IT IS well known that the morbid conditions of dental caries (tooth decay) and periodontitis (gum disease), which cause tooth loss, are caused by germs, but lifestyle factors, including dietary habits, oral hygiene and compliance with the prophylactic programmes, also significantly modify the occurrence and progression of these diseases.

Coronary heart disease, the most prevalent consequence of arteriosclerosis (narrowing of the arteries), is linked with lifestyle-related factors such as smoking and diet, and these factors are also associated with high blood pressure, stroke and diabetes. Patients with these conditions have been reported to have poorer oral health status as compared to control objects, and it has been suggested that chronic infection may be associated with myocardial infarction (heart attack). The atherosclerotic process begins in childhood and youth, because of harmful lifestyles adopted in early life.

A recent study reports that adolescents with a high prevalence of caries had a higher average daily intake of energy originating from fat, and a lower daily fibre intake than others. In addition, smoking among adolescents has been found to be associated with poor oral health status.

The cheapest way to immensely improve the oral health status of a population is what was done in Finland. Like Guyana, back in 1950s and 1960s, practically all Finns were affected by dental caries, and cardiovascular diseases were by far the most important cause of death among the population. Intensive health education was started to improve the level of oral hygiene, and the use of fluorides was introduced mainly in the form of fluoridated toothpastes, as well as supervised fluoride-rinsing programmes at schools and public dental clinics.

School oral health care became an integrated part of the primary health care system in 1972. Since then, the caries situation among the Finnish children has improved significantly. For example, while in 1994 a twelve-year-old had on average seven permanent teeth decayed, missing due to caries, or filled, the corresponding figure was one in 2008.

There has also been a reduction in the occurrence of cardiovascular diseases, the prevention of which is also based largely on activities within the municipal primary health care system, as well as within occupational and school health care. Perhaps what will have an immensely positive effect on the prevention, control and economics of diseases (mainly AIDS, cardiovascular, cancer, caries, periodontal disease and SARS) is the creation of a centralised unit to be known as the Department of Disease Prevention. It has been well-established (and this is done in most countries) that all aspects of disease prevention and control in a country should be coordinated from a single national body with a broad base and relative autonomy, in order to ensure cost effectiveness and efficiency.

Perhaps the most important justification for such an endeavour is the great potential of slashing the current tremendous cost of health-care delivery in the medium to long-term. Certainly, the evidence suggests that, in all countries, it is highly desirable for efforts to promote and maintain oral health to be combined from the very beginning with efforts to control other lifestyle-related health problems.