Lifestyle And Oral

Health
Dr. Zoha Abdullah
II MDS
Public health dentistry

Contents

Introduction
Life Style Variables
Terms associated with lifestyle
Life Style and oral health
Socio-economic Factors
Related literature
Conclusion
References

Introduction
The typical way of life of an
individual, group, or culture.
The termstyle of life
(Lebensstil)
was used by Alfred Adler
dynamics of the personality.
Reflects the.

What is lifestyle?
Denotes the way people live, reflecting a whole
range of social values, attitudes and activities.
Composed of cultural and behavioral patterns
and

life

long

personal

habits

that

have

developed through process of socialization.

Definition
WHO health promotion glossary,
1998
Aaro et al, 1986
Pender J et al, 2006

Terms associated with

lifestyle

Attitudes
Custom
Belief
Taboo
Tradition
Culture
Habit
Behaviour

Lifestyle variables

Personal hygiene
Diet and regularity of meals
Hours of sleep
Physical activity
Personal habits like tobacco, alcohol,
Drug abuse
Anxiety, tension, stressful nature of jobs
Occupation, Education

Factors influencing
lifestyle

Lifestyle as a determinant of
health
Strong evidence has been established regarding the association
between health and lifestyle of individuals.
Many current day health problems like coronary heart disease,
cancer, diabetes etc are associated with lifestyle changes.
In developing countries like India, where traditional lifestyles still
persist, risks of illness and death are connected with lack of
sanitation, poor nutrition, personal hygiene, elementary human
habits, customs and cultural patterns.

The relationship between clinical

variables and adoption of healthy
lifestyles
Subjects with a history of diabetes had more health responsibilities. These
patients need to regularly check and manage their diabetes. Therefore,
the nature of this disease as well as patients role in disease management
might be responsible for the improvement of health responsibility.
Smokers are not adopting Healthy lifestyle behaviors on a regular basis.
Smoking is one of the unhealthy habits that might indicate a lack of sense
for health responsibility, and negatively affect smokers nutritional habits.

The relationship between

sociodemographic factors and
adoption of healthy lifestyles
Women were living healthier lifestyles than men
Women

scored

responsibility,

better
nutrition,

than

men
spiritual

in

health
growth,

interpersonal relationships and stress management.

Married subjects seem to have healthier dietary
lifestyles than single, divorced and widowed subjects.

 Younger subjects reported being more physical active.

Educated subjects were adopting more HLBs; were more

physically active and ate healthier diet.

Subjects used public transportation were physically

more active than those who had private transportation

Lifestyle and oral health

Lifestyle and dental health behavior
Nutrition and oral health
Tobacco and oral health
Alcohol and oral health
Drug addiction and oral health
Stress and oral health
Cultural practices and oral health

Lifestyle and dental health

behaviors
Substantially

higher

proportions

of

regular

dental visitors are found in higher social class

than in lower classes.
There is substantial association between dental

visits, oral hygiene habits, consumption of

sugars and income, working hours and strained
life situation.

 Health behaviors, such as smoking, alcohol

consumption, dietary habits and physical activity

individually or in combination are associated
with general health.
Also associated with dental health behaviors,

and dental health behaviors can be understood

as part of the lifestyle (Schou et al. 1990,
Kuusela 1997).

Oral hygiene behaviors

Use of oral hygiene aids,
Brushing frequency,
Use of dentrifice,
Use of dental services and
Frequency of dental visits

Use of oral hygiene aids

Irregular tooth brushing is associated with Dental
caries and Periodontitis.
Previous studies have reported conflicting results
showing some [Chu et al., 1999] or no effect [Namal
et al., 2005].
People who use tooth brush report to have lower
prevalence of caries than who use finger or who
dont use any other aids for cleaning the teeth.

Frequency of brushing
Data from a number of countries those who start to brush before a
year old, twice a day, & with parental involvement, doubles the odds of
being decay free, irrespective of the level of disadvantage.
Rajala et al. (1980) found that the frequency of tooth brushing correlated
negatively with sugar consumption among 13 to 19 year-old adolescents.
Physical activity was positively related to tooth brushing, while alcohol
consumption and smoking correlated negatively.
Schou et al. (1990) concluded that tooth brushing was not an isolated
behavior but part of a childs lifestyle.

