffered dent al t raum a relat ed t o sport s. Only 11.76% of t he
FRPSHWLWLYHVZLPPHUVWRRNDGDLO\GRVHRIÀXRULGHDJDLQVWRIQRQFRPSHWLWLYH
sw im m ers ( p= 0.029) . Neit her group follow ed an est ablished diet or present ed st at ist ically
VLJQL¿FDQWGLIIHUHQFHVLQWHUPVRIQXWULWLRQDOVXSSOHPHQWGULQNDQGFKRFRODWHLQWDNH7KHUH ZHUHVWDWLVWLFDOO\VLJQL¿FDQWGLIIHUHQFHVLQWHUPVRIRUDOK\JLHQH1RVLJQL¿FDQWGLIIHUHQFH LQFOLQLFDOLQGH[HV'0)73O,DQG*,ZDVSUHVHQWS. m ut ans was harbored by 18.6%
of com pet it ive and t he 32.2% of non- com pet it ive sw im m ers. S. sobrinus was det ect ed in
22.03% of com pet it ive and 91.6% of non- com pet it ive sw im m ers ( p< 0.05) . S. sanguinis
was found only in t he saliva of com pet it ive sw im m ers. The average S- I gA of com pet it ive
VZLPPHUVGHFUHDVHGVLJQL¿FDQWO\DW7S7KHSRROZDWHUKDGDGDLO\DYHUDJHS+
of 7.22. Conclusions: Microbial m arkers, im m une st at us and sport ing charact erist ics are im port ant for est ablishing guidelines for m anagem ent of t raining load in order t o m inim ize physical st ress and t he risk of oral infect ion.
Ke y w or ds: Car iogenic m icr oor ganism . S- I gA. Oral disease. Saliva. Sw im m ing. Spor t dent ist ry.
I N TROD UCTI ON
High per for m ance st andar ds ar e r equir ed for at hlet es, especially for sw im m er s, w ho m ust be t ot ally healt hy individuals. Dent al diseases harm qualit y of life and have a negat ive im pact on self-est eem , eat ing abilit y, and healt h, causing pain, an x i et y, an d i m p ai r ed so ci al f u n ct i o n i n g4 , 1 1 , 1 8 .
Relat iv ely lit t le in f or m at ion is av ailable on t h e correlat ion bet w een t he perform ance of sw im m ing at a com pet it ive level and t oot h decay occurrence14.
Dent al car ies is a lifet im e disease t hat depends on biological fact ors present w it hin t he saliva and dent al plaque. Dent al plaque favors t he em ergence
of m u t an s st r ept ococci an d Lact obacillu s spp., w hich ar e capable of rapidly fer m ent ing diet ar y carbohydrat es and low ering t he pH t o t he ext ent WKDWVLJQL¿FDQWDPRXQWVRIWRRWKGHPLQHUDOL]DWLRQ can occur12,22,23. The concent rat ion of car iogenic
bact eria levels w it hin saliva and plaque det erm ine if caries w ill occur24.
a n d a ct s b y p r ev en t i n g m i cr o b i a l p a t h o g en s f r om en t er in g t h e b od y v ia m u cosal su r f aces, w hich are m ainly responsible for infect ions of t he upper r espirat or y t ract27,28. Several st udies have
dem onst rat ed t hat pract icing differ ent spor t s, in part icular sw im m ing, at a com pet it ive level, leads t o a decrease in S- I gA levels associat ed w it h an in cr eased in cid en ce of u p p er r esp ir at or y t r act infect ions in professional at hlet es9,21,24,28,29.
The purpose of t he present st udy was t o evaluat e t he oral healt h of hard and soft t issues and t he prevalence of caries in young select ed com pet it ive an d n on - com p et it iv e sw im m er s, b y assessin g salivary cariogenic bact eria and concent rat ion of salivary I gA, bot h before and aft er t raining sessions. An addit ional obj ect ive was t o m onit or t he wat er pH of t he sw im m ing pool during t he day t o assess it s pot ent ial role in erosion.
