TOTAL HEALTHPROMOTION

& DISEASE PREVENTION

Etiology and Prevention of Tooth Decay......................................................3Etiology and Prevention of Gum Disease......................................................4How gum disease is a risk factor for heart disease..........................................5Oral bacteria and other connections..............................................................6Risk factors that can’t be changed................................................................7Risk factors that can be modified, changed, or treated....................................8

Risk Factors

Gum disease..............................................................................................9Heart disease...........................................................................................10Cigarette smoking....................................................................................11High blood pressure.................................................................................12High blood cholesterol.............................................................................13Physical inactivity...................................................................................14 Overweight & obesity..............................................................................15Stress.....................................................................................................16

Nutrition

Aim for a healthy weight.........................................................................17Body Mass Index (BMI)..........................................................................18Be physically active................................................................................19Choose sensibly......................................................................................20Choose a variety.....................................................................................21

Medical History Update form..................................................................22Sign-up sheet for patient information sheets..............................................24

TOTAL HEALTHPROMOTION

&DISEASE PREVENTION

This file contains 19 patient information sheets that are for teaching and training purposes only.

Risk Factors, pages 9-16, contain an internet link at the bottom of each page. The link is a resource to change lifestyle and reduce each risk.

There are 3 hidden videos on the following pages:

page 5 - Explaining Why Periodontal Disease May Pose A Risk To Your Health. Click on “heart disease” at the top of the page.

page 11 - Study Shows Yet Another Reason Why Quitters Are Winners. Click on “Kick your smoking habit for good.”

page 21 - Healthy Gums Are Likely to Lie Behind Milk Mustaches. Click on the glass of milk at the bottom of the page.

Hidden links can be found on page 3 Brushing and flossing, page 5 gingivitis, periodontitis, atherosclerosis, and page 6 Stamp Out Diabetes - connect to the American Diabetes

Association. Page 21 contains a web link to the American Dietetics Association.

Tooth decay occurs when your teeth are frequently exposed to foods containing carbohydrates (starches and sugars) like soda pop, candy, ice cream, milk, and cakes. Natural bacteria live in your mouth and form plaque. The plaque interacts with deposits left on your teeth from sugary and starchy foods to produce acids. These acids damage tooth enamel over time by dissolving, or demineralizing, the mineral structure of teeth, producing tooth decay and weakening the teeth.

The acids formed by plaque can be counteracted by simple saliva in your mouth, which acts as a buffer and remineralizing agent. However, though it is the body’s natural defense against tooth decay, saliva alone is not sufficient to combat tooth decay. The best way to prevent tooth decay is to eat a healthy diet and to maintain good oral hygiene habits, by brushing and flossing daily.

Brushing and flossing immediately following a mealhelps stop oral bacteria from converting sugar into acids.

Naturally occurring bacteria in the mouth devours sugar, creating acids that attack tooth enamel.

Cavities form when plaque builds on a tooth and eats into the outer enamel. The presence of xylitol, appearing in sugar-free chewing gum, inhibits the growth of the bacteria that causes tooth decay. The bacteria loses the ability to adhere to the tooth stunting the cavity causing process. Chew sugarless gum, with or without xylitol or sorbitol, after meals or snacks when unable to brush. This will help reduce plaque on teeth, inhibit bacteria and reduce contact time of sugar on teeth. Chewing sugarless gum can increase saliva flow by three times.

Kissing has been linked to the prevention of tooth decay, because it stimulates saliva, which helps reduce the incidence of cavities. During the moments of saliva stimulation, saliva washes out the mouth and helps remove the cavity causing food particles that accumulate after meals.

Each time you eat, you create an environment for oral bacteria to develop. Studies are showing that dental disease is just as related to overeating as heart disease, obesity, diabetes and high blood pressure. So making a habit of eating too much of just about anything, too frequently, should be avoided. Cut down on sweets and between meal snacks. Remember, it’s the sugary and starchy foods that put your teeth at extra risk.

Fluoride

Gum disease is caused primarily by bacterial plaque, a sticky, colorless film that constantly forms on the teeth. If plaque isn’t removed each day by brushing and flossing, it hardens into a rough, porous substance called tartar. Toxins and poisons produced and released by bacteria in plaque irritate the gums. These toxins cause the breakdown of the fibers that hold the gums tightly to the teeth, creating periodontal pockets which fill with even more toxins and bacteria. As the disease progresses, pockets extend deeper and the bacteria moves down until the bone that holds the tooth in place is destroyed.

The worse the disease, the more likely the bacteria are to become blood-borne. Infected gums bleed, making it easier for bacteria to enter your bloodstream. If bacteria become dislodged, the bacteria enter through cuts or sores in your mouth and travel to other parts of the body through your bloodstream. Once bacteria reaches the arteries, they can irritate them in the same way that they irritate gum tissue. This could cause arterial plaque to accumulate in the arteries, which can cause hardening and block blood flow. Compromised blood-flow to your heart can cause a heart attack. Also, arterial plaque can come loose and travel to other parts of the body. If blockage occurs in the brain, it can cause a stroke.

