Category: Scientific publication

The Mouths of Elite Footballers: What Screening 70 Asian Cup Football Players Told Us About Oral Health

When we talk about the health of elite athletes, the mouth is one of the last places most people look. Yet oral health sits surprisingly close to the things we care about in high-performance sport: pain and infection that disrupt sleep and training, systemic inflammation, nutritional habits, and simple day-to-day quality of life. The evidence base in elite football, and in Asian football in particular, has been thin. So together with the Sports Dentistry department at Aspetar we set out to add some hard numbers.

Our study, just published in Research in Sports Medicine, screened the oral health of professional players competing at the AFC Asian Cup held in Qatar in January and February 2023. It is, as far as we are aware, one of the first structured looks at the dental status of elite footballers in this region.

What we did

This was a cross-sectional clinical study. Three dentists carried out standardized examinations on 70 randomly selected players (mean age 26.8 years), using established indices — DMFT for dental caries, BPE for periodontal health, and BEWE for erosive tooth wear — alongside assessment of wisdom-teeth status, dental trauma, and temporomandibular joint (TMJ) function. Using calibrated examiners and validated indices matters here: it means the numbers can be compared against other populations and tracked over time, rather than being one clinician’s impression.

The main results

SPORTS DENTISTRY · ASPETAR

Oral health of elite footballers

70 players screened at the AFC Asian Cup, Qatar 2023 · cross-sectional study using the DMFT, BPE and BEWE indices · mean age 26.8 years

85.7%

had dental caries — mean DMFT 5.6; 77.1% had restorations

88.6%

showed tooth erosion — 10% classified as high risk

82.9%

had gingivitis — 12.9% with signs of periodontitis

30%

sports-related dental trauma — history of injury to teeth or mouth

38.6%

partially erupted wisdom teeth — pericoronitis in 7.1%

21.4%

TMJ disorders — temporomandibular joint dysfunction

A substantial, largely silent oral-disease burden — the case for routine dental screening within athlete health programmes.

Alsaey, Almasri, Tabben, Cardinale et al., Research in Sports Medicine 2025 · DOI 10.1080/15438627.2025.2599859

What the numbers tell us

The headline is the sheer prevalence. Dental caries were present in 85.7% of players, with a mean DMFT of 5.6, and more than three-quarters already carried restorations. Erosive tooth wear was even more common at 88.6%, with one in ten players in the high-risk category — a finding that inevitably raises questions about the acidic sports drinks and gels that are so routine in this population. Gingival inflammation affected 82.9%, and while frank periodontitis was less common at 12.9%, that is still a meaningful proportion in otherwise fit young men.

Beyond decay and gum disease, the structural and functional findings stood out: partially erupted wisdom teeth in 38.6% (with pericoronitis in 7.1%), a history of sports-related dental trauma in 30%, and TMJ disorders in 21.4%. Individually each is manageable; collectively they describe a group of elite athletes carrying a considerable, and largely unmanaged, load of oral pathology.

Why it matters

What strikes me about these numbers is how quiet the problem is. Most of these conditions do not stop a player training or competing — until they do, in the form of acute pain, infection, disturbed sleep, or an emergency the week of a match. Oral health is exactly the kind of modifiable, low-cost factor that high-performance systems are well placed to manage, and yet it is routinely left off the medical screening checklist.

This was a preliminary, single-tournament study with a modest sample, and it describes association and prevalence rather than a direct effect on performance — caveats we are careful to state. But the direction is clear and consistent with what has been reported in other elite cohorts. The practical conclusion is straightforward: dental assessment and preventive care deserve a place in the routine health programmes we build around athletes, not an afterthought once something hurts. Screening is cheap, the interventions are well understood, and the upside — in comfort, sleep, systemic health and availability to train — is real.

My thanks go to our Sports Dentistry colleagues at Aspetar, who led this work, and to the AFC medical team for making the screening possible. It is a small but useful step toward treating the mouth as part of the athlete, rather than a separate specialty that only gets involved in a crisis.

