INTRODUCTION
Dental caries have long represented a significant oral health issue for children and adults. However, in the 1980s, the prevalence of coronal caries in children steadily and gradually declined within segments of the population, following the implementation of fluoride supplements and toothpastes, increased public oral health education, and application of dental sealants.¹ Since they were first utilized in dental offices in the 1970s, dental sealants have been effective in caries prevention.
Sealants, which act as a barrier and are typically applied onto the premolars and molars where decay is most likely to develop, may be resin-based or glass ionomer cement. They have been proven to be effective in preventing pit and fissure caries,² as well as caries on the occlusal surfaces of permanent molars and in high-risk cases.³ Throughout the years, sealants have been implemented into public programs as a way to reach children of low socioeconomic status who are most susceptible to—and often have high instances of—caries. Studies regarding retention rates and clinical benefits of community sealant programs conducted by county health departments determined that children who received sealants had a 71% successful retention rate and considerable protection from occlusal decay up to the fifth grade.⁴ Other studies indicated that sealants are more effective when placed in patients with established risk factors for occlusal caries,⁵ while other studies suggested that knowledge gaps remained regarding the costs and benefits of sealing low- versus high-risk populations.^6-8
That may partially explain why the success of early sealants was a gray area. A cost-benefit and cost-effectiveness analysis regarding preventive dental programs within a hypothetical community examined 4 popular dental preventive programs—community water fluoridation, school water fluoridation, weekly school-based mouthrinses, and school-based sealants—to evaluate maximum caries reduction during a 20-year period. The analysis revealed that community water fluoridation was the most cost effective and beneficial, while school-based dental sealants resulted in negative net benefits.⁹
Further, some past studies evaluating the use and effectiveness of placing sealants on first and second permanent molars in children during a 5-year period indicated that sealant placement was only minimally beneficial in preventing carious lesions.^5,10 Therefore, there has been a lack of agreement amongst clinicians regarding the benefits and use of caries-preventive agents, including sealants.¹¹
The low incidence of dental sealant use is a direct result of a lack of public awareness and patient education, as well as a disproportionate reimbursement for sealants by third-party insurers.¹² In 1988, the average percent of patients 18 years old and younger receiving dental sealants was only 18.7%, and many dental patients were not receiving sealants at all.¹³ This trend continued throughout the years, even though the ADA widely advocated the use of dental sealants as a recommended component to maintaining good oral health.²
In fact, children who do not receive sealants have greater odds of developing carious lesions and needing restorative dental care in the future, costing the healthcare system more money in the long term.14 Perhaps that explains why research regarding caries risk assessment and the use of preventive techniques in children aged 6 to 18 years found that dental sealants and in-office fluoride are the most frequently used caries preventive regimens.¹¹
Currently, new and improved dental sealants are available that are beneficial and cost-effective. They reflect an evolution in which sealants have advanced to become more cost-effective, and research now suggests that properly placed and retained sealants can decrease the occurrence of carious lesions and prevent restorative costs.
 
Characteristics of Dental Sealants
The earliest generations of sealants were vulnerable to fissures, bubbles, and failure to adapt to dentition, which contributed to earlier wear. As a result, they required replacement over time, which is an essential component of caries prevention to avoid bacterial infiltration that can lead to carious lesions. Early sealants typically lasted 6 months to a year.¹⁵
First- and second-generation sealants demonstrated a low viscosity and a high resistance to flow, causing the material to run over the margins of the tooth and other surfaces. These sealants were usually clear and resembled caries in subsequent x-rays. Additionally, early generations of sealants were also moisture incompatible and required application in a dry environment to prevent contamination and sealant failure caused by a weakened sealant bond.
Third-generation sealants showed improvements but were still problematic. These sealants were more viscous and easier to handle and, as a result, the sealant remained on the tooth surface until it was light-cured. However, research showed that LED or halogen lights were insufficient for curing 2-mm-thick opaque or high-filler-loaded sealants, potentially causing microleakage and insufficient microhardness.¹⁶
Adhesion is one of the most important features of a dental sealant. Studies have shown self-adhesive sealants do not have as defined an etching pattern as etch-and-rinse adhesives.¹⁷ A pretreatment conditioning protocol with an appropriate acid is necessary to obtain adequate penetration of a sealing material.¹⁸ Newer generations of sealants can be cured in a moist environment and do not require complete drying of the tooth surface after etching. This is possible due to the hydrophilic agents that today’s sealants contain.
Today, dental professionals have sealant materials that are easy to apply, long-lasting and durable, radiopaque for subsequent dental procedures, and contain fluoride. The process of sealing teeth has been simplified with the introduction of syringes with disposable tips that allow clinicians to apply the sealant directly to the pits and fissures of the tooth surface. Sealants today can last up to 5 or 10 years if regularly cared for after application.¹⁵ This is facilitated by modern technology that permits dentists to view risk factors and monitor sealant application and overall retention.¹⁹ Additionally, contemporary sealants are radiopaque, making dental procedures easier; radiolucent materials could mimic caries in subsequent radiographs and, therefore, be problematic.
 
INTRODUCING A NEW SEALANT WITH HYDROPHILIC CHEMISTRY
UltraSeal XT hydro (Ultradent Products) is a highly filled (53%) and light-curable pit and fissure dental sealant. This sealant is also radiopaque, methacrylate based, and thixotropic. It also contains diurethane dimethacrylate, triethylene glycol dimethacrylate, and methacrylic acid.
UltraSeal XT hydro’s adhesive properties increase the bond strength of the material to the enamel, enhancing marginal retention and reducing microleakage. The thixotropic nature of the material, combined with its hydrophilic chemistry, prevents sealant failure by chasing moisture deep into the pits and fissures of the tooth on a microscopic level. This prevents moisture-related sealant failures common with earlier generations of hydrophobic sealants. Additionally, the traditional step of pretreating teeth with a drying agent is eliminated, resulting in faster and more efficient procedures.
The sealant’s fluorescent properties enable visual verification of the sealant’s margins under a UV black light, making it easier to verify and view marginal retention at the time of placement and at subsequent examinations. The chemical composition contains and releases fluoride, so no additional treatments are necessary. UltraSeal XT hydro is available in 2 shades: Opaque White (clear) and Natural (tooth-colored material), and is applied using a syringe and Inspiral Brush tip (Ultradent Products).
Unlike previously introduced sealants, UltraSeal XT hydro seals to and is retained by dentition for long-term results, similar to its UltraSeal XT plus predecessor.²⁰ Additionally, it is free of bisphenol A (BPA), as tested by an independent third-party laboratory that confirmed levels of less than 0.00000% BPA.21

CASE REPORT
Diagnosis and Treatment Planning
A 9-year-old female presented with deep pits and fissures. Upon examination, it was determined that application of a hydrophilic sealant would be the best course of preventive treatment (Before Image).