Indigenous aids
Use of chewing sticks for cleaning teeth is practiced in many countries
including India, Pakistan, Tanzania, Ethiopia and in Middle East countries.
Danielsons B, 1989 Miswak to be as effective as the toothbrush in
removing oral deposits.
No differences in plaque and gingival bleeding were found between
toothbrush and chewing stick users among 7-15 years old children in
Tanzania (Sote EO, 1987).
Cross sectional studies showed higher plaque and gingival bleeding
(Norman S, 1989) along with deeper pockets (Gazi M, 1990).

Miswak users
had significantly more sites of gingival recession than did the
toothbrush users.
With increased severity of the recession

Johansson et al., reported occlusal wear in a young Saudi

population which was significantly associated with Miswak use.

Early childhood caries and tooth

brushing
Children who commenced tooth brushing earlier
(age 12 months) had significantly lower ECC
experience

compared

to

children

that

commenced tooth brushing later (age 13 months)

(Hallett KB, 2003).

Dentrifices
Fluoridated tooth paste
The review of trials found that children aged 5 to 16
years who used fluoridated toothpaste had fewer
decayed, missing and filled permanent teeth after
three years (regardless of whether their drinking
water was fluoridated).
Twice a day use increases the benefit.
Supported by more than half a century of research,
the benefits of fluoride toothpastes are firmly
established in preventing caries (Marinho VCC,
2003).
Marinho
VCC, Higgins JPT, Logan S, Sheiham A. Fluoride toothpastes for
preventing dental caries in children and adolescents. Cochrane Database
of Systematic Reviews 2003, Issue 1. Art. No.: CD002278.

Whitening toothpastes are commonly used by individuals who

are meticulous with oral hygiene.
May be a reflection of a lifestyle or behavioral attribute of
being overzealous about oral hygiene and such individuals
may be more prone to erosion

Millward et al., 1994a; Zero,

1996; Moss, 1998; Shaw and
Smith, 1999

May be more effective in removing or reducing salivary pellicle,

which has been shown to protect teeth from dental erosion
Meurman and Frank, 1991; Kuroiwa
et al., 1993; Amaechi et al., 1999

Mattila ML et al., 2000 illustrated that parents dental

hygiene habits, together with their educational
backgrounds and or child-rearing skills, were important
in their childrens dental health.
Tooth brushing frequency and the use of extra cleaning
methods are related to the general lifestyle.

remarkable improvement in oral cleaning habits is

difficult to achieve if the general lifestyle is unhealthy.

Dental service utilization

Those who used dental services regularly had less
dental caries and better periodontal health than those
who did not use such services regularly. (Social
Insurance Institution 1991)
According to a study of adolescents (Attwood 1993)
females visited the dentist more frequently than males.

Nutrition and Oral Health

Nutritional status can affect oral integrity
Oral cavity is the pathway to the rest of the body, &
disturbances of the oral cavity can profoundly affect
diet & ultimate nutritional status.
Oral conditions can affect general health, and in turn,
medical conditions often have oral implications and
consequences.
A number of classic studies demonstrated a clear
relationship between sucrose consumption and caries
Vipeholm study by Gustaffson et al., 1954,
prevalence and incidence.
Hopewood House study by Harris, 1963, Turku
Sugar study by Scheinin, 1975, and Tristan da
Cunha study by Fischer FJ 1968
Murray JJ. Prevention of dental diseases. Oxford

Increase frequency of sugar consumption results in increased

caries incidence
Increase is greater when sugar is consumed in retentive
forms, particularly between meals
Total amount of sugar consumed is not critical when
consumed at meal times
An increased prevalence of dental caries was found in children
with high intake of sugar-starch foods when compared with
sugars alone (Garcia-Closas et al., 1997).
Fibrous foods including fruits and vegetables require more
chewing and may produce the benefit of increased salivary flow
and oral clearance.
Murray JJ. Prevention of dental diseases. Oxford