M ATERI AL AN D M ETH OD S
St u dy popu la t ion
The st udy populat ion w as com posed of 1 2 3 subj ect s: 54 com pet it ive sw im m ers ( t est group) and 69 non- com pet it ive swim m ers ( cont rol group) , 58 fem ales and 65 m ales. There was no difference bet w een t est and cont rol group w it h respect t o age ( Table 1) . The swim m ers ( t est and cont rol) at t ended t he swim m ing pools of Chiet i and Francavilla al Mare ( CH) ( I t aly) w it h different t raining am ount s of t im e ( com pet it ive: 2.02± 0.09 hours 5 days a week; non-com pet it ive: 2.03± 0.18 hours one day a w eek) . All at hlet es st ar t ed sw im m ing four year s befor e ( 4.17± 0.27) . We discovered t hat t he com pet it ive sw im m ers t rained for t he sam e am ount of hours in t he swim m ing pools because t he I t alian com pet it ion rules, edit ed by t he Sw im m ing I t alian Federat ion ( FI N) , divide t he at hlet es by age and t he ones in t he sam e cat egory have an ident ical t raining program . 7KLV LV FRQ¿UPHG E\ WKH IDFW WKDW DOO DWKOHWHV belong t o t he sam e Societ y and t hus t hey have t he sam e t rainers. The non- com pet it ive sw im m ers w ere volunt arily enrolled in t he st udy but had t o m eet som e param et er s ( t raining for four year s, not belonging t o a Sport Societ y, and not having a planned t raining pr ogram ) . Par ent al infor m ed consent was obt ained for all pat ient s before t hey w ere exam ined ( Privacy Law DL 196/ 2003) . The select ed subj ect s par t icipat ed volunt ar ily in t he st udy. I n t his st udy, t he approval from t he Et hics
Com m it t ee was not r equir ed since t he r esear ch prot ocol was based on a clinical prot ocol previously approved by t he Depart m ent for m edical use.
The following inclusion crit eria were considered: Absence of syst em ic diseases t hat could affect t h e im m u n e r esp on se or t h at cou ld con d it ion bact erial colonizat ion.
No use of ant ibiot ics for t hree m ont hs prior t o t he beginning of t he st udy.
No ort hodont ic t herapy
.
Dent al care not in progress.
A self- adm in ist er ed qu est ion n air e w as u sed t o obt ain dat a concer ning hour s and fr equency of w eekly t raining, com plet e pat hological hist ory, hist ory of hard and soft t issues of t he oral cavit y, f am ily h ist or y, or al hy gien e pr act ices, f lu or ide int ake, and eat ing habit s ( supplem ent s consum ed and diet ary inform at ion such as int ake of drinks, fruit j uices, and consum pt ion of chocolat es) .
Clin ica l m on it or in g a n d sa liva colle ct ion Bef or e t r ain in g session s ( T1 ) , each p at ien t was clinically evaluat ed. The num ber of decayed, PLVVLQJDQG¿OOHGWHHWK'0)7ZDVUHFRUGHGWR assess t he prevalence of caries according t o World Healt h Organizat ion ( WHO) crit eria. The Silness &
Löe Plaque I ndex ( PlI ) and t he Löe & Silness*LQJLYDO ,QGH[*,ZHUHXVHGWRHYDOXDWHRUDOK\JLHQHDQG periodont al st at us, respect ively.
I n addit ion, an oral ex am inat ion of int raoral m ucosa was perform ed and t he presence/ absence of bad habit s, m alocclusion, and parafunct ional habit s was assessed.