Before Image. Preoperative photo.	After Image. Postoperative photo.

Clinical Protocol
The brush tip was attached to the Ultra-Etch etchant syringe containing 35% phosphoric acid solution. The Inspiral Brush tip was attached to the UltraSeal XT hydro syringe for later application of the sealant. The fissures of the teeth were cleaned using a microetcher (Ultradent Products) (Figure 1). The selected teeth were isolated with cotton rolls in order to avoid saliva contamination (Figure 2).

Figure 1. The tooth was cleaned with plain pumice.	Figure 2. Ultra-Etch 35% phosphoric acid solution (Ultradent Products) was placed for 20 seconds.
Figure 3. The teeth were thoroughly rinsed and dried.	Figure 4. Properly etched teeth should have a frosty appearance.
Figure 5. A small drop of UltraSeal XT hydro (Ultradent Products) was expressed.	Figure 6. Application was done using a painting action, followed by light agitation with the brush tips.
Figure 7. Resin was applied to deep fissures (avoid pooling) and light-cured.	Figure 8. Margins were checked and the occlusion adjusted, as needed.

Etchant was applied to the fissures of the teeth for 20 seconds (Figure 3). The teeth were thoroughly rinsed with a water spray unit and dried with an air-abrasion unit (Figure 4). It was necessary to repeat the etch-and-rinse step in cases where sodium bicarbonate was being used.
Prior to applying the sealant, a small drop of UltraSeal XT hydro was expressed onto the Inspiral brush tip (Figure 5). In order to prevent premature polymerization of the dental sealant, the overhead light was redirected, and the sealant was applied using a painting action, followed by light agitation (Figures 6 and 7).
The sealant was light-cured using the VALO LED curing light (Ultradent Products) on standard mode for 10 seconds. It is recommended that clinicians and patients wear UV protective eyewear when the sealant is light-cured to prevent injuries (Figure 8).
The sealant margins were examined with a black light lens (VALO Black Light Lens [Ultradent Products]) to visually verify marginal retention. The occlusion was then examined and appropriately adjusted (After Image).
 
IN SUMMARY
Sealant placement remains an integral component of preventive dentistry. UltraSeal XT hydro is an innovative dental sealant that is easy to use, cost-effective, and clinically proven to help prevent the formation of cavities in pit and fissure areas.

References

1. Rozier RG, Beck JD. Epidemiology of oral diseases. Curr Opin Dent. 1991;1:308-315.
2. ADA Council on Access, Prevention and Interprofessional Relations; ADA Council on Scientific Affairs. Dental sealants. J Am Dent Assoc. 1997;128:485-488.
3. Ahovuo-Saloranta A, Hiiri A, Nordblad A, et al. Pit and fissure sealants for preventing dental decay in the permanent teeth of children and adolescents. Cochrane Database Syst Rev. 2008 Oct 8;(4):CD001830.
4. Dorantes C, Childers NK, Makhija SK, et al. Assessment of retention rates and clinical benefits of a community sealant program. Pediatr Dent. 2005;27:212-216.
5. Dennison JB, Straffon LH, Smith RC. Effectiveness of sealant treatment over five years in an insured population. J Am Dent Assoc. 2000;131:597-605.
6. Mejàre I. Indications for fissure sealants and their role in children and adolescents. Dent Update. 2011;38:699-703.
7. Feigal RJ, Donly KJ. The use of pit and fissure sealants. Pediatr Dent. 2006;28:143-150.
8. Feigal RJ. The use of pit and fissure sealants. Pediatr Dent. 2002;24:415-422.
9. Niessen LC, Douglass CW. Theoretical considerations in applying benefit-cost and cost-effectiveness analyses to preventive dental programs. J Public Health Dent. 1984;44:156-168.
10. Burt BA. Fissure sealants: clinical and economic factors. J Dent Educ. 1984;48(suppl 2):96-102.
11. Riley JL, Richman JS, Rindal DB, et al. Use of caries-preventive agents in children: findings from the Dental Practice-based Research Network. Oral Health Prev Dent. 2010;8:351-359.
12. Lam A. Increase in utilization of dental sealants. J Contemp Dent Pract. 2008;9:81-87.
13. Cohen L, LaBelle A, Romberg E. The use of pit and fissure sealants in private practice: a national survey. J Public Health Dent. 1988;48:26-35.
14. Dasanayake AP, Li Y, Kirk K, et al. Restorative cost savings related to dental sealants in Alabama Medicaid children. Pediatr Dent. 2003;25:572-576.
15. Tripodi D, Filippakos A, Piattelli A, et al. Wear of dental sealing materials using the replication technique. Eur J Paediatr Dent. 2011;12:95-98.
16. Duangthip D, Ballungpattama S, Sitthisettapong T. Effect of light curing methods on microleakage and microhardness of different resin sealants. J Dent Child (Chic). 2011;78:88-95.
17. Perdigão J, Sezinando A, Gomes G. In vitro sealing potential of a self-adhesive pit and fissure sealant. Quintessence Int. 2011;42:e65-e73.
18. Markovic D, Petrovic B, Peric T, et al. The impact of fissure depth and enamel conditioning protocols on glass-ionomer and resin-based fissure sealant penetration. J Adhes Dent. 2011;13:171-178.
19. Braz AK, Aguiar CM, Gomes AS. Evaluation of the integrity of dental sealants by optical coherence tomography. Dent Mater. 2011;27:e60-e64.
20. Boksman L, Carson B. Two-year retention and caries rates of UltraSeal XT and FluoroShield light-cured pit and fissure sealants. Gen Dent. 1998;46:184-187.
21. Fleisch AF, Sheffield PE, Chinn C, et al. Bisphenol A and related compounds in dental materials. Pediatrics. 2010;126:760-768.  