Frequency of eating and the

amount of sugar
Both the factors are associated with levels of caries. (Gustaffson,
1954 Vipeholm study and Burt BA, 1988)
A higher frequency, especially if it involves constant nibbling or
sipping of beverages was reported to be caries promoting.
(Kandelman, 1997 and Gatenby, 1997)
Papas et al., 1995 reported that subjects who ate more cheese had
low root caries.
Poor diet, specifically frequent consumption of sweet foods and
drinks, is the main cause of dental decay and tooth erosion. (Hinds
K, 1995 and Walker A, 2000)
Moynihan PJ, Role of diet and nutrition in the etiology and prevention of
oral diseases, Bulletin of the World Health Organization, September
2005, 83(9), 694-699.

There is evidence to show that groups of people with a habitually

high intake of sugars also have higher levels of caries.
Children requiring long term administration of sugar containing
medicines (Roberts IF, 1979) and
Confectionery workers (Peterson PE, 1983).
Like wise a low level of dental caries is seen in those who have a
habitually low intake of sugars
Children on strict dietary regimens (Harris R, Hopewood house
study, 1963) and
Children with hereditary Fructose intolerance (Newbrun, 1980).
Moynihan PJ, Role of diet and nutrition in the etiology and prevention of
oral diseases, Bulletin of the World Health Organization, September
2005, 83(9), 694-699.

Type of diet
Epidemiological evidence shows that starch-rich staple foods
pose a low risk to dental health.
People who consume high starch/low sugar diets generally have
low

levels

of

caries

whereas

people

who

consume

low

Sugar study by Scheinin, 1975,

starch/high-sugars diet have highTurku
caries
levels.
Tristan
1968,
Harris,

da Cunha study, Fischer FJ

Hopewood House study by
1963, Newbrun,1980

Epidemiological evidence suggests that intake of fruits is not

significant in the development of dental caries but Grobler, 1989
reported that high consumption of apples or grapes showed an
association with number of missing teeth.

Prolonged feeding and dental caries

Prolonged contact of enamel with human milk has
been shown to result in acidogenic conditions and
softening of enamel [Thomson et al., 1996].
Breast feeding up to 12 months of age is associated
with significantly lower ECC experience compared to
not breast feeding at all or breast feeding beyond 12
months.

There is an inverse relationship between breast

feeding

and

consumption

of

sweetened

drinks

(Lande B., 2004).

Bottle feeding and length of time for bottle contact,
particularly

at

night,

is

the

most

important

determinant for ECC development. (Hallett KB 1998,

Febres C,1997, Derkson GD,1982)

Type of diet and periodontal disease

Al-Zahrani MS et al., 2006 reported that subjects with high intakes of
dairy products had a lower prevalence of periodontal disease than
those with low intakes.
Intake of lactic acid foods was associated significantly with periodontal
disease, especially in non-smokers (Shimazaki et al., 2008).
Tooth loss is associated with changes in diet, particularly a decrease in
fruit and vegetable intakes (Hung HC, 2003 and Joshipura, 1996).

Diet and oral cancer

It has been shown that the risk level for oral cancer decreased
with increasing use of dairy products, fruits and vegetables
But increased with increasing use of red chillies in the diet and
cereal Ragi as main staple diet.
In a case control study by Rao and Desai, (1994) non
vegetarians

showed

vegetarian diet.

39%

excess

risk

compared

to

Socio-economic status
Socioeconomic status may represent a measure of personal drive and
motivation, and may impact on the quality of oral hygiene habits, and
as such represents a valid risk indicator.
Despite significant improvements in the oral health of populations
across the world, it has been reported that lower socio-economic groups
compared to higher socio-economic groups have poorer oral health
[Watt and Sheiham, 1999; Sanders et al., 2006; Sabbah et al., 2007].

Social inequalities in dental caries have been reported

among adolescents from different parts of the world
[Campus et al., 2001; Sogi and Bhasker, 2002; Zurriaga et
al. 2004].
Peterson, 1992 reported higher relative risk and total
amount of caries in children with family backgrounds of low
education and poor family income.