Reference

Alsaey M, Almasri D, Tabben M, Cardinale M, Alkuwari A, Singh GSA, Hashem A. Dental health status of professional football players during the Qatar 2023 AFC Asian Cup: a preliminary study. Research in Sports Medicine, 2025;34(4):451-463. DOI: 10.1080/15438627.2025.2599859 (via PubMed).

From Splits to Heat Strain: A Ten-Year Triathlon Study Built End-to-End with AI

Regular readers will know I have spent the last couple of months playing with AI agents to scrape and visualise publicly available sport data — first football muscle injuries, then a live dashboard for the Giro d’Italia. Those were fun, low-stakes experiments to learn what the tools could do. This post is the point where the experiment turned into something more serious: a full research study, now posted as a preprint, built almost entirely with the same family of AI tools.

I planned, conducted and executed this study — and developed the accompanying digital twin — using Claude Sonnet 5 and Claude Opus, together with Claude Cowork, Claude Code and Claude Design. Cowork orchestrated the data gathering and organisation across ten years of race results and weather records, Code built the statistical models and the digital twin engine, and Design shaped how the outputs are presented. I stayed firmly in the loop throughout as the domain expert: setting the research questions, checking the physiology and the methodology at every step, validating the data, and deciding what the numbers actually meant. I also modified some of the coding as things progressed to develop various analytics steps.

Why triathlon, why heat

Triathlon is an Olympic sport, and elite Olympic-distance racing is shaped by the interplay of swim-bike-run pacing, transition efficiency, the quality of the field, and — increasingly — the heat athletes race in. Major championships are more and more often held in hot conditions, which matters enormously for how athletes and support staff plan training, pacing, cooling and acclimatization. Despite there being a decade of publicly available race results and weather records out there, nobody had linked the two together at scale. That gap was the starting point.

The study had four aims: characterise the performance signature of a podium finish; reconstruct the thermal environment of championship venues over ten years; identify which athletes seem resilient to heat; and, building on all of that, prototype a digital twin that could support race planning.

Ten years of racing, in numbers

A few things stood out. Bike and run splits each contribute roughly equal unique variance to total race time, but the run leg is the real discriminator between the podium and the rest — it was the single most important feature in the podium-prediction models, at 45.5% importance for men and 48.9% for women. Somewhat counter-intuitively, the slope linking heat to performance did not reach statistical significance for either sex (men p=0.065, women p=0.104), which is a useful reminder not to over-interpret heat effects from headline temperature alone. DNF rates, on the other hand, told a clearer story, ranging from 12.7–16.3% for men and 11.7–18.8% for women across World Triathlon’s Green and Blue flag heat-risk categories.

Building the digital twin

The last aim — and the part I am most excited about — was turning ten years of descriptive analysis into something forward-looking. The digital twin prototype couples a performance model with a thermo-physiological heat-strain model, so it can be used to explore pacing, cooling and acclimatization decisions ahead of a race rather than just explaining results after the fact. On a temporal hold-out (training on earlier years, testing on later ones — the fairest test for something meant to inform future decisions), it achieved a mean absolute error of 0.490 z-units for men and 0.468 for women (r=0.383 and 0.295 respectively). Those are honest, prototype-grade numbers, not a finished predictive tool, and I say so explicitly in the paper.

The usual health warning

This is a preprint. It has not been peer reviewed, and I want to be upfront about that rather than let the AI-workflow angle overshadow it. The underlying data are scraped from publicly available sources, so they carry all the usual caveats about completeness and accuracy that come with that. What I can say is that the statistical approach, the modelling choices and the interpretation were all reviewed and directed by me at every stage — the AI tools accelerated the mechanics of gathering, structuring, analysing and building, but the scientific judgement was, and had to be, human. Critical thinking stays firmly the job of the person in the loop, whatever is doing the typing.