Ms. Brinker is a certified dental assistant and an international speaker and published author. She and her husband Erik are the owners of a new publication called Contemporary Product Solutions. She is past faculty member at the Dawson Academy and Spear Education. An active member of the American Academy of Cosmetic Dentistry (AACD), Ms. Brinker is the first auxiliary to sit on the AACD board of directors. She is a member of the E4D Clinical Operations Operators group and had extensive input for the certified dental designer certification. Since 2009, she has been selected as one of Dentistry Today’s Leaders in Continuing Education. She was also selected as one of Dental Products Report’s 25 Most Influential Women in Dentistry and Dr. Bicuspid’s Dental Assistant Educator of the year for 2012. She can be reached at shannon@cpsmagazine.com.

Disclosure: Ms. Brinker was compensated by Ultradent Products for writing this article.

We all have to die, but we don’t have to die prematurely. In Part 1 of this article, the death records of New Jersey dentists were categorized. The results show that, unfortunately, similar to many other Americans, dentists are dying from lifestyle diseases such as cardiovascular diseases, type II diabetes, cancer, and Alzheimer’s disease. These diseases most often manifest in middle age or later. However, this epidemic is, for the most part, preventable. In Part 2 of this article, these lifestyle diseases are now considered, and methods of prevention are examined.

CARDIOVASCULAR DISEASES

Cardiovascular diseases include heart disease, hypertension, and cerebral stroke.
Prevalence: According to federal statistics, more than 690,000 people died in 2002 from heart disease compared to more than 550,000 deaths from cancer.¹
Etiology: A recent disclosure by the World Health Organization (WHO)² stated that 4.4 million people die due to raised cholesterol levels, 7.1 million people die because of hypertension, 4.9 million people die from tobacco use, and 2.6 million people die as a result of being overweight or obese. A 30-year study revealed that 90% of men and 70% of women who start adulthood at healthy weights eventually wound up being either overweight or obese.^3,4 A recent study⁵ of 29,000 people in 52 countries conducted by 262 scientists found heart disease etiology was the same worldwide. They found that 90% of the risk factors (presented in decreasing importance) can be prevented: 1 = ratio between lipid particles ApoB (bad) and ApoA1 (good); 2 = smoking; 3 = diabetes; 4 = hypertension; 5 = fat belly; 6 = stress; 7 = inadequate intake of fruits and vegetables; and 8 = lack of exercise. New research has shown that smoking only 4 cigarettes a day can be fatal.⁶
Lack of deep sleep leads to an increased production of the hormone ghrelin, which stimulates appetite. A recent study showed that sleep-deprived individuals eat more sweet, salty, and starchy foods.⁷ Cortisone in high doses and in long-term use can increase fat deposits. Cocaine can cause cardiac arrhythmias and sudden cardiac death. More than 2 alcoholic drinks daily can lead to cardiovascular diseases. The lack of vitamins B6, B12, and folic acid results in high homocysteine levels (related to heart attacks). Depression can lead to heart disease. Streptococcal infections can result in rheumatic heart disease and subsequent subacute bacterial endocarditis.⁸ A lack of social support can have a negative effect on the cardiovascular system, and with aging, the immune system becomes less effective and arterial calcification often increases.
Prevention (see also General Preventive Methods in “Live Longer, Live Better: Lifestyle Diseases and Their Prevention, Part 1” in the June 2006 issue of Dentistry Today):

(1) Don’t smoke, or stop smoking.

(2) Drink 1 to 2 glasses of alcoholic beverages per day and a few cups of green tea.

(3) Eat sensibly (don’t overeat) and cut down on snacks.

(4) Eat low-glycemic index complex carbohydrates and reduce high-glycemic index complex carbohydrates.

(5) Have most of your fat intake as monounsaturates and omega-3 oils.

(6) Eat nonfat or low-fat dairy products and a minimal amount of red meat (high saturated fat). Substitute white meat and soy products.

(7) Eat dark chocolate, which has cardiovascular benefits. However, too much can lead to obesity.

(8) Supplement with vitamins B6, B12, folic acid, and vitamin C, and the minerals magnesium, calcium, and potassium, all of which have cardiovascular benefits.

(9) Drink 8 to 10 glasses of water daily, which can help in weight loss (if overweight) and decrease the risk of cardiovascular disease. 

(10) Exercise. Aerobic exercise improves cardiovascular fitness. About 30 minutes 5 to 6 days a week is sufficient. Prolonged aerobics (1 hour or more) can yield excessive free radicals, which can promote the onset of cardiovascular diseases.⁹ Regular bodybuilding lowers body fat percentage and increases muscle tissue, both of which can help prevent cardiovascular diseases.
In order to lose body fat and gain muscle most effectively, the following workout order is suggested:

• A 5-minute warm-up such as running (fast walking) on the track (treadmill), or using exercise bike.

• A 15-minute whole-body stretch.

• About a 45-minute bodybuilding workout. This burns carbohydrates for energy if done to maximum effort. If aerobics is done first, you will be too fatigued to give maximum effort at bodybuilding.

• About 30 minutes of aerobics. Since the bodybuilding will have burned the carbohydrates, the aerobics will then burn fat (helps in weight loss). Also, aerobics often gives a burst of endorphins for a natural high.

• A 5- to 10-minute stretch.

(11) Control stress. Meditate or use other relaxation methods every day. These techniques invoke the relaxation response, which can reduce blood pressure, heart rate, and LDL-cholesterol.10

(12) Get adequate sleep.11 Try to sleep from 7 to 9 hours a night. Research has shown that sleeping too little (6 hours or less) can increase the risk for obesity, heart disease, and premature death.

(13) Reduce or eliminate intake of COX-2 inhibitors (eg, Vioxx, Celebrex, Bextra), which have been implicated in heart attacks.