Keep your mouth healthy!

Always remember that gum disease is caused by plaque buildup. If you remove the plaque effectively, you can minimize your chance for getting gum disease. Removing plaque through daily brushing, flossing and professional cleaning is the best way to minimize your risk.

Your oral health affects your overall health. Oral health means more than an attractive smile. Poor oral health and untreated oral diseases can have a significant impact on quality of life. The condition of the mouth mirrors the condition of the body as a whole.

Gum disease is a serious gum infection that should always be taken seriously. Although gum disease can often show few or no symptoms at all, watch for gums that are red and irritated, or gums that bleed easily.

How gum disease is a risk factor for heart disease

Not only are diseases of the gums and teeth believed to be risk factors for heart disease, but heart disease is also believed to be a risk factor for diseases of the mouth. Therefore, patients with gum disease are encouraged to pay special attention to their oral care to help prevent heart disease, and heart patients are encouraged to follow all heart-healthy recommendations.

Gum disease is a chronic bacterial infection of the gums. The beginning stage of the disease is known as gingivitis, which is a reversible condition marked by inflammation and bleeding of the gums. The later, irreversible stage is known as periodontitis. Periodontitis involves loosening of the teeth and deterioration of the jaw bone that supports them. Advanced gum disease can lead to chewing problems, pain, tooth loss and, possibly heart disease. Research has shown that people with gum disease may be at increased risk for developing heart disease.

Periodontal patients have nearly twice the risk of having a fatal heart attack than patients with healthy gums.

Once oral bacteria enter the bloodstream, they irritate the lining of the artery walls, causing inflammation. This inflammation triggered by infection, promotes the formation of fatty plaques and leaves them vulnerable to the ruptures that cause heart attacks and strokes. This buildup along the inside of the artery walls is known as atherosclerosis. Atherosclerosis may begin as early as childhood, but it is the advanced stages of this condition that are most dangerous later in life. These advanced stages can cause a narrowing of the artery and speed the rate at which the artery is blocked or closed altogether. The arteries are hardened and narrowed as a result of plaque. These masses of plaque may eventually lead to a partial or complete blockage of the blood flow through the artery, leading to the failure of cells and organs throughout the body as they are starved of oxygen. Plaque can be a source of blood clots. If large enough, they can block an artery already narrowed by plaque. If such a clot forms in an artery leading to the heart, the blockage that results can cause a heart attack. When a clot cuts off blood to the brain, the result is a stroke.

If the affected artery is one of the coronary arteries, then a lack of oxygen-rich blood to the heart could cause coronary artery disease and, consequently, increase an individual’s risk of a heart attack, cardiac arrest, and sudden cardiac death.

Gum disease and atherosclerosis

Oral bacteria can enter the bloodstream and travel to major organs and begin new infections. Research is suggesting that this may contribute to the development of heart disease, America’s number one killer; increase the risk of stroke; increase a woman’s risk of having a preterm, low birth weight baby; pose a serious threat to people whose health is compromised by diabetes, respiratory diseases, or osteoporosis.

Stroke. Studies have pointed to a relationship between gum disease and stroke. In one study that looked at the relationship of oral infection as a risk factor for stroke, people diagnosed with acute cerebrovascular ischemia were found more likely to have an oral infection when compared to those in the control group. Periodontitis is a risk factor for atherosclerosis. Heart attacks and stroke are primarily caused by the effects of atherosclerosis.

Osteoporosis. Researchers have suggested a link between osteoporosis and bone loss in the jaw.

However, hormone replacement therapy may offer some protection, estrogen supplementation in women within five years of menopause slows the progression of gum disease. Researchers have suspected that estrogen deficiency and osteoporosis speed the progression of oral bone loss following menopause, which can lead to tooth loss. The study concluded that estrogen supplementation may lower inflammation of the gums and the rate of destruction of the fibers and bone that support the teeth in woman with signs of osteoporosis, thus helping protect the teeth.

Preterm Low Birth Weight Births. For a long time we’ve known that risk factors such as smoking, alcohol use, and drug use contribute to mothers having babies that are born prematurely at a low birth weight. Pregnant women who have gum disease may be seven times more likely to have a baby that is born too early and too small. It appears that gum disease triggers increased levels of biological fluids that induce labor. Furthermore, data suggests that women whose periodontal condition worsens during pregnancy have an even higher risk of having a premature baby.

Diabetes. People with diabetes are more likely to have gum disease than people without diabetes, probably because diabetics are more susceptible to contracting infections. Poorly controlled type 2 diabetic patients are more likely to develop gum disease than well controlled diabetics are. Diabetics who have gum disease should be treated to eliminate the gum infection.

Respiratory Diseases. Bacterial respiratory infections are thought to be acquired through inhaling of fine droplets from the mouth and throat into the lungs, especially in people with gum disease. These droplets contain bacteria that can breed and multiply within the lungs and cause damage. This discovery leads researchers to believe that these respiratory bacteria can travel from the oral cavity into the lungs to cause infection.