Befor e ( T1) and aft er t raining sessions ( T2) , s a l i v a w a s c o l l e c t e d w i t h p a r a f f i n - c h e w i n g st im ulat ion. The saliva sam ples w ere im m ediat ely placed on ice and t ransferred t o t he laborat ories for SURFHVVLQJ$QDOLTXRWRINjOIURPHDFKVDPSOH was t ransferred t o a m icrocent rifuge t ube and used for m icrobiological analysis. The rem ainder of t he VDPSOHZDVSODFHGLQDQHSSHQGRUIWXEHFODUL¿HG by cent rifugat ion at 10,000 Xg for 15 m in at 4° C and frozen at - 20° C for t he t it rat ion of salivary I gA.
D N A e x t r a ct ion fr om sa liva sa m ple s
Th e p r e se n ce o f t h r e e o r a l st r e p t o co cca l sp ecies (St r ep t ococcu s m u t an s, St r ep t ococcu s sobr inus, and St r ept ococcus sanguinis) in each saliva specim en was analysed by PCR. S. m ut ans
ATCC3 1 3 8 3 , S. so b r i n u s ATCC2 7 6 0 7 , a n d S.
Total number Male Female Mean age Training table
Competitive swimmers 54 28 26 12.5±3.29 2.02±0.09 hours x 5 times/ week
Non-competitive swimmers
69 37 32 9.85±3 2.03±0.18 hours/week
sanguinis 49297 w ere used as cont rol species. The VHTXHQFHVRIVSHFLHVVSHFL¿FVHWVRIWKHSULPHUV used in t his st udy ar e list ed in Table 2 . Saliva sam ples w ere st ored at - 20° C unt il DNA ext ract ion ( 2 4 - 4 8 h lat er ) . Vor t ex ed saliva sam ples w er e cent rifuged for 15 m in at 14000 rpm . Next , t he super nat ant s w er e discar ded and indiv idual cell pellet s w ere st ored at - 20° C unt il DNA isolat ion, IRUZKLFKWKHSHOOHWVZHUHUHVXVSHQGHGLQNjO lit hic solut ion ( 50 m M Tris, 10 m M EDTA, 10% SDS) , t reat ed wit h lysozym e ( 5 m g/ m l) and incubat ed for 1 h at 37° C. Prot einase K was added and incubat ed for 1 h at 65° C, DNA was ext ract ed according t o t he phenol: chloroform : isoam yl alcohol m et hod. Nucleic acids were precipit at ed in alcohol, washed wit h 70% ( vol/ vol) alcohol, and suspended in double- dist illed wat er t o creat e t he DNA t em plat e.
Polym e r a se ch a in r e a ct ion
Negat ive cont rols ( no DNA) and posit ive cont rols w it h DNA com ing from pure bact erial cult ures w ere WHVWHG $PSOL¿FDWLRQ ZDV SHUIRUPHG LQ NjO react ion, cont aining 10 m M Tris- HCl, pH 8.0, 50 m M .&O[3&5%XIIHUP00J&ONj0RIHDFK nucleot ide, 30 m l of each prim er, 2.5 U Hot St art Taq DNA Polym erase ( Quiagen S.P.A. Milan I t aly) DQGNjORI'1$7HPSODWH7KHUHDFWLRQPL[WXUHZDV denat ured at 95° C for 3 m in, follow ed by 30 cycles of denat urat ion at 98° C for 30 sec, annealing at 70° C for 30 sec, and ext ension at 72° C for 1 m in. The react ions w ere conduct ed in a t herm ocycler iCyclar Syst em ( Bio- Rad Laborat ories srl, Segrat e, ,WDO\ $PSOL¿FDWLRQ RI XELTXLWRXV SULPHUV ZDV conduct ed in t he sam e way. Elect rophoret ic bands w ere visualized and phot ographed w it h a UV rays t r an sillu m in at or ( gel Doc 2 0 0 0 , Bio- Rad) af t er VWDLQLQJIRU¶ZLWKHWKLGLXPEURPLGHNjJPO The sizes of t he PCR product s w ere est im at ed from t he elect rophoret ic m igrat ion of product s relat ive t o a 100- base- ladder m arker ( Am ersham Pharm acia Biot ech, AB, Uppsala, Sweden) .
