Oral health plays an important role in maintaining overall health and well-being. Lack of proper oral health care can lead to the proliferation of various pathogens, resulting in oral diseases such as dental caries, periodontal disease, and subsequent tooth loss (1). The relationship between oral and general health has been extensively studied, particularly regarding the systemic release of chemical mediators resulting from the inflammatory burden generated by oral diseases, which may negatively affect preexisting inflammatory processes (2).

Recently, there has been a growing interest in the interplay between oral diseases and physical exercise. Extensive research has been conducted to highlight the protective role of physical exercise in mitigating the severity of oral diseases such as periodontal disease (3). Another line of investigation has explored the potential impact of oral diseases on athletic performance (4). This attention has grown due to a rising interest in adopting healthier lifestyles that include both dietary choices and physical activity.

Improving quality of life requires a multidisciplinary approach. Oral health is consistently associated with quality of life indicators in the general population. Engaging in physical exercise at higher-than-usual levels is associated with a 31% lower risk for infectious diseases (5).

Physical activity involves movements performed by skeletal muscles that result in energy expenditure. On the other hand, physical exercise is a set of planned, structured, and repetitive physical activities aimed at improving or maintaining physical fitness (6).

Physical exercise is associated with improved mental health, cognition, depression, anxiety, and neurodegenerative diseases (7). Regular physical activity is consistently correlated with an improved quality of life. Physical activity or inactivity is the primary environmental factor that modulates cardiorespiratory fitness, which is the body's ability to absorb and distribute oxygen to muscles and organs during prolonged physical exercise. Low cardiorespiratory fitness is strongly linked to a higher risk of cardiovascular diseases and stroke, and serves as an independent risk factor for type 2 diabetes (8).

Engaging in sports, at the amateur or professional level, is an excellent activity for regular physical exercise. The focus of most athletes is to surpass limits and break records. Therefore, understanding the biological mechanisms and factors that influence sports performance has attracted greater interest for evaluating and monitoring the oral health of athletes and physically active individuals. In addition to infectious and inflammatory diseases, orofacial and dental injuries have gained special attention due to their extended recovery time and potential irreversible damage to athletes. Managing orofacial injuries and developing preventive measures are at the forefront in sports dentistry.

It is essential to concisely evaluate the potential relationships between oral diseases or alterations and physical activity or exercise, as well as the role of oral diseases in athletic performance. For this purpose, an assessment of the main points already studied, and the gaps still present in the literature is necessary, to more precisely direct future research in the area. Therefore, the present study provides an overview of related research and a knowledge map and discusses publication metrics and the key topics regarding the relationship between physical activity/exercise and oral diseases.

The main goal of this study was to provide information to elucidate the understanding of the knowledge-construction process surrounding oral diseases and physical activity or exercise. By using bibliometric analysis tools and mapping of the current century literature, it was possible to identify the most discussed topics, the least addressed or neglected points and discuss future perspectives for research on the relationship between oral diseases and physical exercise. Upon analyzing the data found, the literature indicated that the presence of oral diseases and alterations can negatively impact quality of life and physical fitness levels (13, 14). Moreover, regular physical exercise was beneficial not only for overall health but also for oral health (15, 16). However, contrary to the popular belief that athletes are generally healthier than the rest of the population, athletes had higher rates of oral disease (17–20). Current studies have indicated that participation in competitions is associated with an increased risk of infectious diseases. The pursuit of breaking records and constantly pushing limits may be linked to the dysregulation of an athlete's immune system (5).

The first mention in the literature of the relationship between physical exercise and oral changes concerned athletes, particularly in boxing, and the occurrence of orofacial injuries, and the development of devices to minimize damage (21). Over the years, dental research focusing on exercise has ceased to be exclusive to athletes and has begun to encompass the general population. At the beginning of this century, studies conducted with nonathletes followed a similar publication pattern to those conducted with athletes. Starting in 2013, we observed an increase in research involving the general population, which suggests a strong interest in studying the impact of oral diseases on physical fitness and quality of life of the general population, as well as regular non-competitive physical exercise practice.

The three articles with the highest number of citations among the selected articles investigated orofacial and dental injuries as well as the level of knowledge among sports practitioners regarding injury prevention. The occurrence of orofacial or dental injuries during sports has been a long-standing concern. Since 1890, there have been reports on the use of devices to minimize damage caused by trauma in this area (21). Orofacial and dental injuries have evident negative effects on athletes, justifying the historical interest of researchers in this subject, which is been reflected in the large number of scientific articles addressing the topic. Concerns regarding the level of knowledge among athletes and coaches about the prevention and first aid for these injuries have remained constant in this century (22–27).

The most productive author was Andreas Filippi, who contributed 11 articles as the last author. One of his main areas of research focus is interdisciplinary dental traumatology. He is the Head of the Department of Oral Surgery at the University Center for Dental Medicine Basel, Switzerland and has the highest number of contributions in this field. Other indicators of the prominence of oral and dental injuries over other oral alterations include the result that the journal with the highest number of publications in this area was Dental Traumatology and that Jens Ove Andreasen was the second author with the highest number of co-citations among the selected articles. He is recognized as the most productive author in the field of dental traumatology worldwide (28).