Identifying risk factors, as well as undertaking lifestyle changes that will reduce risk, are hallmarks for risk reduction and disease prevention in regard to gum disease. The ultimate goal is to maintain oral health and to prevent the onset of any form of gum disease. Some of the risk factors for gum disease include, increasing age, cigarette smoking, poor oral hygiene habits, hormonal changes in girls/women, medications, illnesses, genetic susceptibility, poor eating habits, stress, and a diabetes diagnosis. Risk reduction is an integral part of prevention, treatment and maintenance of periodontal disease. Major risk factors for heart disease have been identified and are well-understood. Attempts to reduce risk exposure have been highly successful in lowering the incidence of the disease. Gum disease, combined with other risk factors, can increase a persons chance of having a heart attack or stroke. A lifestyle that includes consistent oral hygiene care, weight control, physical fitness, sensible eating habits, avoidance of cigarette smoking, reduction of cholesterol, and control of high blood pressure, may prevent many chronic diseases, to include tooth decay, gum disease, and heart disease.

Since studies suggest that people who have gum disease seem to be at a higher risk for heart attacks, it is paramount to identify other controllable risk factors, and reduce risk by practicing a lifestyle that minimizes the risk of future heart disease and stroke. Risk factor modification has clearly been shown to save lives.

The American Heart Association has identified several risk factors. Some of them can be modified, treated, or controlled, and some can’t. The more risk factors you have, the greater your chance of developing coronary heart disease.

Risk factors that can’t be changed

Increasing age - About four out of five people who die of coronary heart disease are 65 or older. At older ages, women who have heart attacks are more likely than men are to die from them within a few weeks.

Sex - Cardiovascular disease is the leading killer of men and women in the United States. Heart disease kills 500,000 American women each year, over 50,000 more women than men. Women have heart attacks, on average, 10 years later than men. Women are more likely than men to have a second heart attack within a year of the first one. Women and men may experience different symptoms of a heart attack.

Heredity (including Race)- Children of parents with heart disease are more likely to develop it themselves. African Americans have more severe high blood pressure than Caucasians and a higher risk of heart disease. Most people with a strong family history of heart disease have one or more risk factors.

Just as you can’t control your age, sex and race, you can’t control your family history. It’s even more important to treat and control any other risk factors you have.

Risk factors that can be modified, treated, or controlled

Cigarette smoking - Smokers’ risk of heart attack is more than twice that of nonsmokers. Cigarette smoking is the biggest risk factor for sudden cardiac death. Cigarette smoking also acts with other risk factors to greatly increase the risk for coronary heart disease.

High blood pressure - High blood pressure increases the heart’s workload, causing the heart to enlarge and weaken. When combined with obesity, smoking, high blood cholesterol or diabetes, the risk of heart attack or stroke increases several times.

High blood cholesterol - As blood cholesterol rises, so does risk of coronary heart disease. When other risk factors (such as high blood pressure and tobacco smoke) are present, this risk increases even more.

Physical inactivity- A sedentary lifestyle is a risk factor for coronary heart disease. Regular, moderate-to-vigorous physical activity helps prevent heart and blood vessel disease.

Overweight and obesity - People with excess body fat, especially in the waist, are more likely to develop heart disease and stroke even without other risk factors. Excess weight increases the strain on the heart. It also raises blood pressure, blood cholesterol, and triglycerides levels, and lowers HDL (good) cholesterol levels.

Heart disease - Heart disease is one of the most preventable diseases in existence. Numerous studies have demonstrated that commitment to basic lifestyle changes significantly reduces the chance of having a first heart attack and can reduce the overall risk for heart disease.

Gum disease - Gum disease is a threat to oral and total health. Gum disease is a bacterial infection, and all infections are cause for concern. Oral bacteria in the bloodstream may contribute to the development of heart disease.

Stress - Avoid unhealthy strategies to include overuse of alcohol, the overuse of either illegal or prescription drugs, smoking, overeating, violence, and yelling at or verbally abusing others.

Gum Disease Gum disease is a chronic infection of the gums and surrounding tissue. Gum disease is a threat to your oral and total health. Several theories exist to explain the link between gum disease and heart disease. Gum disease is a bacterial infection, and all infections are cause for concern.

Gum disease is a risk factor for the development of heart disease, including atherosclerosis. The same bacteria that cause gum disease and irritate your gums might travel to your arteries. Once bacteria reaches the arteries, they can irritate them in the same way that they irritate gum tissue. This could cause plaque to accumulate in the arteries, which can cause narrowing and block blood flow. Heart disease is characterized by a narrowing of the arteries due to a build up of fatty plaque. Blood clots can also obstruct normal blood flow, restricting the amount of nutrients and oxygen required for the heart to function properly. This may lead to heart attacks and strokes.

Lifestyle to Reduce Risk• Brush twice daily.

• Floss once a day. Daily flossing helps improve oral and total health.

• Visit your oral health care provider regularly for a checkup and professional cleaning.

• Eat a well-balanced diet.