TYPE II DIABETES (ADULT-ONSET DIABETES, INSULIN-RESISTANT DIABETES)

Prevalence: Currently 18 million Americans have diabetes and approximately 800,000 new cases of diabetes are diagnosed annually.¹² Most are type II diabetes, and many more diabetics are undiagnosed. In addition, 2 out of 5 Americans age 40 to 74 are prediabetic; they have a 30% risk of becoming diabetic within 3 years and a 50% risk within 10 years.¹³
Etiology: Type II diabetes results from obesity; elevated triglycerides; low HDL cholesterol; hypertension; cigarette smoking; low intake of fruits and vegetables; high levels of stress;^8,14 lack of exercise; metabolic syndrome; amphetamine use (can raise blood glucose level and increase insulin resistance); lack of deep sleep; genetics; and aging.
Prevention: The preventive methods discussed under Cardiovascular Diseases are equally as important for preventing type II diabetes. Since drinking 8 to 10 glasses of water daily helps in weight loss, it can also help prevent type II diabetes.

CANCER

Prevalence: It has been estimated that there will be more than 1,370,000 new cases of cancer in the United States this year, and more than 570,000 deaths.¹
Etiology: A recent estimate by the American Cancer Society is that one third of all cancers are related to smoking, and another one third are related to obesity, poor diet, and lack of exercise. Researchers at the American Cancer Society did a 16-year study of 900,000 people who were cancer-free at the start.¹⁵ They found that excess body fat could account for 14% of all cancer deaths in men and 20% of those in women. Re-evaluation of the data by Gabe Mirkin revealed that lack of muscle, rather than just having too much fat, causes cancer. Muscles get smaller with aging because of the lack of bodybuilding. Muscle is the main source of protein needed to fight infection and tumors.¹⁶
Recent studies^17,18 have  found that excess weight and physical inactivity together could account for 31% of all premature deaths, 59% of deaths from cardiovascular disease, and 21% of deaths from cancer in nonsmokers.  Both increased body fat and reduced exercise were found to be strong and independent predictors of death. Other etiological factors are obesity; smoking and tobacco chewing; excessive alcohol intake; aflatoxins; excess red meat consumption (especially processed meats); pollution; toxins; radiation; viruses, fungi, bacteria, and parasites;^19,20 stress; insufficient sleep; lack of social support; sunlight (melanoma); genetics (higher risk for being male, older, and African American); and having type I diabetes.¹⁹ Aerobic exercise may decrease the possibility of getting colon, prostate, breast, and endometrial cancers.²¹ However, as mentioned before with respect to heart disease, prolonged aerobics can yield excessive free radicals, which can promote the onset of cancer and premature aging.⁹  Regular bodybuilding lowers the percentage of body fat and increases muscle tissue, which in addition to helping prevent cardiovascular disease can also help prevent cancer.
Sarcopenia is a loss of muscle mass that is more prevalent with older individuals. It has been estimated that skeletal muscle mass decreases between 35% and  40% in men and women in the 5 decades of life between 20 and 80 years of age. A recent study examined 200 adults aged 64 to 93 and found that the prevalence of sarcopenia was 22.6% in women and 26.8% in men. Other studies have shown that almost half of men and women more than 80 years old suffer from sarcopenia.²² Sarcopenia results from agerelated declines in testosterone and growth hormone; decreased muscle protein synthesis in the elderly; poor nutritional status in the elderly; lack of exercise (especially of the progressive resistance type); and genetics. Even though aging and genetics might be involved, recent research has shown that sarcopenia can be prevented to a significant degree22 (discussed below). Sarcopenia can lead to fractures, injuries, and falls, which could be fatal. Also, loss of muscle can increase the chance of getting cancer  or infectious diseases such as pneumonia. Both outcomes are related to depressed immunity subsequent to lack of muscle protein.²² Several studies have shown that strength training (bodybuilding) in the elderly can improve body composition, increase muscle mass, and prevent and even reverse sarcopenia.
Prevention: The preventive methods discussed under Cardiovascular Diseases and Type II Diabetes can also help prevent cancer. The following methods are also recommended:

(1) Increase insoluble fiber (see also General Preventive Methods in “Live Longer, Live Better: Lifestyle Diseases and Their Prevention, Part 1” in the June 2006 issue of Dentistry Today), which promotes gastrointestinal tract health and may help prevent colon cancer.

(2) Reduce omega-6 oils (polyunsaturates) such as corn, safflower, and cottonseed oils. Excess amounts have been implicated in cancer etiology.

(3) Decrease the intake of red meat and eliminate processed meats such as bacon, bologna, salami, sausages, and hot dogs. The nitrites and nitrates in these foods have been implicated as carcinogens.

(4) Drinking 8 to 10 glasses of water reduces the risk of colon cancer by 45%, bladder cancer by 50%, and can lower the risk of breast cancer.²³

(5) Green tea and lycopene (in tomatoes) appear to help prevent cancer.           

ALZHEIMER’S DISEASE

Although cancers are debilitating, destructive, and often fatal, at least the individual is aware of his or her surroundings. This is not true with Alzheimer’s disease.
Prevalence: According to the CDC, more than 4 million Americans have Alzheimer’s disesase.²⁴
Etiology: Although the  etiology is uncertain, certain predisposing factors exist: excess dietary fat and cholesterol; excessive total caloric intake and obesity; exposure to aluminum; certain viruses, especially Herpes simplex  virus 1; head trauma;^24,25 and chronic stress. A recent study showed that people who constantly worry had more than double the risk of developing Alzheimer’s disease than nonworriers.²⁶
Genetics is the only definite etiologic factor. Restricted blood flow in the brain could contribute to the series of events that lead to the tangles and clumps of protein in the brain that characterize Alzheimer’s disease. Memory loss and changes in thinking skills and personality are more likely to have occurred when tangles and clumps are accompanied by signs of stroke and narrowed, clogged blood vessels feeding the brain.^26,27
Prevention: A new study has shown that doing 4 or more different exercises (eg, swimming, biking, walking, running) reduces the risk of Alzheimer’s disease.²⁷ About 30 minutes of activity 5 to 6 days a week is sufficient.     
Other possible preventive methods are as follows:^28,29

(1) Perform bodybuilding exercises.