Socio-economic status, caries and

periodontitis
Striking social inequalities have been reported with respect to
dental caries and periodontal diseases among adolescents [Antunes
et al., 2004; Lpez et al., 2006].
Social inequality in dental health was found to be more significant in
older age groups in which the disadvantaged groups have higher
proportion of teeth with unmet treatment needs, number of missing
teeth due to caries, lower number of filled teeth (Beal, 1989).
Higher social class people have reported more frequent dental visits
than the lower social classes (Todd and Lader, 1991) and people in
higher social class tend to believe that tooth loss is preventable.

SES and dental knowledge, attitudes and beliefs

High scores on dental knowledge and attitudes to teeth and dental
care tend to be more frequent in people with a back ground of high
education (Peterson, 1992) and such parents also claimed to brush
their Childs teeth on a daily basis than parents of lower education.
The potential for parental influence on adolescents health behaviors
was found to be larger if both the parents were consistent in their
behaviors (Rossow, 1993).
Chen, 1995 considers low SES individuals have more fatalistic health
beliefs, lower perceived need for and utilization of dental health care
services.

Socio-economic status and feeding

habits
The use of sweetened drinks rather than milk occurs earlier in
infants from low income families (Mohan A et al., 1998).
Parents

from

disadvantaged

families

have

poor

understanding of the effects of constant exposure of teeth from

sugared drinks in feeding bottles.
There is a perception that giving water as an alternative to milk
or sweetened drinks is cruel and is rejected by children.
Milk is viewed as a food rather than a drink and water in a
feeding bottle is seen as a sign, by parents, of poverty
(Chestnut IG et al., 2003).

Children from lower SES groups, with poorer oral

hygiene, had less dental erosion than children from
higher SES groups [Millward et al., 1994a] but
Milosevic et al., 1994 and Al-Dlaigan et al., 2001a
reported opposite results.

Literacy and Oral cancer

Literacy as a factor in oral cancer needs careful
interpretation

because

factors

like

poor

socio-

economic status, under-nourishment, tobacco habits,

poor dental hygiene are commonly associated.
Rao et al., (1994) reported Illiteracy and non
vegetarian diet as high risk factors.
In a study by Rao and Desai, (1998) illiterates had a
higher risk for anterior tongue cancer

Alcohol and oral health

Effects on the oral cavity, such as oropharynx cancer,
missing/ loss of teeth, and a greater risk for developing
periodontal problems. Larato DC, 1972 and Harris CK et al.
1996).
Rao & Desai, (1998) reported the association of
consumption of alcohol with cancers of anterior tongue but
not with cancers of posterior tongue.
Studies found independent risk for alcohol usage which
was synergistic when combined with tobacco chewing and
smoking.
Excessive & constant alcohol consumption may affect host
response to infections caused by bacteria, thus increasing
host vulnerability (Szabo G, 1999).

Alcohol consumption was independently related to periodontal

disease independently of oral hygiene status (Tezal M et al., 2001).
Alcoholism leads to adverse effects on bone metabolism and healing
(Tezal M, 2001) may cause abnormalities in immune system function,
caused by years of dependence, which can modify the host response
(Khocht A, 2003 and Schleifer SJ, 1999).
Oral health in alcoholics might also be explained by other factors,
such as malnutrition (Harris CK, 1996), stress, depression, (Ducci F,
2007, Vettore MV, 2003) and behavior (Enberg N, 2001).

Tobacco and Oral Health

Tobacco use as a risk factor

All the major forms of

tobacco - cigarettes
cigars, pipe tobacco
and smokeless tobaccos
(chewing tobacco and
snuff) have oral health
consequences.

Smoking and oral health

Cigarette smoking is one of the foremost risk factors related to
the prevalence and severity of periodontal disease (Amarasena
et al. 2002, Hujoel et al. 2003, Petersen 2003a).
increased prevalence and severity of periodontitis,
greater marginal bone loss,
deeper periodontal pockets,
more severe attachment loss and
more teeth with furcation involvements
(Johnson & Bain 2000, Petersen 2003a)
Less bleeding on probing is observed, misleading the clinical
picture with regard to deep pockets and bony defects.