Why this matters to me

I hope this prototype is the beginning of something bigger rather than a one-off curiosity. There is an enormous amount of publicly available data across sport that nobody has the time to properly interrogate and organise — results archives, weather records, GPS feeds, injury registries. What changed for me this year is that a single person, using these AI tools well, can now plan, run and analyse a study of this scale in weeks rather than requiring a full research team and many months. I want to keep using that capability to ask more questions like this one across sports science and sports medicine, and to be transparent about the process as I develop more tools and research questions.

If you want to dig into the full methods, results and figures, the preprint is here: From Splits to Heat Strain: A Ten-Year Analysis of Performance Determinants and a Digital Twin Prototype for Olympic-Distance Triathlon Developed Using a Generative AI Workflow (DOI: 10.21203/rs.3.rs-10216961/v1). As always, comments and critique are very welcome — that is rather the point of putting it out as a preprint while it goes through formal peer review.

A One-Year Study of Endurance Runners: Training, Laboratory and Field Tests

I have been away form the blog for few months now. The move to Qatar has meant adjusting to life in the desert and learning a lot new relevant aspects of my new job. There are so many things to learn and too many things to do. Sadly the time to update the blog has been less than expected. Abandoning Windos for Mac has also not helped, as I am still trying to find a good software solution to be able to blog more often (if you have suggestions, feel free to email them!). 
Anyway, I want to share the news that finally this paper has been published. This was the result of a lot of hard work from Dr. Andy Galbraith and a collaboration with Professor Louis Passfield’s group at University of Kent to make sure we made the most out of the data gathered in the study. Hopefully more data of this study will be published in the future.
Here is the abstract:

A One-Year Study of Endurance Runners: Training, Laboratory and Field Tests

Section: Original Investigation
Authors: Andy Galbraith1, James Hopker1, Marco Cardinale2,3,4, Brian Cunniffe3 and Louis Passfield1
Affiliations: 1Endurance Research Group, School of Sport and Exercise Sciences, University of Kent, Chatham Maritime, United Kingdom. 2Aspire Academy, Doha, Qatar. Department of Computer Science, University College London, London, United Kingdom. School of Medical Sciences, University of Aberdeen, Aberdeen, Scotland.
Acceptance Date: March 18, 2014
Abstract:
Purpose:
 This longitudinal study examined the training and concomitant changes in laboratory and field-test performance of highly trained endurance runners. Methods: Fourteen highly trained male endurance runners (mean ± SD: VO2max 69.8 ± 6.3mL·kg-1·min-1) completed this 1-year training study commencing in April. During the study the runners undertook 5 laboratory tests of VO2max, lactate threshold (LT) and running economy, and 9 field tests to determine critical speed (CS) and the modelled maximum distance performed above CS (D’). The data for different periods of the year were compared using repeated measures ANOVA. The influence of training on laboratory and field test changes was analysed by multiple regression.Results: Total training distance varied during the year, and was lower in May-July (333km [SD: ± 206km], P=0.01) and July-August (339km [SD: ± 206km], P=0.02) than in the subsequent January-February period (474km [SD: ± 188km]). VO2max increased from the April baseline (4.7L·min-1 [SD: ± 0.4L·min-1]) in October and January periods (5.0L·min-1 [SD: ± 0.4L·min-1], P<0.01). Other laboratory measures did not change. Runners’ CS was lowest in August (4.90m·s-1 [SD: ± 0.32m·s-1]) and highest in February (4.99m·s-1 [SD: ± 0.30m·s-1], P=0.02). Total training distance and the percentage of training time spent above LT velocity explained 33% of the variation in CS. Conclusion: Highly trained endurance runners achieve small but significant changes in VO2max and CS in a year. Increases in training distance and time above LT velocity were related to increases in CS.
Keywords: VO2max, critical speed, distance running, endurance, performance changes