(2) Use relaxation techniques such as deep breathing, yoga, and meditation.

(3) Use other methods to counteract stress (eg, aerobic exercise, have friends, take vacations, have hobbies).

(4) Do mental exercises such as crossword puzzles, flash cards, and chess.

(5) Take stimulating classes and have a stimulating job.

(6) Improve organizational skills.

(7) Have a balanced diet. This includes fruits and vegetables; white meat chicken and turkey; and omega-3-containing fish such as wild salmon.

A MAJOR CONSIDERATION

Considering these chronic diseases, the recent report from WHO³⁰ is frightening and hopefully will awaken the readers of this article. The report stated that ailments such as heart disease, cancer, and diabetes would kill nearly 400 million people over the next 10 years. Lee Jong-Woo, the director-general of WHO, drew attention to the increasing threat from diseases that in part can be prevented by healthier diets and giving up smoking. Until recently, these chronic diseases were overshadowed by infectious diseases such as HIV/AIDS, even though these chronic diseases cause far more deaths.  Chronic or noncommunicable diseases account for 3 out of 5 deaths worldwide, the WHO report stated. As has already been discussed, the report emphasized that exercise and better diets (more fruits and vegetables and less saturated fats, sugar, and salt) can help prevent 80% of premature cases of heart disease, strokes, and diabetes, and at least 60% of all cancers.

CONCLUSION

A recent study found that only 3% of a large sampling of Americans practice a healthy lifestyle (not smoking, being normal weight, eating 5 or more servings of fruits and vegetables daily, and engaging in at least 30 minutes of physical activity 5 times a week or more).³¹ However, it is never too late to begin a positive lifestyle program.

(1) Stop smoking (for smokers). This is essential.

(2) A healthy diet is easy to implement, and healthy food can taste good.

(3) A variety of exercises can be done in your own office; elaborate equipment is not needed. A recent study, which is the first one to determine if exercise helps people live longer, has shown that people who exercise regularly, which means getting a good workout almost every day, can add about 4 years to their life spans.³² (A good diet, not smoking, and controlling stress can add several additional years.) The study was substantial, as it followed 5,000 middle-aged and elderly Americans for more than 40 years. 

(4) Learn to relax; meditation is easy to learn and very effective.
Start today to change (unless you are already following a healthy lifestyle). Improved health and a long life are the rewards.

References

1. American Cancer Society. Cancer Facts and Figures 2005. Atlanta, Ga: American Cancer Society; 2005. Available at: http://www.cancer.org/docroot/STT/content/STT_1x_Cancer_Facts__Figures_2005.asp. Accessed April 28, 2006.

2. World Health Organization. Preventing chronic diseases: a vital investment. Available at:
http://www.who.int/chp/chronic_disease_report/contents/en/index.html. Accessed May 16, 2006.

3. Hitti M. Getting older without adding extra weight. WebMD Medical News. Available at: http://my.webmd.com/content/article/113/110593.htm. Accessed May 20, 2006.

4. Vasan RS, Pencina MJ, Cobain M, et al. Estimated risks for developing obesity in the Framingham Heart Study. Ann Intern Med. 2005;143:473-480.

5. Ross E. Study: heart disease causes same globally. Philadelphia Inquirer. August 30, 2004:A9. Available at:
http://www.phillyburbs.com/pb-dyn/news/94-08292004-357250.html. Accessed May 16, 2006.

6. Bjartveit K, Tverdal A. Health consequences of smoking 1-4 cigarettes per day. Tob Control. 2005;14:315-320.

7. Davis JL. Sleep loss feeds appetite: mixed-up hormones lead to munchies, bigger waistlines. WebMD Medical News. Available at: http://my.webmd.com/content/article/98/104617.htm. Accessed May 20, 2006.

8. Giessel BE, Koenig CJ, Blake RL.   Management of bacterial endocarditis.
Amer. Fam. Phys., 2000; 61(6).   Available at: http://www.aafp.org/afp/20000315/1725.html. Accessed June 7, 2006.

9. Morse D. Surviving Stress: Simple, Safe, Strategic Solutions. College Station, Tex: Virtualbookworm.com Publishing; 2004.

10. Morse D. Electronic Pharmacy of the Mind: Use of Brain Wave Synchronizers and Other Relaxation Methods to Control Stress. Atlanta, Ga: Cryptic Press; 1998:82-84.

11. Stein R. Scientists finding out what losing sleep does to a body. Washington-post.com, October 10, 2005;Health section:A01. Available at:  http://www.lef.org/lefcms/aspx/PrintVersion.aspx. Accessed May 22, 2006.

12. Hudnall C. Defying diabetes. AARP Bulletin. 2005;46:22-23.

13. Prevalence and incidence of diabetes. Available at: http://www.wrongdiagnosis.com/d/diabetes/prevalence.htm. Accessed October 10, 2005.

14. Diabetes: type 2 diabetes. WebMD Health. Available at: http://my.webmd.com/content/article/59/66844?z=1667_00000_0000_rl_03. Accessed October 6, 2005.

15. Calle EE, Rodriguez C, Walker-Thurmond K, et al. Overweight, obesity, and mortality from cancer in a prospectively studied cohort of U.S. adults. N Engl J Med. 2003;348:1625-1638.

16. Mirkin G. Lack of muscle increases cancer risk. Available at: http://ezinearticles.com/?Lack-of-Muscle-Increases-Cancer-Risk&id=125751. Accessed June 7, 2006.

17. Hu FB, Willett WC, Li T, et al. Adiposity as compared with physical activity in predicting mortality among women. N Engl J Med. 2004;351:2694-2703.

18. Calle EE, Teras LR, Thun MJ, et al.  Adiposity and physical activity as predictors of mortality. N Engl J Med 2005; 352:1381-1384.

19. Buche J. Fungal/mycotoxin etiology of human disease (particularly cancer). Healing Cancer Naturally Web site. Available at: http://www.healingcancernaturally.com/causes6.html. Accessed May 22, 2006.