In a study by Rao and Desai, 1998 predominance of smoking

habit was seen in cancer of base of the tongue patients
(particularly bidis) and chewing habit among the patients of
anterior tongue cancer group.
Significantly more lesions of the hard palate were detected in
reverse smoking group than with conventional chutta group
which shows that heat factor can act as a co-carcinogen.

Smokeless tobacco
The results of many studies have revealed relationships of betel quid
chewing with oral cancer and oral soft tissue lesions (Ahmed & Islam
1990, Ko et al. 1992, 1995, Yang et al. 2005, Thomas et al. 2007).
Ghosh et al., 1996 reported that keeping the tobacco in the cheek
pouch overnight/night quid habit showed an increase risk of oral
cancer.
Reichart et al. (1996) found a strong correlation between the
duration and frequency of betel quid used per day and the presence
of oral mucosal lesions.
Pan

tobacco

chewing

and

smoking

synergistically for cancers of oral cavity.

was

shown

to

interact

Studies showed the relationship between betel quid

chewing and periodontal disease (Mehta et al. 1955,
ChoudhuryHypersalivation
et al. 2003, Chatrchaiwiwatana 2006).

Higher amounts of dental attrition and sensitivity is seen in

betel quid chewers than the non chewers (Kumar S, 2004).

Singh and von Essen, (1966) and UR Parija, (1991)

reported that left buccal mucosa is more often
affected than the right buccal mucosa
right handed persons
had a definite tendency
of keeping the quid in
the mouth on left side

Drug addiction and oral health

Cannabis abusers have poorer oral health than non-users, with
higher DMFT scores, higher plaque scores and less healthy
gingiva.
An important side effect of cannabis is Xerostomia (Darling
MR, 1993 and Hubbard HR,2002)
Oral cancer usually occurs on the anterior floor of the mouth
and the tongue (Zhang, 1999).

synergistic

effect

between

tobacco

and

marijuana smoke has been observed.

The association between the presence of oral
papilloma and cannabis smoking may be related
to suppression of the immune response by
cannabis.

Ecstacy and oral health

93-99% of the users experienced a dry mouth during an ecstacy
induced trip. (can persist up to 48 hours)
An excessive consumption of soft drinks which increase caries
rates and erosion is reported with its use. The risk of enamel
erosion is enhanced by the reduced saliva secretion and buffering
capacity.
Nausea and vomiting were also reported as side effects, which
could also enhance the enamel erosion.

Excessive tooth wear is due to clenching and

grinding
Ecstasy

users

report

more

frequently

TMJ

tenderness compared to individuals who use other

illicit drugs.
Mucosal ulcerations are seen with local application.

Oral cocaine use also caused dental erosion and

resulted in cervical abrasion and gingival laceration
due to excessively vigorous tooth-brushing during
stimulation.
Also associated with bruxism and dental attrition

Stress and Oral Health

Studies suggested that pH of saliva changes under emotional stress.
Changes occurring in saliva as a result of stress (acute or chronic)
can initiate psycho physiological changes in oral cavity, such as
periodontal disease or increased carious activity.
Stress is thought to manifest in periodontium through behavioural
changes, such as increased smoking
Individuals with high mean CAL values had higher scores on the job
and financial strain scales than periodontally healthy individuals.
(after adjusting age, gender, cigarette smoking & systemic disease)
(Ng SKS et al., 2006)

Cultural Practices and Oral Health

The mouth and the face have been and continue to be the
subject of many oral and written beliefs, superstitions, and
traditions and the object of a wide range of decorative and
mutilatory practices and is observed among people in all
regions of the developed and underdeveloped world.
At the same time they have been the cause of considerable
suffering for many.

bhu SR, Wilson DF, Daftary DK, Johnson WN, Oral diseases in Tropics, 1993, 91-1

Tooth mutilations

Tooth mutilation practices have been recorded in

inhabitants of non-tropical environments and largely
confined to societies which have been able to maintain
These
include
their practices
geographical
orBasic
cultural
isolation.
reasons
for tooth mutilatio

bhu SR, Wilson DF, Daftary DK, Johnson WN, Oral diseases in Tropics, 1993, 91-1

Tooth evulsion
Involves the extraction of one or more permanent
teeth. But the practice of deciduous tooth removal is
rare and would appear to be confined to parts of
East Africa.