• Avoid smoking and chewing tobacco.

www. adha.org

Heart Disease Heart disease is America’s number one killer. Heart disease is one of the most preventable diseases in existence. Numerous studies have demonstrated that if you commit yourself to four basic lifestyle changes - not smoking, eating healthfully, exercising regularly, and controlling your blood pressure - you can significantly reduce your chances of having a first heart attack. Research has also demonstrated that a healthy lifestyle that includes daily flossing may promote total health as much as diet and exercise. A number of studies have also suggested that people with gum disease may face an increased risk of heart disease.

www.americanheart.org/heartprofilers

This web site is a free interactive tool that provides personalized information, based on the latest clinical research, to enable heart disease patients, their families and care givers to manage their disease and make better treatment decisions.

Lifestyle to Reduce Risk

Lowering your risk for heart disease is easier than you think. Just take these simple steps:

• Eat a sensible diet low in fat, trans fat, saturated fat and cholesterol.

• Schedule time for physical activity.

• If you smoke, stop smoking.

• Get regular medical checkups and follow your doctor’s and nurse’s advice to control your blood pressure, cholesterol and body weight.

• Visit your oral health care provider regularly, practicing consistent and thorough oral hygiene everyday.

High Blood Pressure High blood pressure is the number one modifiable risk factor for stroke. It may also contribute to heart attacks, kidney failure and atherosclerosis. People with uncontrolled high blood pressure are:

• Three times more likely to develop heart disease• Six times more likely to develop congestive heart failure• Seven times more likely to have a stroke

Lifestyle to Reduce Risk

The American Heart Association states that to maximize the beneficial effects of diet on blood pressure:

• Don’t eat a lot of salt• Eat enough fruits, vegetables, and fat-free or low-fat

dairy products• Have your blood pressure checked regularly• Lose weight if you are overweight• Be more active• Limit alcohol to no more than two drinks a day.

Alcohol can increase your blood pressure• Take medicine the way your doctor tells you• Know what your blood pressure should be and try to

keep it at that level.

This web site includes easy-to-understand information about high blood pressure, basic tips on how to control high blood pressure, suggested questions to ask your doctor, and heart-healthy recipes.

www.nhlbi.nih.gov/hbp/index.html

High Blood Cholesterol Too much cholesterol in your blood can lead to heart disease - America’s number one killer. While some cholesterol is needed for good health, too much cholesterol can raise your risk of having a heart attack or stroke. High blood cholesterol is a reversible risk factor for heart disease.

The extra cholesterol in your blood may be stored in your arteries and cause them to narrow. This called atherosclerosis. Large deposits of cholesterol can completely block and artery, so blood can’t flow through. If an artery that supplies blood to your heart becomes blocked, a heart attack can occur.

Recent studies have demonstrated a link between gum disease and heart disease. Oral bacteria can affect the heart when they enter the bloodstream which may contribute to the narrowing of the arteries, and in conjunction with other risk factors, may lead to heart disease, and a heart attack.

Lifestyle to Reduce Risk• Have your cholesterol checked regularly.

Take steps to lower it if it’s high.• Don’t smoke.• Have your blood pressure checked

regularly. Take steps to lower it if it’s high.

• Be more physically active.• Maintain a healthy weight.• Eat healthy foods that are low in

saturated and trans fat, cholesterol, and sodium.

• Don’t drink too much alcohol. It can increase your blood pressure.

This web site provides information for those who want to prevent heart disease; information for those with heart disease who want to reduce their risk of having a heart attack; a “how to” step-by-step guide to lowering cholesterol.

www.nhlbi.nih.gov/chdLive Healthier, Live Longer

Physical Inactivity Physical inactivity and unhealthy eating contribute to obesity,cancer, heart disease, and diabetes. Together, they are responsible for at least 300,000 deaths per year. Only cigarette smoking causes more preventable deaths in the United States. People who avoid the behaviors that increase their risk for chronic diseases can expect to live healthier and longer lives.

Regular physical activity reduces the risk of developing or dying from some of the leading causes of illness in the United States. Regular physical activity improves health in the following ways:

• Reduces the risk of dying prematurely from heart disease and other conditions.• Reduces the risk of developing diabetes.• Reduces the risk of developing high blood pressure.• Reduces blood pressure in people who already have high blood pressure.• Reduces the risk of developing colon and breast cancer.• Helps maintain a healthy weight.• Helps build and maintain healthy bones, muscles, and joints.• Helps older adults to become stronger and better able to move about without falling.• Reduces feelings of depression and anxiety.• Promotes psychological well-being.

www.justmove.org

This web site has an exercise diary to keep track of your progress online, fitness resources, and information to help you decide which fitness type best describes your lifestyle.

Lifestyle to Reduce Risk

• Talk to your doctor or nurse about activities that are right for you.

• Start slowly and build up as your heart gets stronger.• Try to exercise at the same time of day so it becomes

a regular part of your lifestyle.• Be committed to change.• Keep track of your progress on-line with Just

Move.org. Get recommendations for getting the greatest benefit from physical activity in your daily life.