20. Gross L. The role of viruses in the etiology of cancer and leukemia in animals and in humans. Proc Natl Acad Sci U S A. 1997;94:4237-4238.

21. Aerobic exercise: What 30 minutes a day can do for your body. MayoClinic.com. Available at:
http://www.mayoclinic.com/health/aerobic-exercise/EP00002. Accessed May 23, 2006.

22. Rosick ER. Protecting muscle mass as you age. Life Extension. 2003;9:45-51. Available at: http://www.lef.org/magazine/mag2003/aug2003_report_muscle_01.html. Accessed May 28, 2006.

23. Moore D. The health benefits of drinking water. DrDonnica.com. Available at: http://www.drdonnica.com/today/00007230.htm. Accessed May 23, 2006.

24. Prevalence and incidence of Alzheimer’s disease. Available at: http://www.wrongdiagnosis.com/a/alzheimers_disease/prevalence.htm. Accessed May 23, 2006.

25. Itzhaki RF. Possible factors in the etiology of Alzheimer’s disease. Mol Neurobiol. 1994;9:1-13.

26. Wilson RS, Barnes LL, Bennett DA, et al. Proneness to psychological distress and risk of Alzheimer disease in a biracial community. Neurology. 2005;64:380-382.

27. Grant WB, Campbell A, Itzhaki RF, et al. The significance of environmental factors in the etiology of Alzheimer’s disease. J Alzheimers Dis. 2002;4:179-189.

28. Podewils LJ, Guallar E, Kuller LH, et al. Physical activity, APOE genotype, and dementia risk: findings from the Cardiovascular Health Cognition Study. Am J Epidemiol. 2005;161:639-651.

29. Khalsa DS. Preserving memory as we age. Life Extension. 2005;11:83-85. Available at: http://www.lef.org/magazine/mag2005/nov2005_atd_01.htm. Accessed May 28, 2006.

30. Harnischfeger U. WHO: chronic disease may kill 400M by 2015. Report on UN study, October 5, 2005. Available at: http://abcnews.go.com/Health/wireStory?id=1184865. Accessed May 24, 2006.

31. Reeves MJ, Rafferty AP. Healthy lifestyle characteristics among adults in the United States, 2000. Arch Intern Med. 2005;165:854-857.

32. Franco OH, deLaet C, Peeters A, et al.   Effects of physical activity on life expectancy with cardiovascular disease.  Arch Intern. Med. 2005; 165: 2355-2360.

Dr. Morse is professor emeritus from Temple University and adjunct professor at Camden County College, where he teaches “Stress Manage-ment” and “Health and Wellness.” In addition to his dental degree, he has graduate degrees in endodontics, microbiology, clinical psychology, and clinical nutrition. He has written more than 250 scientific articles and 16 books, including 4 medical mystery thrillers (the latest is Malprac-tice, PublishAmerica, Baltimore, Md, 2003) and 12 nonfiction books (the latest is Surviving Stress: Simple Safe Strategic Solutions, Virtualbookworm.com Publ, College Station, Tex, 2004). He has lectured throughout the United States and in 30 countries and presents courses on stress management, humor and spirituality in pain management, dealing with dental malpractice, overcoming death anxiety, health and wellness, and fitness for life. Dr. Morse tries to “practice what he preaches.” He has been meditating regularly for more than 30 years, trying to eat healthfully for more than  50 years, and doing bodybuilding and aerobics for almost 60 years. At age 74, in July 2005, he took first place in the Natural USA Bodybuilding Championships for Men Age 70 and Older. Dr. Morse can be reached at dentpsych@aol.com, (856) 795-1360, or publishedauthors. net/donmorse/index.html.

SURVEY MATERIALS AND METHODS

The premise for examination of mortality of New Jersey dentists is that this could be used as an estimate of the mortality rate of American dentists. The New Jersey Dental Association maintains a record of all New Jersey dentists who have died in the last 25 years and were members of the association. Since most New Jersey dentists are, or were, members of the association, these records are an accurate estimate of the mortality rate of New Jersey dentists. The association receives the information from newspaper obituary columns and notices sent by relatives of the deceased. In November 2005, all of the obituary listings were categorized.

RESULTS

Number and Etiology: From January 1980 through November 2005, 1,123 dentists had died. However, most of the notices did not report death etiology. Nevertheless, in 16.4% of the total (184/1,123), the cause of death was listed. It was considered that this was a representative sample.
Mortality by Gender: Although currently many women are dentists and about 50% of dental students are female, the population for this study was overwhelmingly male, with only 3 women dentists having died (3/1,123 or about 0.3%). Therefore, no separation by gender was done.
Mean, Median, and Mode: The mean age of death was 76.9 years. The median age of death was 78.2 years. The mode age of death was 82 years.
Mortality by Age Cluster: The mean age of death (76.9 years) was slightly less than the current general American population mean (77.7 years).2 However, when the 3 female deaths are excluded, the mean remains 76.9 years, which is better than the current American male mean of 74.9 years. Mortality of dentists can also be considered by examining the median and age clusters. The median of 78.2 years shows that half of the dentists died earlier than that age and half died later. Almost 49% of the dentists died at age 80 or higher (548/1,123). The largest number of any age cluster was the 80s (415/1,123 or 37%), with age 82 showing the most deaths (58, almost 6% of the total deaths). A relatively large number (127/1123 or 11.3%) died in their 90s, and 6 dentists (0.6%) died in their 100s. Nevertheless, more than 51% (575/1,123) of the dentists died from ages 30 through 79. Twenty-six percent (292/1,123) died in their 70s, 13.6% (153/1,123) died in their 60s, and 7.7% (86/1,123) died in their 50s. The remaining breakdown showed that 2.7% (30/1,123) died in their 40s and 1.2% (14/1,123) died in their 30s. See Table 1 for a summary of mortality by age groups.
One interesting finding was that more dentists died in the year 1985 (73, about 6.5% of the total deaths) than any other year. In the other years, the number ranged from 34 (2004) to 65 (1988). The mean age of death for 1985 was 75.5, the median was 77.5, and the mode was 82. The mean (75.5) was slightly lower than the general mean (76.9), and the mode (82) was identical. The median (77.5) was also a little lower than the general median (78.2). The sample also showed that dentists in the year 1985 died from the same diseases as the general population (cardiovascular disease, cancer, and type II diabetes). The increased mortality of 1985 was either related to some environmental occurrences that year in New Jersey, or it was just a coincidence.
Breakdown of Etiology Sample: Most of the dentists in this sample (Table 2) died from the same major lifestyle diseases and conditions prevalent in the US population (to be discussed in Part 2 of this article).