Ritual tooth evulsion

bhu SR, Wilson DF, Daftary DK, Johnson WN, Oral diseases in Tropics, 1993, 91-1

Mutilations of the tooth crown

Patterns of tooth crown mutilation generally involve
from 2 to 12 permanent anterior teeth.

Complications includes

bhu SR, Wilson DF, Daftary DK, Johnson WN, Oral diseases in Tropics, 1993, 91-1

Lacquering and dyeing of teeth

The custom of deliberately staining teeth is largely
confined to some regions of Asia and South-east Asia
(including India).
The motivation for tooth crown staining is variable. (related
to concepts of beauty and sexual appeal or maturity)

Mutilations of soft tissues

Tattooing
Includes tattooing of the skin, lip and gingiva (popular in
many non-tropical and tropical areas of the world).
Tattoos in the oral region must be distinguished from other
forms of diffuse, intrinsic, or acquired pigmentation of oral
mucosa.

Other forms of soft tissue mutilation

1) Piercing of lips & perioral soft tissues & insertion of materials such as
wood, ivory or metal
(2) Temporary piercing of orofacial soft tissues for ceremonial purposes
(3) Uvulectomy
(4) Facial scarring
Intraoral and perioral jewellery can cause mucogingival defects.
(cleft-like defects, recession or no recession in the area of piercing.)
Oral piercing, particularly tongue piercing, is strongly correlated with
chipping, fracture & cracking of teeth & with incisal abrasion.
Common complications include pain, inflammation, swelling, and
masticatory, swallowing and speech difficulties.

bhu SR, Wilson DF, Daftary DK, Johnson WN, Oral diseases in Tropics, 1993, 91-1

De Moor et al., 2000 reported tooth fracture as the most

common dental complication associated with tongue piercing.
Another complication was following an inferior dental nerve
block injection, jewellery in the tongue could accidentally
traumatize teeth because of loss of tongue sensation.
Kiesr JA, 2005 reported no significant associations between
piercings and abnormal tooth wear or trauma.

A glimpse of the literature

Lifestyle health behaviours of 11to 16-year-old youth with physical

disabilities
To determine the Health Behaviours in School-aged Children, a WHO
Cross-national Study questionnaire, was administered to 101 youth
with physical disabilities.
Their responses were compared with youth in a Canadian national
sample.

In comparison with the national sample, youth with

physical disabilities reported that they were equally
healthy, but experienced higher frequency of symptoms
of poor health such as headaches, stomachaches and
backaches.
With respect to lifestyle health behaviours they were less
likely to smoke, drink alcohol and use marijuana than
their counterparts in the national sample.
Youth with physical disabilities reported less healthy
diets, less exercise and more sedentary leisure activities.

Maternal Cigarette Smoking and

Oral Clefts: A Population-Based
Study
MUIN J. KHOURY et al

Analyses of 1984 data from the Maryland

Birth Defects
Mothers of infants with oral clefts
(cleft lip with or without cleft palate;
and cleft palate) smoked more during
pregnancy than mothers of infants
with other defects.

Relationships between various aspects

of lifestyle and dental health behaviors
in a rural population in Japan
Shoji Harada et al

Dental health behaviors such as tooth brushing

frequency, use of extra cleaning devices, and
regular dental visits to a dentist.
The data included data on the demographic factors,
dental health behavior, and various aspects of
lifestyle, i.e, mental condition, alcohol consumption,
smoking habit, physical activity, social activity,
dietary habits, and presence of systemic diseases.
Subjects who had never smoked brushed their teeth
more frequently.
The results indicate that dental health behavior is
associated with lifestyle as well as demographic

Lifestyle and Oral health

Bharathi Purohit et al
Lifestyle has been associated with oral
health; specifically dental caries,
periodontal disease, number of teeth and
edentulousness.
Worldwide strengthening of public health
programmes through the implementation of
effective measures for the prevention of oral
disease and promotion of oral health is urgently
needed.
The challenges of improving oral health are
particularly great in developing countries.

