Lifestyle-related factors

28 World Health • 47th Year, No. 1, January-February 1994 lifestyle·related factors Aulikki Nissinen & Hannu Hausen C oronary heart disease, the most prevalent consequence of atherosclerosis, is closely linked with lifestyle-related factors such as smoking and diet, and these factors are also associated with hypertension, cerebrovascular diseases and diabetes. Dental caries and periodontitis, which cause tooth loss, are caused by microorganisms but lifestyle factors- including dietary habits, oral hygiene and compliance with prophylactic programmes - also modify the occurrence and progression of these diseases. Patients with cardiovascular or cerebral infarction have been reported to have poorer oral health status as compared to control subjects, and it has been suggested that chronic oral infection may be associated with myocardial infarction. The atherosclerotic process begins in childhood and youth, because of harmful lifestyles adopted in early life. A recent study reports that adolescents with a high prevalence of caries had a higher average daily intake of energy originating from fat and a lower daily fibre intake than others. In addition, smoking among adolescents has been found to be associated with poor oral health status among Finnish schoolchildren. Even though the possible common etiology of dental caries and other prevalent chronic diseases has not yet been confmned, it seems justified to combine preventive action with regard to the cardiovascular diseases, diabetes and dental caries. Based on a concept of the integration of risk factors, WHO has started the InterHealth programme, which seeks to reduce the occurrence of chronic diseases and their lifestyle-related determinants in developed countries and to maintain a low level of these Cleaning teeth with a chewstick. Oral hygiene and a sensible diet, through primary health care in all countries, can protect against other diseases. diseases and related lifestyle factors in developing countries. Back in the 1950s and 1960s practically all Finns were affected by dental caries, and cardiovascular diseases were by far the most important cause of death among the population. Intensive health education was started to improve the level of oral hygiene, and the use of fluorides was introduced mainly in the form of fluoridated toothpastes, as well as supervised fluoride rinsing programmes at schools and dental clinics. School oral health care became an integrated part of the primary health care system in 1972. Since then, the caries situation among Finnish children has improved significantly. While in 1974 a twelve- year-old had on average 7.3 permanent teeth decayed, missing due to caries, or filled, the corresponding figure was 1.2 in 199l.lt is impossible to assess the exact contribution made by the different components of the oral health programme, but it is likely that most of the improvement is due to the ubiquitous exposure of the population to fluorides, especially fluoridated toothpastes. There has also been a reduction in the occurrence of cardiovascular diseases, the prevention of which is also based largely on activities within the municipal primary health care system as well as within occupational and school health care. Even though the prevention of both oral diseases and other chronic diseases is an integral part of the primary health care system, the fact is that so far these activities have been run more or less separately in Finland and there is still a long way to go before these activities are truly integrated. Certainly the evidence suggests that, in all countries, it is highly desirable for efforts to promote and maintain oral health to be combined from the very beginning with efforts to control other lifestyle-related health problems. • Professor Aulikki Nissinen is with the Department of Community Health and General Practice and Professor Hannu Hausen is with the Department of Community Dentistry at the University of Kuopio, P. 0 Box 1627. 7021 1 Kuopio, Finland.