Overweight and Obesity Obesity is a condition in which a person is more than 20 percent over his or her ideal weight. As a major risk factor, obesity is the second leading cause of preventable death, surpassed only by cigarette smoking. For most people, weight gain can be prevented or controlled by adequate diet and exercise.

Ideally, good habits begin in childhood, because studies have shown that overweight children are likely to carry this condition into adulthood. Poor eating habits are often established during childhood.

When added to regular physical activity, avoidance of smoking, - maintaining a healthy weight may provide significant benefit in the prevention of heart disease.

Eating much more fat than you need for energy can lead to weight gain and obesity. Excess calories are stored in the body as fat; if too much body fat builds up, weight gain is inevitable. Diets that are high in cholesterol, saturated and trans fat greatly increases the risk of atherosclerosis, high blood pressure and obesity.

Lifestyle to Reduce Risk

www.nhlbi.nih.gov/subsites/index.htm(click on Aim for a Healthy Weight)

This web site gives information on clinical guidelines and practical tools for identifying, assessing and treatingoverweight and obesity.

• It is important for you to talk to your doctor or nurse so he or she can recommend the best treatment.

• Lose weight slowly.• Eat a variety of foods to include, fruits,

vegetables, and whole grains with little added fat or sugar.

• Eat less fat, especially trans and saturated fat, and cholesterol.

• Aim to prevent further weight gain.• Be active for at least 30 minutes each day.

Your heart will be healthier if you reach and maintain your best weight, taking the extra strain off your heart and lowering your risk for heart problems.

Healthy food habits can help you reduce another risk for a heart attack - high blood cholesterol. Most American diets are too high in fat, especially trans and saturated fat. A diet low in fat will reduce your chances of heart disease and help you maintain a healthy weight.

Stress Irrespective of what you do, you have and will experience stress at some time in your life.

• Stress is recognized as a silent killer today. The American Medical Association stated that stress was the cause of 80 to 85 percent of all human illness and disease or at the very least had a detrimental effect on our health.

• Every week, 95 million Americans suffer some kind of stress related symptom for which they take medication.

The heart and vascular system is one of the largest and most important body systems. The cardiovascular system’s primary functions are to deliver oxygen and vital nutrition to cells throughout the body. Heart disease and stroke are the number one and number three killers in the United States. They are often referred to as “silent killers”, along with stress, because the first symptom or sign in many cases is a fatal event. Stress increases heart rate and blood pressure. It changes the inner lining of your arteries, making our blood more likely to clot. Stress may change the way cholesterol is handled by your arteries and, in doing so, may increase fatty plaque accumulation associated with atherosclerosis. People under stress may overeat, start smoking or smoke more than they otherwise would. Triggers for heart attacks for both sexes include arterial blockage, stress, exercise, and heavy meals. While male triggers appear to be physical, female triggers appear to be emotional. Some studies have indicated that men have physical exertion, such as shoveling snow, prior to heart attacks while women experience emotional stress. Emotional stress may place a strain on more than your heart, emotional anxiety could affect your oral health. Emotional factors play a significant role in adult gum disease. Researchers discovered that the severity of gum disease increased with the number of negative life events experienced in a patient’s in a patient’s life. People who endure negative occurrences tend to compromise their oral care. To prevent stress from affecting your oral health, frequently brush and floss every day, and have your teeth professionally cleaned regularly.

• Take one thing at a time and be realistic about your expectations

• Exercise regularly and eat a balanced diet• Don’t disrupt your sleep patterns• Meditate• Allow enough time for yourself each day to perform

daily tasks such as brushing and flossing

http://holistic-online.com/stress/stress_home.htm

You will learn how to detect symptoms of stress,recognize diseases that are often mistaken for stress, and common sense ways to manage and prevent stress.

Aim for a Healthy WeightAssessment of overweight involves using three key measures:

Body Mass Index (BMI)

Waist Circumference

Risk Factors for Diseases and Conditions Associated with ObesityThe more risk factors you have, the more you are likely to benefit from weight loss if you are overweight or obese.

• Do you have a personal or family history of heart disease?• Are you a male older than 45 years or a post menopausal female?• Do you smoke cigarettes?• Do you have a sedentary lifestyle?• Has your doctor told you that you have

- high blood pressure?- abnormal LDL (bad) cholesterol, low HDL (good) cholesterol, high

triglycerides?- diabetes?

• Aim for a healthy weight. If you are at a healthy weight, aim to avoid weight gain. If you are already overweight, first aim to prevent further weight gain, and then lose weight to improve your health.

• Eat a well-balanced diet, with little added fat or sugar, include vegetables, fruits, and grains (especially whole grains) .

• Select sensible portion sizes.• Get moving. Get regular physical activity to balance calories from the foods you eat.• Keep in mind that even though heredity and the environment are important influences, your

behaviors help determine your body weight.

The BMI is a measure of your weight relative to your height. Combined with waist circumference and additional risk factors, yields your risk for developing obesity-associated diseases.

Men are at increased relative risk for disease if they have a waist circumference greater than 40 inches; women are at an increased relative risk if they have a waist circumference greater than 35 inches.