DISCUSSION

Close to 50% of the dentists in this survey died in their 80s and older. However, more than 50% died in their 70s and younger. Similar to other professions, many dentists want to practice through their 70s, and many more want to enjoy their retirement years. However, this is impossible if they die early because of their lifestyle. Methods to reverse this trend are considered in Part 2 of this article.
Until recently, heart disease was the number one killer of Americans under the age of 85. This has recently been replaced by cancer.³ Stroke is the third leading killer.⁴ Considering all ages, heart disease remains the leading killer.⁵ The results of this sample show similar results. Under the age of 85, there were 63 deaths from cancer and 56 from cardiovascular disease (heart disease and stroke). From 85 and older, there were 16 deaths from cardiovascular disease and 7 deaths from cancer.
Although chronic obstructive pulmonary disease (COPD) is the fourth leading American cause of death,4 in this sample only 1 death was from COPD. COPD is related to chronic asthma, bronchiectasis, chronic bronchitis, and emphysema. Cigarette smoking is a leading cause of cardiovascular disease, cancer, and COPD. Apparently, many of the dentists who died in this study had been cigarette smokers and had eaten red meat and other foods high in saturated fat. From personal experience of attending many dental meetings over the course of 40 years, until the last 15 years ashtrays were found at all tables, and many dentists smoked cigarettes during their meals. In addition, the main course was usually steak or roast beef.  Fortunately, this meeting style has changed drastically for the better.
Accidents are the fifth leading cause of death in America.⁴ Most are from motor vehicles, and many others are home-based. In this sample, accidents, along with type II diabetes, were the third leading cause of deaths.  Most were automobile accidents, a few were home-based, and one was from an airplane. To help prevent automobile accidents, when youÌre driving, donÌt drink; be wide awake; wear a seat belt; donÌt talk on a cell phone; donÌt pay attention to the radio, CDs, tapes, or TV; and donÌt watch your partner, unless he or she is in distress, sick, dying, or becoming aggressive. Also, be alert around the house and at work.
Type II diabetes is the sixth leading killer of Americans.^4,6 As mentioned above, type II diabetes, along with accidents, was the third leading cause of death in this sample. Type II diabetes is related to ingesting sucrose and high-fructose corn syrup products and high-glycemic index complex carbohydrates (eg, white flour products such as white bread, pasta, pizza, and white rice). Again, relative to personal 40-year dental meeting attendance, a rich, high-fat, high-sugar dessert was usually served.
Influenza and pneumonia is the seventh leading killer of Americans.⁷ Pneumonia, along with AlzheimerÌs disease, kidney disease, and suicide was the next leading cause of death in this sample. Related to agerelated impaired immunity, pneumonia is a frequent cause of death in older individuals, as was also found in this sample. AlzheimerÌs disease is the eighth leading killer of Americans.^8,9 In the present study, there were likely more than the 3 reported cases of AlzheimerÌs disease, but this condition often goes unreported.
Kidney disease, which includes nephritis, nephritic syndrome, and nephrosis, is the ninth leading cause of death in America.^8,9 Although genetics is involved in kidney disease etiology, other preventable causes are type II diabetes, toxins, kidney stones, and adverse reactions to medications and illegal drugs.
Septicemia (serious infection of the blood stream) is the 10th leading cause of death in America.⁷ However, no cases of septicemia were found in this sample.
Suicide is the 11th leading cause of death in America.⁷ Suicide results from the following conditions and life-styles:10 depression; high levels of stress; lack of social support; life-threatening sickness or injury; monetary, romantic, or family loss; loss of self-esteem; mind-altering drugs; brainwashing; religious fanaticism; and low levels of serotonin. Serotonin, associated with poor impulse control and a tendency to be violent and aggressive, has been found to be deficient in people who have attempted suicide. Genetics might also be related to a predisposition to depression. Suicide is not often reported as the cause of death, and some accidents might also be suicidal. Some of the aforementioned factors (especially depression) were undoubtedly involved in the present sample. Drug toxicity researcher Williamson has stated, controversially, that dentists, related to mercury intoxication, have a high level of depression and suicide.¹¹ Nevertheless, evidence for this contention is lacking.¹²
Parkinson’s disease is a chronic, progressive, unremitting neurologic disease that usually begins after the age of 50.¹³ In the United States it is found in about 1 million people. Untreated patients have a mortality rate 3 times greater than nonafflicted individuals. Victims usually die from pneumonia, urinary tract infections, or CNS vascular lesions. Unfortunately, even with treatment with drugs such as Levodopa, the mortality rate is still about the same. Genetics appears to be involved, but environmental factors, such as drinking well water and being exposed to pesticides, are also implicated. The 3 dentists in the sample died in their 70s from undisclosed complications.
ALS is an often-fatal degenerative neuromuscular disease. Although exact etiology is unknown, a higher incidence was found in military personnel, football players, and cigarette smokers. In this sample, only 1 dentist died from ALS.¹⁴
Cystic fibrosis is a degenerative lung disease related to infection by Pseudomonas aeruginosa. Although it often kills people in their 30s, in this sample the dentist died in his 80s. For treatment, the antibiotic azithromycin appears to be of benefit.¹⁵
Rheumatoid arthritis (RA) is a serious, chronic disease. The prognosis is uncertain because of the prolonged nature of the disease and the wide variation in its course. Premature death usually comes from cardiovascular disease, infection, lung and kidney disease, or GI bleeding.¹⁶ There is some evidence for preventive and therapeutic benefits from dietary omega-3 oils. Doses of up to several grams per day may be necessary for therapeutic effects in long-standing cases of RA, but lower doses appear to provide benefits in reducing the mortality.¹⁷ In this sample, 1 dentist in his 80s died from cardiovascular complications of RA.

