Lifestyle Behaviors That Promote Oral Health Also Decrease Risks for Chronic Disease
In a widely publicized study from the CDC and the German Institute of Human Nutrition,1 adult men and women who followed four healthy lifestyle factors—never smoking, healthy diet, physical activity, and body mass index (BMI) under 30—were 78 percent less likely to develop chronic conditions, such as cardiovascular disease, type 2 diabetes, cancer and stroke. Adults who adhered to just one of the four healthy behaviors lowered their chronic disease risk by nearly 50 percent, and their risk levels decreased progressively as their number of healthy behaviors increased.
Although the study did not include dental assessments, the findings are significant for dentists and patients because three of the four unhealthy factors—tobacco use, poor dietary practices, and excess body weight—have strong correlations with oral health, periodontal disease, and systemic health conditions, including cancer, heart disease, and diabetes. The study, published in the August 10/24, 2009 Archives of Internal Medicine,1 received online news coverage from the Los Angeles Times,2 HealthDay News,3 MedPageToday4 and others.
In the study, scientists from the CDC examined data from 23,153 German adults aged 35 to 65 years who were recruited between 1994 and 1998 to participate in the European Prospective Investigation Into Cancer and Nutrition (EPIC)-Potsdam study. At baseline, participants' weight and height were measured, and personal interviews were completed to obtain baseline data on chronic disease history, physical activity, dietary practices (i.e., maintaining a diet high in fruits, vegetables, and whole-grain bread, but low in red meat), and other lifestyle factors. The participants were tracked for nearly eight years (through December 2006) with periodic questionnaires, and the authors reviewed the associations between self-reported healthy lifestyle behaviors and the incidence of chronic disease over time.
While only 9 percent of the study participants practiced all four healthy behaviors, they had a 78 percent reduction in risk when compared with those who engaged in no healthy behaviors. Those who followed each of the four health behaviors had 93 percent reduced risk for diabetes, 81 percent lower risk for heart disease, 50 percent reduction in risk for stroke, and 36 percent lower risk for cancer.
Study participants who followed just one healthy behavior reduced their chronic disease risk by nearly half (47 to 53 percent), and having a BMI under 30 (the standard threshold for obesity) reduced risk for chronic disease more than any other factor, especially for diabetes. German adults who followed two healthy lifestyle factors, such as never smoking and keeping BMI under 30, saw their chronic disease risk drop 72 percent, the largest reduction among all dual combinations of health behaviors. Similarly, adults with a BMI under 30 who exercised more than 3.5 hours each week were 64 percent less likely to develop chronic disease. Overall, each individual lifestyle factor was associated with reductions in chronic disease risk for men and women. Based on these findings, the authors draw a simple conclusion that often goes underemphasized: "adopting a few healthy behaviors can have a major impact on the risk of morbidity."
This conclusion complements a well-established body of evidence that has shown the substantial benefits of healthy lifestyle practices (e.g., never smoking and proper diet) on oral disease, general health, and longevity. The study strongly suggests that following one or more healthy practices can significantly improve patient health and reduce the risks for morbidity and mortality. The study also underscores the importance of promoting health interventions for tobacco cessation and proper nutrition in clinical settings. By following this guidance, dentists can help patients optimize oral health and prevent oral and systemic disease.
Dentists commonly treat patients who follow one or more of the unhealthy behaviors assessed in the EPIC-Potsdam study, such as tobacco use, poor dietary practice, or insufficient physical activity. The dental community can provide a substantial public service by promoting the benefits of tobacco cessation, healthy diet, and weight management to improve oral health and prevent chronic disease across the lifespan. As seen in one recent study, oral health professionals who initiated behavior interventions for tobacco cessation in dental offices increased tobacco abstinence rates by over 40 percent.5
Dentists have long recognized the association between frequent exposure to sweetened soft drinks and other sugar-containing substances in the oral cavity with increased risks of dental decay. Clinicians can educate patients about proper nutrition and oral health, including eating a well-balanced diet and limiting the number of between-meal snacks. Obesity and physical inactivity are important risk factors for developing type 2 diabetes, which is also associated with increased risk for periodontal disease. Dentists are encouraged to promote patient awareness of the relationship between obesity and early-onset diabetes, an increasing public health problem among overweight children. Patients can also be referred to their physician or a registered dietician for further nutritional counseling. For more information on tobacco cessation and healthy dietary practices, dentists and patients are encouraged to consult the following resources:
- Treating Tobacco Use and Dependence: 2008 Update—the U.S. Public Health Service guideline that provides evidence-based recommendations supporting effective treatments for tobacco cessation; and
- the U.S. Department of Agriculture’s Dietary Guidelines for Americans, which are designed to promote optimal health and to prevent obesity-related diseases, including cardiovascular disease, type 2 diabetes and cancers.
1. Ford ES, Bergmann MM, Kroger J, Schienkiewitz A, Weikert C, Boeing H. Healthy living is the best revenge. Arch Intern Med 2009;169(15): 1355–1362. Available at: http://archinte.ama-assn.org/cgi/reprint/169/15/1355. Accessed August 18, 2009.
2. Yurkiewicz S. Four healthy choices to change your life. Los Angeles Times, August 11, 2009. Available at: http://www.latimes.com/news/custom/scimedemail/la-sci-lifestyle11-2009aug11,0,2836626.story. Accessed August 18, 2009.
3. More Evidence Healthy Living Brings Long Life. HealthDay News, August 10, 2009. Accessed August 18, 2009.
4. Fiore K. Four lifestyle factors prevent cancer, diabetes, and CVD. MedPage Today, August 10, 2009. Available at: http://www.medpagetoday.com/PrimaryCare/DietNutrition/15458. Accessed August 18, 2009.
5. Carr AB, Ebbert JO. Interventions for tobacco cessation in the dental setting. A systematic review. Community Dent Health 2007; 24(2):70–4.
- Dietary Guidelines for Americans and MyPyramid (JADA "For the Dental Patient" page, September 2006)
- Diet and Tooth Decay (JADA "For the Dental Patient" page, April 2002)
Document Posted August 2009