Body Mass Index (BMI)

Talk to your doctor to see if you are at an increased risk and if you should lose weight. Your doctor will evaluate your BMI, waist measurement, and other risk factors for heart disease. People who are overweight or obese have a greater chance of developing high blood pressure, high blood cholesterol, type 2 diabetes, heart disease, stroke, and certain cancers, and even a small weight loss (just 10 percent of your current weight) will help lower your risk of developing those diseases.

To estimate your body mass index (BMI), first identify your weight (to the nearest 10 pounds) in one of the columns across the top. Then move your finger down the column until you come to the row that represents your height. Inside the square where your weight and height meet is a number that is an estimate of your BMI.

Be Physically Active People who get regular exercise are less likely to have a heart attack and/or die from heart disease. Exercise has dramatic benefits for the heart and blood vessels, which include the following:

• Decreasing the heart’s need for oxygen. The heart can work more efficiently.

• Strengthening the heart muscle. The heart pumps fewer times while still meeting the body’s demand for oxygen-rich blood.

• Reducing the level of triglycerides and LDL (bad) cholesterol. Both of these types of blood fats have been associated with an increased risk of heart disease.

• Increasing the level of HDL (good) cholesterol. Moderately high levels of HDL cholesterol have been identified as a protective factor against heart disease.

• Lowering blood pressure. High blood pressure puts an added strain on the cardiovascular system.

• Helping to keep the blood vessels clear of blood clots and the buildup of fatty plaque.

• Reversing the process of atherosclerosis.

Regular physical activity, fitness and exercise are critically important for the health and well-being of people of all ages. Research has demonstrated that virtually all individuals can benefit from regular physical activity, whether they participate in vigorous exercise or some type of moderate health-enhancing physical activity.

Despite the well-known benefits of physical activity, most adults and many children lead a relatively sedentary lifestyle and are not active enough to achieve these benefits. A sedentary lifestyle is defined as engaging in no leisure-time physical activity (exercise, sports, physically active hobbies) in a two-week period.

Participation in regular physical activity, at least 30 minutes of moderate activity on at least 5 days per week, or 20 minutes of vigorous physical activity at least 3 times per week, is critical to sustaining good health.

Washing and waxing a car for 45-60 minutesPlaying volleyball for 45-60 minutesWalking 2 miles in 30 minutesBicycling 5 miles in 30 minutesPlaying basketball for 15-20 minutesGardening for 30-45 minutesStair walking for 15 minutesRunning 1 1/2 miles in 15 minutesJumping rope for 15 minutesDancing fast (social) for 30 minutesSwimming laps for 20 minutesPushing a stroller 1 1/2 miles in 30 minutesRaking leaves for 30 minutesPlaying touch football for 45 minutesWashing windows or floors for 45-60 minutes

Examples of moderate amounts of physical activity

Choose Sensibly• Choose a diet that is low in

saturated fat, trans fat and cholesterol and moderate in total fat.

• Choose beverages and foods to moderate your intake of sugars.

• Choose and prepare foods with less salt.

• If you drink alcoholic beverages, do so in moderation.

KNOW THE DIFFERENT TYPES OF FATS

Saturated Fats - Foods high in saturated fats tend to raise blood cholesterol. These foods include high-fat dairy products (cheese, whole milk, cream, butter, and regular ice cream), fatty fresh and processed meats, the skin and fat of poultry, lard, palm oil, and coconut oil.

Dietary Cholesterol - Foods that are high in cholesterol also tend to raise blood cholesterol. These foods include liver and other organ meats, egg yolks, and dairy fats.

Trans Fat - Foods high in trans fat tend to raise blood cholesterol. These foods include those high in partially hydrogenated vegetable oils, such as many hard margarines and shortenings. Foods with a high amount of these ingredients include some commercially fried foods and some bakery goods.

Unsaturated Fats - Unsaturated fats (oils) do not raise blood cholesterol. Unsaturated fats occur in vegetable oils, most nuts, and olives. Some fish, such as salmon, tuna, and mackerel, contain omega-3 fatty acids that studies have shown to be protective against heart disease.

SUGARS AND TOOTH DECAY

Foods containing sugars and starches can promote tooth decay. The more often you eat foods that contain sugars and starches, and the longer these foods remain in your mouth before you brush your teeth, the greater your risk for tooth decay. Foods containing added sugars provide calories, but may have few vitamins and minerals. Major sources of added sugar include soft drinks,cakes, cookies, pies, fruitades and drinks, candy, and dairy desserts such as ice cream. Brush and floss after eating sticky foods.

TIPS TO REDUCE SALT AND SODIUM

Use fresh poultry, fish, and lean meat, rather than canned or processed types. Use herbs, spices and salt-free seasoning blends in cooking and at the table. Choose “convenience” foods that are lower in sodium. Look for “with no salt added.”

If you drink alcoholic beverages, have only one drink a day for women; two drinks a day for men. That’s 12 oz. beer, 5 oz. wine, or 1 1/2 oz. whiskey. Studies show that moderate consumption lowers the risk of heart attack for people middle age by 30 to 50 percent.

