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Preventive dentistry

Chlorine-induced dental pigmentation in a long-term swimmer

British Dental Journal volume 237, pages 859–860 (2024)Cite this article

Swimmer's mouth, first noted over 30 years ago, involves brown tartar deposits, known as swimmer's stain and/or calculus.1 Chlorinated pool water, with a higher pH, breaks down salivary proteins, causing staining on the enamel pellicle. This condition is common in swimmers exposed to treated water for over six hours weekly.2,3 The pH level of swimming pools is crucial for two reasons: it affects chlorine's ability to kill germs, and it influences how comfortable the water is for swimmers. As pool pH rises, chlorine becomes less effective.2 A swimmer's body pH ranges from 7.2 to 7.8, and pool water outside this range can cause eye and skin irritation. Similarly, saliva's pH ranges from 5.8 to 7.6, depending on flow rate.2,4 Improper chlorination, especially in gas-chlorinated pools, can lead to acidic water, contributing to dental issues such as enamel erosion, calculus buildup, and staining. Tooth demineralisation occurs when pH drops below 6.0, which happens more easily when pool pH is poorly maintained.5 Optimal pool pH (7.2-7.8) is essential to protect tooth enamel and prevent swimmer's mouth. Pool maintenance teams, therefore, monitor pH levels regularly, ideally keeping them between 7.2 and 7.6 to ensure both swimmer safety and effective sanitation.3

Traditional preventive strategies, such as routine dental cleanings and regular checkups, may not be sufficient to prevent staining in competitive swimmers. We advocate additional measures should be considered, such as regular fluoride treatments, using fluoride toothpaste before and after swimming,4 and preferably wearing mouthguards lined with fluoride gel during swimming. However, fluoride usage should be closely monitored by dental professionals to prevent overexposure.

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References

  1. Leads from the MMWR. Erosion of dental enamel among competitive swimmers-Virginia. JAMA 1983; 250: 716.

  2. Moore A B, Calleros C, Aboytes D B, Myers O B. An assessment of chlorine stain and collegiate swimmers. Can J Dent Hyg 2019; 53: 166-171.

  3. Dawes C, Boroditsky C. Rapid and severe tooth erosion from swimming in an improperly chlorinated pool. J Can Dent Assoc 2003; 74: 359-361.

  4. Zebrauskas A, Birskute R, Maciulskiene V. Prevalence of dental erosion among the young regular swimmers in Kaunas, Lithuania. J Oral Maxillofac Res 2014; doi: 10.5037/jomr.2014.5206.

  5. Bretz W A, Carrilho M R. Salivary parameters of competitive swimmers at gas-chlorinated swimming-pools. J Sports Sci Med 2013; 12: 207-208.

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Authors and Affiliations

  1. Assistant Professor, Department of Oral Pathology and Microbiology, Nair Hospital Dental College, Mumbai-400008, India

    N. Parekh

  2. Professor and Head, Department of Conservative Dentistry and Endodontics, Nair Hospital Dental College, Mumbai-400008, India

    K. Singh Banga

  3. Associate Professor, Department of Oral Pathology and Microbiology, Dr D. Y. Patil Dental College and Hospital, Navi Mumbai-400706, India

    S. J. Shetty

  4. Professor and Head, Department of Oral Pathology and Microbiology, Nair Hospital Dental College, Mumbai-400008, India

    R. S. Desai

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  1. N. Parekh
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  2. K. Singh Banga
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  4. R. S. Desai
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Correspondence to N. Parekh, K. Singh Banga, S. J. Shetty or R. S. Desai.

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Parekh, N., Singh Banga, K., Shetty, S. et al. Chlorine-induced dental pigmentation in a long-term swimmer. Br Dent J 237, 859–860 (2024). https://doi.org/10.1038/s41415-024-8165-2

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  • DOI: https://doi.org/10.1038/s41415-024-8165-2

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