Brazil is the most productive country in the fields of publications related to oral diseases and physical exercise. It is the only country that officially recognizes sports dentistry as a dental specialty to date. This interest from the “country of soccer dates back to 1958, when dentist Dr. Mário Trigo accompanied the Brazilian national football team during the World Cup held in Sweden. Curiously, the inclusion of a dentist in the team staff, who was responsible for the athletes’ health, occurred simultaneously with the team's first world championship.

The study of how diseases affect populations, known as epidemiology, played a fundamental role in most of the selected articles. The second most frequent keyword among publications was “epidemiology” highlighting the epidemiological role of most selected articles. Many studies have evaluated the prevalence of major oral diseases such as orofacial lesions, caries, tooth loss, pulpal diseases, periodontal disease, and temporomandibular disorders.

Good general health practices, along with physical activity, have been associated with improved oral health practices and a lower occurrence of tooth decay in the general population (29–31). However, high rates of dental caries were observed in athletes. A high-risk profile for dental caries may be a consequence of a diet high in carbohydrates and a significant intake of sports and/or energy drinks with high sugar content (19, 20), proliferation of microorganisms and decrease in the level of S-IgA (32). Nevertheless, there are still few studies evaluating the risk factors athletes face for developing diseases such as tooth decay.

According to Tibúrcio-Machado et al., half of the world's adult population has at least one tooth with apical periodontitis. However (33), the present study found a low number from the articles that evaluated pulpal and periapical diseases. The difficulty determining diagnosis and the need for complementary evaluations, such as imaging examinations, may justify such occurrences. The majority of the studies selected in this review evaluated the epidemiological assessment for the need for endodontic treatment in athletes (34–36).

Among the oral diseases evaluated in this review, periodontal disease was the oral alteration with the highest number of clinical studies (16 articles). Many of these studies had observed the positive effects of physical exercise (37–40). Furthermore, the hypothesis that a high oral inflammatory burden may be associated with lower levels of physical fitness has led to an increasing number of studies examining the association between periodontal disease and physical fitness during the past decade (13, 41–45). The prolonged use of substances by athletes, such as anabolic androgenic steroids, has resulted in increased gingival inflammation (46).

The need for fluid and nutrient replenishment during physical activities, especially when performed at high intensity, encourages athletes to consume large quantities of energy and sports drinks (47). Due to the acidic pH of these beverages, the relationship between their consumption and prevalence of dental erosion has been widely studied. Studies have shown that a high intake of sports drinks can be considered a risk factor for dental erosion, although an isolated association cannot be statistically proven. Weekly training duration and low fluid intake during sports activities are associated with higher rates of dental erosion. Medeiros et al. (48) her important risk factor for dental erosion that should be evaluated among individuals engaged in physical activities. These factors have been associated with so-called “early dental aging,” a concern in contemporary dentistry that deserves special attention in sports practitioners.

The high prevalence of oral diseases in athletes raises important questions about the biological mechanisms of these diseases in this population. A more cariogenic microbiota has been observed in athletes compared to the general population, especially after sports practice (49–52). It is known that an imbalance in the oral microbiota, associated with frequent carbohydrate consumption or reduced saliva flow, can lead to caries, and excessive plaque accumulation increases the risk of periodontal diseases (53). Oral diseases such as periodontal disease and apical periodontitis have been associated with increased systemic inflammatory biomarkers and oxidative stress (54, 55). The findings of Mendoza-Nunez et al. (37) suggest that practicing Tai Chi has antioxidant and anti-inflammatory effects that are linked to the improvement of periodontal disease in the elderly. However, the mechanisms of the impact of oral diseases, especially inflammatory ones, on the sports performance of elite athletes still do not seem to be clear.

This study is limited by the use of a single database, WoS-CC, which, despite its comprehensive coverage, may not have retrieved papers published exclusively in other databases, potentially leading to different results and incomplete data. Additionally, the choice to include only publications from the 21st century excludes studies from earlier periods. Therefore, it is not possible to assert that all articles from this century addressing this topic were retrieved. Care must be taken when establishing trends and identifying gaps. The bibliometric methodology is not based on a qualitative analysis of articles; its main objective is to evaluate the behavior of the literature, such as the main terms used, productive authors, and journals, enabling the identification of key trends and gaps in scientific knowledge. This indicates that it does not make judgments regarding the quality of the studies.

Although the findings of this study do not directly enable informed decision-making regarding protocol choices and comprehensive clinical safety evaluations, they motivate the development of new primary research. Given the trend towards a more integrative approach in science, research that explores the relationship between dentistry and exercise has contributed to the reintegration of the oral cavity into the overall body system. To achieve this, it is crucial to focus on dysfunctional habits that can contribute to premature tooth wear as well as oral inflammatory diseases that can have systemic implications.

The predominant oral condition of interest remains orofacial trauma, despite the growing number of studies demonstrating the high prevalence of oral diseases such as dental caries and periodontal disease. The current literature is still heavily focused on evaluating the prevalence of oral diseases; however, there is an urgent need for a deeper understanding of the factors that lead athletes to have high rates of oral diseases and for a more thorough investigation of the impact of these diseases on sports performance. To address these issues, we suggest that more studies, especially randomized clinical trials, be conducted.