MODERATION

Choose A Variety• Choose a variety of grains daily, especially whole grains.

• Choose a variety of fruits and vegetables daily.

A diet low in nutrients can diminish the body’s ability to fight infection. Gum disease is an infection. A well-balanced diet benefits your oral health as well as your overall general health. Diseases that interfere with the body’s immune system, such as leukemia and AIDS, may worsen the condition of the gums. Adults should consume at least three servings of calcium each day. The relationship between calcium intake and gum disease is likely due to calcium’s role in building density in the bone that supports your teeth. Calcium is necessary for healthy bones, teeth, muscle contractions and other body functions. In addition to calcium, research has shown that not getting enough vitamin C may put you at increased risk for gum disease. A balanced diet contains proteins, carbohydrates, essential fatty acids, vitamins and minerals, and fiber. Nutrient-dense foods include whole grains, fruits and most vegetables.

Soy

Fish oil

Alcohol

Carotenoids

Fruits

Whole Grains

Vegetables

Vitamin B-12

Folic Acid

Calcium

Vitamin A

Proteins

Vitamin K

Vitamin D

Beans

Vitamin E

Antioxidants

Garlic

CarbohydratesEssential Fatty Acids

American Dietetic Association www.eatright.com

CarbohydratesOatsOats

Fiber

PATIENT’S NAMELast First Date of Birth

Have there been any changes in your health since your last dental visit? Yes/No

RISK ASSESSMENT FOR CARDIOVASCULAR DISEASE (CVD) This risk assessment is designed to identify patients who are at high risk of developing cardiovascular disease.

If two or more risk factors are identified, refer the patient to an appropriate medical provider for further evaluation.Use only as a screening tool, and not to make a diagnosis of cardiovascular disease.

1. Age? ______ (Higher risk: Women: >55 years old, Men: > 45 years old)

2. Do you smoke or live or work with others who smoke tobacco daily? ______ (Answer yes if you have smoked anytobacco in the past month or have been exposed to secondhand smoke.)

3. Have you been told your blood pressure is too high ( > 140/90 mm Hg)? _____(Normal: <120 and <80 mm HgPrehypertension 120-139 or 80-89 mm Hg; Stage 1 HTN 140-159 or 90-99 mm Hg; Stage 2 HTN > 160 or > 100 mm Hg)

4. Is your total cholesterol level > 240 mg/dL? ______ (TC<200 mg/dL, LDL <100 mg/dL, HDL >60 mg/dL, TG <150 mg/dL)

5. Is your diet high in saturated fat, trans fat and/or dietary cholesterol?_____ (Limit saturated fat and avoid trans fat)

6. Is your fasting blood sugar level > 126 mg/dL? ______(Desirable: <100 mg/dL; Prediabetes: 100-125 mg/dL)

7. Do you have diabetes or have a family history of diabetes? ______ (Parent, brother or sister who has diabetes)

8. Are you or have you ever been under the care for heart problems? ______ (Type: _____________________)

9. Do you have a family history of heart disease? ______ (Father/brother had heart attack before age 55; mother or sister had a heartattack before age 65; mother, father sister, brother or grandparents had a stroke)

10. Are you fairly inactive? Do you exercise fewer than 3 times a week? ______ (Min: 30 mins. 5 days per week)

11. Are you overweight according to the BMI? ______ (Normal weight: <24.9, Overweight: 25-29.9, Obese: 30 or greater)

Date Patient signature

Tobacco Use: Current Former Never

Form: Frequency: Referral:

Diet Screening: Low Risk Moderate Risk High RiskReferral:

Blood Pressure:Referral:

Staff: Ask about tobacco use and document, advise those whouse to quit, and refer to quitline. Screen patient for dietary andnutritional risk. Measure and record blood pressure.

Patient: Include medications, medication changes, majorillnesses, hospitalizations, operations, pregnancy, diet changes,allergies, high blood pressure, diabetes, or heart problems.

Form designed by C. Austin Risbeck, 2004

HEALTH HISTORY UPDATE

PATIENT’S NAMELast First Date of Birth

Have there been any changes in your health since your last dental visit? Yes/No

Date Patient signature

Have there been any changes in your health since your last dental visit? Yes/No

Date Patient signature

Have there been any changes in your health since your last dental visit? Yes/No

Date Patient signature

HEALTH HISTORY UPDATE-2

Tobacco Use: Current Former Never

Form: Frequency: Referral:

Diet Screening: Low Risk Moderate Risk High RiskReferral:

Blood Pressure:Referral:

Tobacco Use: Current Former Never

Form: Frequency: Referral:

Diet Screening: Low Risk Moderate Risk High RiskReferral:

Blood Pressure:Referral:

Tobacco Use: Current Former Never

Form: Frequency: Referral:

Diet Screening: Low Risk Moderate Risk High RiskReferral:

Blood Pressure:Referral:

Staff: Ask about tobacco use and document, advise those whouse to quit, and refer to quitline. Screen patient for dietary andnutritional risk. Measure and record blood pressure.

