Background Previous research indicates that poor oral health is common in elite athletes and is associated with negative self-reported impacts on wellbeing, training and performance. However the strength of evidence is limited.

Objective We aimed to conduct a methodologically robust study of oral health, the determinants of oral health and associated self-reported impacts across different sports using a trained and calibrated examiner and validated outcome measures.

Design Cross-sectional observational clinical and questionnaire study of representative samples of elite (Olympic and professional) athletes.

Setting Athlete medical and training facilities.

Participants 300 UK athletes aged 18 years and over, on podium placement/potential programmes or participating as professional athletes.

Interventions (or Assessment of Risk Factors) We measured dental caries, erosion, periodontal health, wisdom teeth infections, self-reported oro-facial trauma, oral health preventive and risk behaviours and potential for behaviour change.

Main Outcome Measurements We used validated clinical indices for caries, erosion and periodontal health. Self-reported impact on athlete performance was measured using a modification of the OSTRC overuse injury questionnaire.

Results One third (33%) of athletes had caries into dentine and 35% had erosion with dentine exposed in at least one tooth. One quarter (24%) had chronic inflammatory periodontitis, however only 6% reported oro-facial trauma related to their sport. Many athletes (49%-83%) reported consumption of sports drinks, bars and gels during training and competition. Most (96%) athletes reported good oral hygiene habits. One third (34%) reported a negative impact on performance.

Conclusions UK elite athletes have significant levels of oral disease with one third reporting a negative impact. Despite most athletes reporting beneficial oral health behaviours, additional health promotion and preventive measures are required to mitigate risk factors and reduce self-reported performance impacts.