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The t it rat ion of salivary I gA was perform ed by using LC- ex am inat ion Par t igen im m unodiffusion 'DGH%HKULQJ0DUEXUJ*PE+*HUPDQ\
Sw im m in g pool w a t e r colle ct ion
Sam ples of sw im m ing pool wat er ( 10 m l) w ere also collect ed in t est t ubes at r egular int er vals t hroughout t he day and sent t o t he laborat ory for pH evaluat ion. pH values w ere analyzed by a pHm et er (OHWWURIRU6FLHQWL¿F,QVWUXPHQWV%RUVHD,WDO\
St a t ist ica l a n a lysis
The Wilkoxon m at ched- pairs signed- rank t est was used for t he st at ist ical analysis. All p- values ORZHUWKDQZHUHFRQVLGHUHGVLJQL¿FDQW
RESULTS
The dem ographic and clinical charact er ist ics of t he st udied populat ions are present ed in Table 1 and Table 3. The com pet it ive sw im m ers t rained 2.02± 0.09 hour s 5 t im es a w eek and t he non-com pet it ive sw im m ers 2.03± 0.18 hours a w eek. Age and gender w ere sim ilar in t he t w o groups. While 14.7% of com pet it ive swim m ers had suffered dent al t raum a r elat ed t o spor t s, t her e w er e no cases in t he cont r ol gr oup. Only 11.76% of t he FRPSHWLWLYHVZLPPHUVWRRNDGDLO\GRVHRIÀXRULGH against 32.65% of non- com pet it ive swim m ers, wit h DVWDWLVWLFDOO\VLJQL¿FDQWGLIIHUHQFH
Dat a concerning t he diet ary habit s show ed t hat neit her group follow ed an est ablished diet and t hat t heir nut rit ional supplem ent drink and chocolat e LQWDNHVZHUHVLJQL¿FDQWO\GLIIHUHQWS
6WDWLVWLFDOO\VLJQL¿FDQWGLIIHUHQFHVLQRUDOKDELWV bet w een t he t w o groups w ere observed. The m ost frequent ly report ed by t he st udy populat ion w ere nail bit ing, sleep bruxism , and at ypical swallow ing. 7KHDQDO\]HGFOLQLFDOLQGH[HV'0)73O,*,GLG QRWSUHVHQWVWDWLVWLFDOO\VLJQL¿FDQWGLIIHUHQFHV7DEOH 4) . I t is not ew ort hy t hat 94.12% of com pet it ive sw im m ers present ed values of PlI low er t han 1.5
Bacterial species 3ULPHUSDLUV¶¶ $PSOL¿FDWLRQ
length
Reference
S. mutans 5’- GGC ACC ACA ACA TTG GGA AGC TCA GTT 433 bp 17
5’- GGA ATG GCC GCT AAG TCA ACA GGA T
S. sobrinus 5’- GAT GAT TTG GCT CAG GAT CAA TCC TC 328 bp 17
5’-ACT GAG CCA GTA GTA GAC TTG GCA ACT
S. sanguinis 5’- GGA TAG TGG CTC AGG GCA GCC AGT T 313 bp 17
5’-GAA CAG TTG CTG GAC TTG CTT GTC
Ubiquitous primer 5’-GAT TAG ATA CCC TGG TAG TCC AC 602 bp 7
5’-CCC GGG AAC GTA TTC ACC G
against 77.55% of t he non- com pet it ive sw im m ers, DVWDWLVWLFDOO\VLJQL¿FDQWGLIIHUHQFH7DEOH
As show n in Table 6, 18.64% of com pet it ive and 32.2% of non- com pet it ive swim m ers harbored
S. m ut ans in t heir saliva. S. sobrinus was present
in 22.03% of com pet it ive sw im m ers and 91.6% of non- com pet it ive sw im m ers, w it h a st at ist ically VLJQL¿FDQWGLIIHUHQFHEHWZHHQWKHWZRJURXSV2Q t he ot her hand, S.sanguinis was det erm ined only in t he saliva sam ple of t he com pet it ive sw im m ers.
