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Implementation of a behavioural change intervention to enhance oral health behaviours in elite athletes: a feasibility study
  1. Julie Gallagher,
  2. Paul Ashley,
  3. Ian Needleman
  1. Centre for Oral Health and Performance, University College London, Eastman Dental Institute, London, UK
  1. Correspondence to Professor Ian Needleman; i.needleman{at}


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

Aim To develop, implement and evaluate a pragmatic oral health promotion intervention that integrated the capability, opportunity, motivation and behaviour model of behavioural change into the knowledge transfer system for effective implementation of preventive interventions.

Methods Repeated measures study. Athletes and support team together viewed one 10 min presentation and three 90 s information films. Athletes alone received oral health screening, personalised advice and an oral health toolkit. Outcome measures included: (1) oral health knowledge, athlete-reported performance impacts (Oslo Sports Trauma Research Centre, OSTRC score), use of oral hygiene aids, gingival inflammation (bleeding) score, recorded at baseline, 4–6 weeks and 12–16 weeks and (2) athlete feedback.

Results We recruited 62 athletes; 44 (71%) male and 58 (93.5%) white British, 55 (88.7%) athletes completed the study. Mean knowledge score improved from 5.69 (1.59) to 6.93 (1.32) p<0.001. Mean OSTRC score reduced from 8.73 (14.54) to 2.73 (11.31) p<0.001. Athlete use of prescription strength fluoride toothpaste increased from 8 (12.9%) to 45 (80.4%) p<0.001. Athlete-reported use of interdental cleaning aids at least 2–3 x week increased from 10 (16.2%) to 21 (34%) p=0.013. Bleeding score remained unchanged.

Conclusion This behavioural change intervention was successfully implemented within different elite sport environments. It was associated with an increase in athlete oral health knowledge, enhanced oral health behaviour, a reduction in self-reported performance impacts and high participant retention.

  • implementation
  • behaviour
  • elite performance
  • sports & exercise medicine

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  • Contributors JG was responsible for the first and final draft. PA and IN reviewed and contributed to the final draft. JG, PA and IN contributed to the study design. JG collected and analysed the study data.

  • Funding This study was funded by a BASEM research bursary. JG is a PhD candidate, supported by a joint award from GSK and UCL IMPACT. The Brushlink devices were provided free of charge.

  • Competing interests The Centre for Oral Health and Performance is part of the UK IOC Research Centre for Prevention of Injury and Protection of Athlete Health with the Institute of Sport Exercise and Health (ISEH) and the National Centre for Sport and Exercise Medicine (NCSEM).

  • Patient and public involvement Patients and/or the public were involved in the design, or conduct, or reporting, or dissemination plans of this research. Refer to the Methods section for further details.

  • Patient consent for publication Not required.

  • Ethics approval We received ethical approval from UCL Research Ethics Committee Chair’s approval (Project ID 6388/002).

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement All data relevant to the study are included in the article or uploaded as supplementary information. The full study protocol and additional deidentified participant data including additional secondary outcomes is available on request from the corresponding author. The intervention short films can be viewed at

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