The number-one killer in America (for both men and women), heart disease is the result of the narrowing of the arteries that supply the heart with blood, oxygen, and nutrients. This process, called coronary artery disease, can generally be traced to a condition called atherosclerosis, the build-up of cholesterol-rich fatty deposits, or plaques, on the inside of arterial walls. As these deposits accumulate over time, the coronary arteries narrow to the point that the flow of oxygenated blood to the heart is impeded. (Arterial spasms — triggered by smoking, extreme emotional stress, or exposure to very cold temperature —may also cause coronary arteries to narrow suddenly and dangerously.)

The Risk Factors — and How You Can Reduce Yours
Major risk factors for cardiovascular disease include cigarette smoking, high blood pressure, high cholesterol and/or triglycerides, diabetes mellitus, obesity, sedentary lifestyle, and poor nutrition. Prevention and treatment centers around these risk factors — and these approaches will help you lower risk for many other types of illness, as well as helping you feel great and have more energy overall.

1. Don’t smoke.
Cigarette smoking remains the leading preventable cause of cardiovascular disease in women, with more than 50 percent of heart attacks among middle-aged women attributable to tobacco. Risk of cardiovascular disease begins to decline within months of smoking cessation and reaches the level of persons who have never smoked within 3 to 5 years.

2. Lower your cholesterol.
High blood cholesterol is a condition that greatly increases your chances of developing coronary heart disease. Extra cholesterol in the blood settles on the inner walls of the arteries, narrowing them and allowing less blood to pass through them to the heart. Aim for total cholesterol below 200 mg/dL; LDL cholesterol below 130 mg/dL and HDL above 35 mg/dL.

3. Maintain a healthy weight.
Obesity and sedentary lifestyles are epidemics in the United States that contribute to increased risk of cardiovascular disease. The prevalence of obesity has increased among both men and women in the United States in the past decade; currently about one third of adult women (or 34 million) are classified as obese. Also, 60% of both men and women get no regular physical activity. Obesity, especially abdominal adiposity, is an important risk factor for cardiovascular disease in women.

4. Exercise regularly.
Recent evidence suggests that even moderate-intensity activity, including brisk walking, is associated with substantial reduction of cardiovascular disease risk. These findings support the 1995 federal exercise guidelines endorsing 30 minutes of moderately intense physical activity most days of the week, a program that should be feasible and safe for most of the population. Regular exercise and maintenance of healthy weight should also help reduce insulin resistance and the risk of non–insulin-dependent diabetes mellitus, which appears to be an even stronger risk factor for cardiovascular disease in women than in men. Diabetes is associated with a threefold to sevenfold elevation in cardiovascular disease risk among women, compared with a twofold to threefold elevation among men. Approximately half of all deaths in patients with non–insulin dependent diabetes mellitus are due to heart disease.

5. Eat less saturated fat, more produce & more fiber.
Diets low in saturated fat and high in fruits, vegetables, whole grains, and fiber are associated with a reduced risk of cardiovascular disease. Also, a recent study reported in the Annals of Internal Medicine journal confirmed that the consumption of fruits and vegetables, particularly green leafy vegetables and vitamin C-rich fruits and vegetables, seems to have a protective effect against coronary heart disease. You may even think about moving toward more flexitarian or vegetarian eating habits: A vegetarian diet reduces the risk of coronary artery disease, and may even reverse existing coronary artery disease when combined with other lifestyle changes. A Mediterranean diet that uses olive oil can reduce the risk of coronary artery disease.

6. Avoid trans fats.
Trans fatty acids have been linked to adverse lipid profiles and an increased risk of cardiovascular disease. This includes most margarines. The role of other fatty acids, including monounsaturated, polyunsaturated, and marine omega-3 fatty acids, remains controversial.

7. Consume alcohol only in moderation.
Moderate intake of alcohol is related to reduction of cardiovascular disease — but may raise blood pressure and increase risk of breast cancer. Early surgical menopause is linked to increased risk of cardiovascular disease, which appears to be negated by the use of estrogen therapy.

8. Arm yourself with risk-reducing supplements.
Antioxidant vitamin supplements, particularly vitamin E and homocysteine-lowering agents such as folate and B6, have promising roles in prevention of cardiovascular disease, but conclusive evidence may hinge on the results of several ongoing randomized clinical trials. When it is found in unusually high levels, homocysteine brings the same degree of risk as having high cholesterol does. The B vitamins, especially folic acid and B12, will drive elevated homocysteine levels down to normal, often without the need of any prescription medication.

9. Give yourself some new stress-management tools.
Poorly controlled stress may have an adverse effect on blood lipids. An attitude of hostility has been powerfully linked with a higher incidence of cardiac events, and cynical distrust has been associated with accelerated progression of carotid artery disease. Relaxation methods (meditation, breathing exercises), yoga, and stress management techniques are essential for preventing cardiovascular disease and coronary artery disease and for reducing the risk of recurrent cardiac problems. Meditation improves exercise tolerance and decreases electrical changes associated with poor circulation to the heart. Meditation has also been shown to lower cholesterol and reverse carotid artery thickening. Also consider acupuncture, which has been shown to help relax the myocardium and improve circulation.