Competitive swimmers Non-competitive swimmers
Dental stains 11.76 2.04
Dental erosion 2 1
Dental trauma 14.7 0
Oral habits 2.94§ 28.57§
P = 0.003 S
Aphthae 8,8 16.3
Decay presence 38.24 42.86
Fluoride intake 11.76§ 32.65§
P = 0.029 S
Chocolate intake 20.59§ 59.18§
P = 0.000 S
Sport drinks intake 84.62§ 15.38§
P = 0.000 S
Fruit intake 17.65 8.16
Dental anomalies 44.12 59.18
6WDWLVWLFDOVLJQL¿FDQFHRIWKHGLIIHUHQFHVEHWZHHQWKHJURXSVS
7DEOH Prevalence (%) of clinical characteristics and eating habits between genders
Competitive swimmers Non-competitive swimmers
Plaque Index (PlI) 94.12%* 77.55%*
Gingival Index (GI) 8.82% 20.41%
6WDWLVWLFDOVLJQL¿FDQFHRIWKHGLIIHUHQFHVEHWZHHQWKHJURXSVS Table 5- Clinical indexes in the studied population
Competitive swimmers Non-competitive swimmers
S. mutans 18.64 32.2
S. sobrinus 22.03 91.6 †
S. sanguinis 10.16 0
6WDWLVWLFDOVLJQL¿FDQFHRIWKHGLIIHUHQFHVEHWZHHQWKHJURXSVRUWLPHH[DPLQDWLRQVS
Table 6- Percentage (%) of saliva samples from the studied population with presence of the main microorganisms examined (pre- and post-training)
Competitive swimmers Non-competitive swimmers
DMFT 0.0822187±0.1014739 0.10857±0.12798
Plaque Index (PlI) 0.607±0.539 0.7476±0.7189
Gingival Index (GI) 0.0493±0.186 0.0611±0.121
Table 4- Clinical parameters of the experimental groups at baseline
No difference was not ed bet w een pre and post -t raining sam ples.
Com pet it ive sw im m er s show ed a st at ist ically VLJQL¿FDQW GHFUHDVH RI WKH DYHUDJH YDOXH LQ WKH t it rat ion of S- I gA ( Table 7) . The average values of WKHFRPSHWLWLYHVZLPPHUVZHUHVLJQL¿FDQWO\KLJKHU t han of t he non- com pet it ive sw im m ers.
The wat ers sam ples from t he pools had a daily average pH value of 7.22 and bot h swim m ing pools followed hygiene recom m endat ions, which included a double daily pH r egist er, daily assessm ent of ant im icrobial concent rat ion in t he wat er, quant it y RI SXUL¿HG DQG UHQHZHG ZDWHU DQG ZDWHU DQG environm ent al t em perat ures.
D I SCUSSI ON
The exercise involved in rout ine sport pract ice exposes at hlet es t o t he onset of num erous diseases. A n u m b er o f f a ct o r s, i n cl u d i n g t h e l ev el s o f com pet it ion and of exposure, can affect t he higher or lower incidence. For t his reason t he present st udy considered t w o groups of sw im m ers at t ending t he sam e environm ent ( sam e pools) and sam e years of pract ice ( 4.17± 0.27) , but w it h different t raining loads. Result s from t his st udy indicat ed t hat at hlet es engaged in sw im m ing at a com pet it ive level, w it h m ore hours of t raining in pool wat er, had a higher in ciden ce of den t al st ain s an d t r au m a. Den t al inj uries associat ed wit h various t ypes of sport s have oft en been described in lit erat ure6,10,19,30.