ALCOHOL AND ORAL HEALTH.

PETTI, S.;SCULLY, C.
Head and neck cancers, dental erosion,
maxillofacial trauma and dental injuries,
growth
deficiency,
such
as
abnormal
maxillary/mandibular growth and disturbed
odontogenesis, sialosis and, possibly, dry
mouth
Dental caries and periodontal disease
(among chronic alcoholics who neglect
themselves with poor oral hygiene and
diet).
The long-term effectiveness of the various forms
of treatment at the individual level is not related
to the type of treatment but to the timeliness of
the intervention and cooperation of the patient.

Conclusion
Lifestyle is associated with some, but not all, of the background or
predisposing factors of oral diseases.
Lifestyle may be an essential explanatory factor connecting oral
and general health.
Thus, controlling lifestyle is essential when studying the biological
influences of oral health on general health.
Health care providers should bear in mind the restrictions a
persons lifestyle may have on the improvement of individual
behavior.

 Increasing urbanization, demographic and socioenvironmental changes require different approaches to

oral health actions.
It is unlikely that improvements in oral health can be
achieved by isolated interventions that target specific
behaviors.
The most effective, sustainable interventions combine
social policy and individual action through which
healthy living conditions and lifestyles are promoted.

References
Health promotion glossary. World heath organization, Geneva. 1985
Health promotion glossary. World heath organization, Geneva. 1998
Leif edvard aar,bente wold,lasse kannas andmatti rimpel. Health
behaviour in schoolchildren, a WHO cross-national survey. A presentation of
philosophy, methods and selected results of the first survey. Health Promot.
Int.(1986)1(1):17-33.
Pender J, Murdaugh C, Parsons M. Health Promotion in Nursing Practice, 5th
edn. Upper Saddle River, NJ, USA: Prentice-Hall, 2006.
Community oral health by Cynthia pine ,2nd edition
Text book of social and preventive medicine by Park,18 th edition.
Lifestyle, dental caries and number of teeth. CDOE,1994,22:5-9

 Moynihan PJ, Role of diet and nutrition in the etiology and prevention
of oral diseases, Bulletin of the World Health Organization, September
2005,83(9), 694-699.
Marinho VCC, Higgins JPT, Logan S, Sheiham A. Fluoride toothpastes
for preventing dental caries in children and adolescents. Cochrane
Database of Systematic Reviews 2003, Issue 1. Art. No.: CD002278.
Cristine da Silva Amaral F, Ronir Raggio Luiz, & Anna Thereza Lea,
The Relationship Between Alcohol Dependence & Periodontal Disease,
J Periodontol, June 2008 vol 79, no 6, 993-998.
F. Vzquez-Nava, R.E.M. Vzquez, G.A.H. Saldivar, G.F.J. Beltrn A.V.M.
Almeida, R.C.F. Vzquez, Allergic Rhinitis, Feeding and Oral Habits,
Toothbrushing and Socioeconomic Status. Caries 142 Res
2008;42:141147.

 I. Perera, L. Ekanayake Social Gradient in Dental Caries among

Adolescents in Sri Lanka, Caries Res 2008;42:105111.
Sogi GM, Bhasker DJ: Dental caries and oral hygiene status of school
children in Davangere related to their socio-economic levels: an
epidemiological study. J Indian Soc Prev Dent 2002; 20: 152157.
R.J

Genco,

A.W.Ho,

s.G.Grossi,

R.G.Dunford

and

L.A

Tedesco,

Relationship of stress, distress, and inadequate coping behaviors to

periodontal diseases. J Periodontol 1999;70:711-723.
Anwar T Merchant, Waranuch Pitiphat, Mary Franz, and Kaumudi J
Joshipura, Whole-grain and fiber intakes and periodontitis risk in men.
Am J Clin Nutr 2006;83:1395400.
Carole Palmer Diet, Nutrition and Oral Health

