Background Poor oral health of elite athletes is associated with negative performance impacts. There is a need for oral health promotion and prevention strategies that are effective within the elite sport environment

Objective To develop, implement and evaluate a pragmatic oral health promotion intervention based on contemporary behaviour change theory and informed by input from all stakeholders in elite sport.

Design Interrupted time-series intervention study.

Setting Three separate UK elite athlete-training centres.

Patients (or Participants) 62 athletes from two Olympic and one professional athlete training squads; 55 athletes completed the study.

Interventions (or Assessment of Risk Factors) Two levels: Level 1. Athletes and support team viewed combined one 10-minute presentation focussed on building motivation and three 90-second information films. Level 2. Athletes alone received oral health screening, personalised advice and an oral health toolkit focussed on opportunity and capability. Follow-up of athletes at one and three months.

Main Outcome Measurements Impact on performance (OSTRC questionnaire), oral health knowledge (8-item questionnaire), gingival inflammation, self-reported oral health problems and oral hygiene routines.

Results At baseline, 41 (66.1%) athletes had evidence of caries, 29 (46.8%) evidence of erosion, mean bleeding score was 11.57 (8.11), 44 (71%) were male and 58 (93.5%) white British. Mean OSTRC score reduced from 8.73 (14.54) to 2.73 (11.31) p<0.001. Mean knowledge score improved from 5.69 (1.59) to 6.93 (1.32) p<0.001. Gingival bleeding score was unchanged. Self-reported oral health problems reduced. Athlete use of prescription fluoride toothpaste (2800 ppm) increased from 8 (12.9%) to 45 (80.4%, p<0.001).

Conclusions This behaviour change theory-based intervention was implemented within different elite sport environments. It was associated with a reduction in self-reported performance impacts, an increase in athlete oral health knowledge and enhanced oral health behaviour.