The incidence of dent al st ains was higher in com pet it ive swim m ers com pared t o non-com pet it ive ones. Alt hough t he difference was not st at ist ically VLJQL¿FDQWLWFDQEHFDXVHGDVFODLPHGE\(VFDUWLQ et al.11 ( 2000) , by t he chem ical used t o disinfect
t he pool wat er in bot h sw im m ing pools analyzed and by t he t im e spent inside sw im m ing pools and SHUIRUPLQJVXI¿FLHQWO\YLJRURXVSK\VLFDOH[HUFLVHLQ order t o perm it cont act bet w een wat er and dent al surfaces. I n t his st udy, t he am ount of t raining t im e of t he com pet it ive sw im m ers ( 2.02± 0.09 hours 5 t im es a w eek) falls under t he condit ion m ent ioned by Escart in, et al11( 2000)of m ore t han 6 hours of
t raining per week as t he t im e necessary t o increase t he risk of dent al st ains. Alt hough t he values are m uch low er t han t hose r epor t ed by Escar t inet , al11( 2000) ( pr evalence of Dent al St ains ( DS) of
60.2% in t he sw im m ers) , it is possible t o st at e t hat com pet it ive swim m ers had a high risk of developing ext rinsic dent al st ains.
Com pet it ive sw im m ers had a low prevalence of parafunct ional behaviors. The m ost frequent oral habit s report ed by non- com pet it ive swim m ers were nail bit ing, sleep bruxism , and at ypical swallow ing, wit h an incidence sim ilar t o t hose report ed in young adolescent s in t he lit erat ure15.
Dat a con cer n in g t h e d iet ar y h ab it s sh ow ed t hat in bot h gr oups, because of t he age of t he VDPSOHQRRQHIROORZHGDVSHFL¿FGLHWIRUWUDLQLQJ or com pet it ions. I nt ake of nut rit ional supplem ent GULQNVE\FRPSHWLWLYHVZLPPHUVZDVVLJQL¿FDQWO\ different from non- com pet it ive sw im m ers. Dent al erosion is a furt her pot ent ial problem associat ed w it h sp or t s d r in k s1 , 5 , 1 4. Th is st u d y sh ow ed n o
pot ent ial problem s relat ed t o t he consum pt ion of t hese beverages, as dem onst rat ed by low dent al erosion frequency.
Som e aut hors believe t hat if t he pH of t he wat er in t he pool decreases below t hat of saliva, erosions on t he dent al enam el m ay occur3,18. I n t his st udy,
t he wat ers of t he pools show ed a daily pH of 7.2, t hereby m eet ing t he required pH values ranging from 7.20 t o 9.0 and having lit t le or no effect on swim m ers in relat ion t o t he developm ent of erosions ( 2% vs 1% ) .
I n t h i s st u d y, a f t er t r a i n i n g , t h er e w a s a VWDWLVWLFDOO\VLJQL¿FDQWGHFUHDVHLQWKHFRQFHQWUDWLRQ of salivary I gA levels of select ed sw im m ers. S- I gA av er age v alu es bef or e an d af t er t r ain in g w er e VLJQL¿FDQWO\ KLJKHU LQ FRPSHWLWLYH DWKOHWHV WKDQ in non- com pet it ive sw im m ers. The result s of t his VWXG\FRQ¿UPHGWKHPDMRULW\RIVWXGLHVLQWKDWDFXWH bout s of exercise reduced S- I gA levels in a variet y of endurance sport s, including sw im m ing7,8,16,25,28.
These result s cont rast ed w it h som e aut hors w ho indicat ed t hat t here are no differences in salivary con cen t r at ion s of S- I g A b et w een at h let es an d non- at hlet es, except w hen at hlet es are engaged in heavy t raining13,25. Several st udies dem onst rat ed
t hat S- I gA concent rat ion changes and in part icular an absolut e concent rat ion of less t han 40 m g/ L was report ed t o relat e t o increased Upper Respirat ory Tr act I n f ect ion ( URTI ) in cid en ce in at h let es2 8.