Staff: Ask about tobacco use and document, advise those whouse to quit, and refer to quitline. Screen patient for dietary andnutritional risk. Measure and record blood pressure.

Staff: Ask about tobacco use and document, advise those whouse to quit, and refer to quitline. Screen patient for dietary andnutritional risk. Measure and record blood pressure.

Patient: Include medications, medication changes, majorillnesses, hospitalizations, operations, pregnancy, diet changes,allergies, high blood pressure, diabetes, or heart problems.

Patient: Include medications, medication changes, majorillnesses, hospitalizations, operations, pregnancy, diet changes,allergies, high blood pressure, diabetes, or heart problems.

Patient: Include medications, medication changes, majorillnesses, hospitalizations, operations, pregnancy, diet changes,allergies, high blood pressure, diabetes, or heart problems.

Form designed by C. Austin Risbeck, 2004

TOTAL HEALTH & DISEASE PREVENTION

Client Information Sheets

Sheet #E-mailName

1 Tooth Decay-Cause & Prevention 11 Risk factor-Overweight & Obesity2 Gum Disease-Cause & Prevention 12 Risk factor-Stress3 How gum disease is a risk factor for heart disease 13 Nutrition: Aim for a healthy weight4 Risk factor-Gum disease 14 Nutrition: Body Mass Index (BMI)5 Risk factor-Heart disease 15 Nutrition: Be physically active6 Oral bacteria & other connections 16 Nutrition: Choose sensibly7 Risk factor-Cigarette smoking 17 Nutrition: Choose a variety8 Risk factor-High blood pressure 18 Risk factors that can’t be changed9 Risk factor-High blood cholesterol 19 Risk factors that can be changed

10 Risk factor-Physical inactivity

If You Have Diabetes, Talk to Your Doctor aboutYour Increased Risk for Heart Disease and Stroke

Questions to Ask

If you have diabetes, you areat high risk for having a heartattack or stroke. In fact, twoout of three people with diabetes die from heart diseaseor stroke.

You can help to lower yourrisk by managing the ABCs ofdiabetes. A is for A1C, a testthat measures average bloodglucose over the past 2 to 3months; B is for blood pres-sure; and C is for cholesterol.

Talk to your doctor or othermember of your health careteam about the link betweendiabetes and heart disease. Puta check next to the questionsyou want to address at yournext visit.

QWhat are my ABCnumbers and what are

my ABC goals?

A Ask your health careteam about your ABC

goals. Goals recommended formost people with diabetes arelisted in the following box.

Q How often should myABCs be checked?

A The American DiabetesAssociation recommends

that people with diabetes gettheir A1C level checked at leasttwice a year and blood pressuremeasured at every visit. Mostpeople with diabetes shouldhave cholesterol levels checkedat least once a year.

QWhat steps can I taketo reach each of my

ABC goals?

A Work with your healthcare team to develop a

diabetes care plan that fits yourlifestyle. To reach your ABCgoals, you may have to makechanges to your meal plan orexercise routine. Usually, medi-cines are needed to keep yourABCs on track. Many peoplewill require multiple medicinesto reach all of their goals.

Q Can taking medicinessuch as aspirin, ACE

inhibitors or statins help mereduce my risk for a heartattack or stroke?

A Medicines such as aspirinand certain pills for

blood pressure and cholesterolhave been shown to reduce thechances of having a heartattack or stroke. Work withyour health care team to deter-mine which medicines are bestfor you.

ADA My My Goals Numbers Goals

A1CBelow 7 ______ ______

Blood pressureBelow 130/80 ______ ______

CholesterolLDLBelow 100 ______ ______

HDLAbove 45 (men) ______ ______

Above 55 (women) ______ ______

TriglyceridesBelow 150 ______ ______

www.diabetes.org/MakeTheLink

QWhat are symptoms ofheart attack and stroke

that I need to watch for? DoI need special testing todetect heart disease?

A Warning signs of a heartattack may include pain

or tightness in your chest,shoulder, neck or jaw; short-ness of breath; sweating orlight-headedness; and indiges-tion or nausea. In people withdiabetes, feeling sick to yourstomach or short of breath,even without chest pain, ismore common. Some people

with diabetes have no symp-toms at all.

Warning signs of a strokeinclude sudden weakness ornumbness of your face, arm, orleg on one side of your body;sudden confusion or dizziness;sudden trouble talking or see-ing; or sudden severe headache.

If you have warning signs ofa heart attack or a stroke, call 9-1-1 right away.

In addition to your regularcheck-ups, your health careteam may do special tests tocheck the condition of yourheart and blood vessels.

QWhat’s the best way forme to quit smoking?

A Quitting smoking is oneof the hardest things you

will ever do, but you’ll be gladyou did it.

Nicotine patches, gum andnew medicines can help.Making a plan can also helpyou get through tough times.Ask your doctor or other member of your health careteam for help.

For more information on diabetes and cardiovascular disease, contact the American Diabetes Association at

1-800-DIABETES (1-800-342-2383).

Visit us online at diabetes.org/MakeTheLink

www.diabetes.org/MakeTheLink