GENERAL PREVENTIVE METHODS

1. Don’t take drugs unless medically necessary.

2. Don’t overeat; cut down on snacks. Even overeating of healthy foods is dangerous; calories do count.

3. Eat the right foods. These include the following:

4. If you don’t eat sufficient fruits and vegetables, beneficial antioxidant and anti-inflammatory supplements are as follows:

5. Exercise regularly. Exercise is generally beneficial, but if one exercises while mentally stressed, blood pressure and heart rate can increase greatly, and the immune system can be inhibited.¹⁸ (Exercise is discussed more completely in Part 2.)

6. Try to maintain a healthy weight. Metabolism slows down with aging. Hence, later in life you should reduce food intake and increase exercise. This is just the opposite of what occurs with most people.

7. Have regular medical and dental checkups as well as podiatric and optometric checkups.

8. If depressed, get psychological or psychiatric help.

9. Avoid toxic agents, pollutants, and firearms.

10. Be optimistic. Research has shown that optimistic people have less chronic disabling diseases, recover quicker when sick, and live longer than pessimistic people.¹⁸

11. Consider being spiritual. Research has shown that people who are either religious or spiritual have less chronic disabling diseases, recover quicker when sick, and live longer than nonreligious or nonspiritual people.¹⁸

12. Be humorous. Research has shown that people who regularly use humor have less chronic disabling diseases, recover quicker when sick, and live longer than people who rarely use humor.¹⁷

13. Take frequent vacations. Research has shown that people who take frequent vacations have less chronic disabling diseases, recover quicker when sick, and live longer than people who rarely take vacations.¹⁹

PREVIEW

In Part 2 the major lifestyle diseases cardiovascular disease, cancer, type II diabetes, and Alzheimer’s disease are examined, and methods for their prevention are considered.

References

1. Obituary records of the New Jersey Dental Association. One Dental Plaza, North Brunswick, NJ 08902. Reviewed October and November, 2005.

2. The World Factbook: United States Ò Life expectancy at birth, total population (2006 est). Central Intelligence Agency Web site. Available at: http://www.cia.gov/cia/publications/factbook/geos/us.html. Accessed October 5, 2005.

3. Gardner A. Cancer now the leading killer of Americans: displaces heart disease for top spot, new report finds. HealthDay News; January 19, 2005. Available at: https://www.healthforums.com/library/1,1258,article~11452,00.html. Accessed April 28, 2006.

4. Study reveals trends in U.S. death rate, leading causes of death over 30 years. [Summary of article published in JAMA. 2005;294:1255]. Available at: http://www.emaxhealth.com/8/3191.html. Accessed October 5, 2005.

5. American Cancer Society. Cancer Facts and Figures 2005. Atlanta, Ga: American Cancer Society; 2005. Available at: http://www.cancer.org/ docroot/STT/content/STT_1x_Cancer_Facts__Figures_2005.asp. Accessed April 28, 2006.

6. Diabetes: Type 2 Diabetes. WebMD Web site. Available at: http://my.webmd.com/content/article/59/66844?z=1667_00000_0000_rl_03. Accessed October 6, 2005.

7. Arias E, Smith BL. Deaths: preliminary data for 2001. Nat Vital Stat Rep. 2003;51:1-44.

8. Prevalence and incidence of AlzheimerÌs disease. Available at: http://www.wrongdiagnosis.com/a/alzheimers_disease/prevalence.htm. Accessed October 4, 2005.

9. Prognosis of kidney disease. Available at: http://www.wrongdiagnosis.com/k/kidney_disease/prognosis.htm. Accessed November 24, 2005.

10. Suicide: etiology of suicide. SparkNotes Web site. Available at: http://www.sparknotes.com/psychology/abnormal/suicide/section1.html. Accessed November 20, 2005.

11. OÌBrien J. Mercury amalgam toxicity. Life Extension. May 2001. Available at: http://www.lef.org/magazine/mag2001/may2001_report_mercury_1.html. Accessed November 20, 2005.

12. Alexander RE. Stress-related suicide by dentists and other health care workers. Fact or folklore? J Am Dent Assoc. 2001;132:786-794.

13. Conley SC, Kirchner JT. ParkinsonÌs disease Ò the shaking palsy. Under-lying factors, diagnostic considerations, and clinical course. Postgrad Med. 1999;106:39-50. Available at: http://www.postgradmed.com/issues/1999/07_99/conley.htm. Accessed November 2005.

14. Weisskopf MG, McCullough ML, Calle EE, et al. Prospective study of cigarette smoking and amyotrophic lateral sclerosis. Am J Epidemiol. 2004;160:26-33.

15. Conova S. Pivotal new drug for cystic fibrosis. Columbia University Health Sciences Web site. Available at:  http://www.cumc.columbia.edu/news/in-vivo/Vol2_Iss17_oct27_03/cystic_fibrosis.html. Accessed October 2005.

16. Federman R. What is the effect of rheumatoid arthritis on mortality? About.com Web site. Available at: http://arthritis.about.com/od/mortality/f/mortalityra.htm. Accessed November 21, 2005.

17. Cleland LG, James MJ. The role of fats in the lifecycle stages. Adulthood Ò prevention: rheumatoid arthritis. Med J Aust. 2002;176(suppl 11):S119-S120. Available at: http://www.mja.com.au/public/issues/176_11_030602/S119-S120.pdf.

18. Morse D. Surviving Stress: Simple, Safe, Strategic Solutions. College Station, Tex: Virtualbookworm.com Publishing; 2004.

19. Gump BB, Matthews KA. Are vacations good for your health? The 9-year mortality experience after the multiple risk factor intervention trial. Psychosom Med. 2000;62:608-612.

Dr. Morse is professor emeritus from Temple University and adjunct professor at Camden County College, where he teaches stress management and health and wellness. In addition to his dental degree he has graduate degrees in endodontics, microbiology, clinical psychology, and clinical nutrition. He has written more than 250 scientific articles and 16 books, i