Therefore, since S- I gA act s as a m arker of m ucosal im m unit y, t his st udy show ed t hat it s decline could
S-IgA Pre-training S-IgA Post- training
Competitive swimmers 0.091087±0.2218976 0.0443333±0.0167551*
Non-competitive swimmers 0.035087±0.0049992** 0.0347826±0.0044206**
6WDWLVWLFDOVLJQL¿FDQFHRIWKHGLIIHUHQFHVEHWZHHQWKHJURXSVRUWLPHH[DPLQDWLRQV3
* vs pre-training ** vs competitive
be associat ed wit h a decrease in host defenses, and VSHFL¿FDOO\ RI WKH PRXWK ZLWK SRVVLEOH QHJDWLYH consequences on healt h st at us.
The m icrobiological analysis show ed t hat only 1 8 . 3 6 % an d 2 2 . 0 3 % of com pet it iv e sw im m er s h ar b or ed S. m u t an s an d S. sob r in u s in t h eir saliv a, r espect iv ely. On t h e ot h er h an d, t h ese bact er ia w er e det ect ed in 32.2% and 91.6% of non- com pet it ive swim m ers. Moreover, S. sanguinis
was det erm ined only in t he saliva sam ple of t he com pet it iv e sw im m er s. Mut ans st r ept ococci (S. m ut ans and S. sobr inus) ar e closely associat ed w it h t he developm ent of dent al caries in hum ans.
S. sanguinisZDVVLJQL¿FDQWO\DVVRFLDWHGZLWKGHQWDO
KHDOWKDQGWKHUHVXOWVRIWKLVVWXG\FRQ¿UPHGWKDW
S. sanguinis has been report ed t o be in relat ively high num ber s w hen t he num ber s of S. m ut ans
ar e low, as r epor t ed in com pet it iv e sw im m er s. Moreover, in com pet it ive sw im m ers t he presence of high num bers of S. sanguinis was associat ed w it h low car ies r isk , as suggest ed by Seow, et al.26 ( 2009) . A high percent age of non- com pet it ive
sw im m ers harbored cariogenic bact eria and t heir grow t h is favored by eat ing habit s such as a large int ake of chocolat e.
Therefore, t he result s suggest ed t hat t he t im e of t raining w as t he per iod charact er ized by t he least int ensive salivary funct ions and physiologic responses as a decrease in t he salivary level of I gA. Sw im m ing at com pet it ive levels det erm ined higher S- I gA average values, bot h before and aft er t raining, t han for non- com pet it ive sw im m er s. A low num ber of com pet it iv e sw im m er s har bor ed car iog en ic m icr oor g an ism s in t h eir saliv a; on t he cont rary, t hey show ed a higher frequency of “ pr ot ect ive” bact er ia as S. sanguinis, associat ed ZLWKORZFDULHVULVNDVFRQ¿UPHGE\ORZHUYDOXHV of act ive car ies. Several st udies2,20 r epor t ed t hat
t he oral healt h of t hose w ho pract ice t he sport at a com pet it ive level was harm ed, wit h a high incidence of oral problem s such as caries, t raum a, et c. The difference from t he result s of t his st udy was t he age of t he exam ined subj ect s, proving it is crucial t o avoid t he problem s described in t he lit erat ure by im plem ent ing a prevent ion program .
CON CLUSI ON S
7KLV VWXG\ FRQ¿UPV WKH XVHIXOQHVV RI XVLQJ m i c r o b i a l r i s k m a r k e r s , i n c l u d i n g m u t a n s st r ep t ococci. Non - m icr ob ial car ies r isk f act or s included visible plaque, child age, race, salivar y and pool wat er pH, and eat ing habit s. Furt herm ore, m ucosal im m une st at us and sport charact erist ics ( int ensit y, durat ion and frequency of t raining) are consider ed useful for est ablishing guidelines for nut r it ional suppor t and m anagem ent of t raining load. I n t his way, it w ould be possible t o m inim ize
physical st ress and subsequent ly t he risk for oral infect ion.
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