 Life circumstances, lifestyle and oral heath among older Canadians. CDH
1997,14: 214-220
Association of lifestyle with periodontal health. CDOE 1995,23:155-158
Life style and dental health behaviour. CDOE 2005, 33. 17-24.
Gamboa VT. Oral health status and traditions in the Philippines. Int
Dent J.1984 Dec;34(4):257-60.
Cheong YH The fading links between tradition and oral health in
Singapore. Int Dent J.1984 Dec;34(4):253-6.
Rodd HD,Davidson LE. 'Ilko dacowo:' canine enucleation and dental
sequelae in Somali children. Int J Paediatr Dent.2000 Dec;10(4):290-7.
Rodd HD,Davidson LE. Smokeless Tobacco and Some Tobacco-specific
N-nitrosamines. By International Agency for Research on Cancer.
Community Dent Health. 1997 Jun;14(2):84-8.
Kuusela S,Honkala E,Rimpel A,Karvonen S,Rimpel M. Trends
in toothbrushing frequency among Finnish adolescents between 1977
and 1995. Community Dent Oral Epidemiol.1989 Dec;17(6):317-21.

 Nrmark S,Mosha HJ. Relationship between habits

and dental health among rural Tanzanian children.
Marilyn w. Woolfolk et al. Determining dental
checkup frequency.
JADAmay 1999130(5):715-723;
Dr.Scott L.Tomar. Smoking-Attributable
Periodontitis in the United States: Findings From
NHANES III. Journal of Periodontology May 2000, Vol.
71, No. 5, Pages 743-751.
Raymond B.Bridgeset al. Periodontal Status of
Diabetic and Non-Diabetic Men: Effects of Smoking,
Glycemic Control, and Socioeconomic Factors.
Journal of Periodontology November 1996, Vol. 67,
No. 11, Pages 1185-1192 , DOI
10.1902/jop.1996.67.11.1185

 Little SJ,Stevens VJ,LaChance PA,Severson HH,

Bartley MH,Lichtenstein E,Leben JR. Smokeless
tobacco habits and oral mucosal lesions in dental patients.
J Public Health Dent.1992 Fall;52(5):269-76.
Z A Majid. Dental health in Malaysia.
International Dental Journal (Impact Factor: 1.04). 01/1985;
34(4):261-5.
Ohrn R,Enzell K,Angmar-Mnsson B. Oral status of 81
subjects with eating disorders. Eur J Oral Sci.1999
Jun;107(3):157-63.

 Lussi A,Schaffner M,Hotz P,Suter P. Dental erosion in a

population of Swiss adults. Community Dent Oral Epidemiol.1991
Oct;19(5):286-90.
Maria do Carmo Matias Freire,Rosana Barbosa de Meloand
Simonne Almeidae Silva. Dental caries prevalence in relation to
socioeconomic status of nursery school children in Goiania-GO, Brazil.
Community Dentistry and Oral Epidemiology Volume 24,Issue 5,pages
357361,October 1996
Petersen PE. Social inequalities in dental health. Towards a theoretical
explanation. Community Dent Oral Epidemiol.1990 Jun;18(3):153-8.
Olojugba OO,Lennon MA. Sugar consumption in 5 and 12-year-old
school children in Ondo State, Nigeria in 1985. Community Dent Health.
1990 Sep;7(3):259-65.

 Kai E. Masalin,Heikki T. Murtomaa and Kari P. J. Dental Caries Risk in

Relation to Dietary Habits and Dental Services in Two Industrial
Populations. Journal of Public Health Dentistry. Volume 54,Issue 3,pages
160166,June 1994
Rizk SP,Christen AG. Falling between the cracks: oral health survey of
school children ages five to thirteen having limited access to dental
services. ASDC J Dent Child. 1994 Sep-Dec;61(5-6):356-60.
Schou L,Eadie D. Qualitative study of oral health norms and behaviour
among elderly people in Scotland. Community Dent Health. 1991
Mar;8(1):53-8.
Tor sterberg,Gunnar E. Carlsson, Dan Mellstrmand Walter
Sundh. Cohort comparisons of dental status in the adult Swedish
population between 1975 and 1981. Community Dentistry and Oral
Epidemiology. Volume 19,Issue 4,pages 195200,August 1991