10. Ask your health professional about herbs and nutritional supplements that may be useful in preventing and treating cardiovascular disease, including:

- Bilberry
- Turmeric (curcumin)
- Fenugreek
- Ginger
- Guggul
- Ginkgo
- Garlic (one garlic clove is roughly equal to 4 mg to 1 gram of garlic; a daily dose of 600 to 800mg may be recommended)
- Onion
- Vitamin B12
- Folic acid (500 to 5000 micrograms daily may be recommended)
- B6
- L-Carnitine
- Coenzyme Q10 (100 to 300 mg daily may be recommended)
- Vitamin E (400 to 800 International Units daily may be recommended)
- Magnesium (200 to 400 mg daily may be recommended)
- Niacin (A typical oral dose of 100 mg, three times daily; may gradually increase to avg. dose of 1 gram three times daily, with a maximum dose of 6 grams. Extended release tablets: Dosing may begin with one 375-milligram tablet at bedtime and be increased by no more than 500 mg per four-week period, to a maximum of 2,000 mg, given as two 1,000-milligram tablets before bed)
- Fish oils (6 grams daily may be recommended))
- Soy (Isoflavones may be recommended))

Toothbrushing

What’s the best toothbrush? The brand is not as important as the size and texture of the brush. You should always choose a soft or ultra soft toothbrush with rounded bristle ends. The brush head shouldn’t be too big for your mouth. It is difficult to reach all the places where plaque hides with a large brush. Look for compact sizes, they have smaller brush heads but the handles are for adults. Replace your toothbrush on a regular basis, every two to three months or when you notice the bristles fraying. Toothbrushes with fraying bristles won’t clean as well and they can irritate the gums. Children are likely to wear out toothbrushes more quickly because their brushing strokes are not yet perfected and they have a tendency to chew on the bristles. Parents should keep a close eye on their children’s brushes. Toothbrushes should be allowed to air-dry between uses. If you brush frequently, alternating between toothbrushes is recommend.

How often should you brush?

If you are healthy and free of periodontal disease, two to three times a day should be adequate. In the morning after breakfast and before bed are the most important times to brush. Try to schedule additional brushings around meals. If you have a form of periodontal disease, increased brushing is necessary. I usually recommend a minimum of three times and up to five times per day. Controlling plaque is a tough business. Many of my patients keep a toothbrush at work to make mid-day brushing convenient. The key is to make your routine as uncomplicated as possible. The optimum amount of time to brush is two minutes. Two of your daily tooth-brushings should be for two minutes and supplement with shorter brushing times if necessary. If you time yourself the next time you brush, you might be surprised how quickly you go.

What is the best brushing technique?

Since everyone’s mouth is different, individual instruction given by your dentist or dental hygienist is essential. Unless you use a proper technique, you can brush five times a day and still not get your teeth clean. There are some basic techniques to follow in proper tooth-brushing:
1. Focus your soft bristled toothbrush at the gumline. This is where plaque hides.
2. Begin by placing the bristles of your toothbrush at a 45-degree angle on the outside of your teeth (cheek side) where the gums and teeth meet.
3. Move the brush in a circular motion brushing two to three teeth at a time.
4. Use light pressure so the bristles glide gently between the teeth.
5. The same method is used on the inside (tongue side) surfaces of the back teeth.
6. To brush the inside of the front teeth, hold the brush vertically using a back-and-forth motion.
7. Then move to the biting surfaces using the same back-and-forth motion.
8. Finish by brushing your tongue.
9. Bacteria that forms on your tongue, especially on the base (back), can cause mouth odor. Start at the tip and work your way back down the middle, then each side. Special tongue cleaning devices are sold, but your brush is adequate.
Parents will need to assist their children until they are about five years old. Their small motor skills are still developing and it is impossible for them to be effective alone. I recommend that children be allowed to brush alone first, then parents should brush them gain.

Flossing

Is flossing really necessary? In a word—yes. Periodontal disease in adults starts primarily between the teeth. Plaque forms mainly at the gumline (where the teeth and gums meet) and in between the teeth. Brushing takes care of the gumline and flossing reaches between the teeth. Think of it this way: There are five sides to each tooth. When you brush, only three are cleaned (top, outside, and inside). That means the surfaces on the sides (between) of the teeth are untouched. The plaque has a protected environment, free to damage the teeth, gums and bone. There is no real substitute for flossing. Floss reaches below the gumline into the pocket area where plaque bacteria multiplies and toxins are produced. Daily flossing is required to hinder calculus formation, which leads to future breakdown. There are other dental tools that can be used to clean between teeth but floss is the only one that can remove plaque below the gumline. Children can be expected to start flossing for themselves, around age eight. Until then, parents need to floss for them. Guidance from your hygienist on how to floss your child’s teeth is advisable. The trick is to start early.

Which floss is the best?

There are dozens of flosses on the market, waxed, unwaxed, flat, round string, ribbon, textured, spongy, flavored, fluoridated, etc. According to a recent study from Ohio State University-Columbus, there aren’t significant differences between flosses. The primary issue is comfort and ease of use for the flosser. In my opinion, a flat, waxed floss is preferred because it is less likely that the gum tissue will be cut. For my patients who have wider spaces between their teeth, I recommend the textured or woven flosses. You can get a floss recommendation from your own hygienist, and once you’ve tried a few different types, I’m sure you’ll find a favorite. Flossing aids are very popular. They simplify hold the floss. They are especially useful for people who have trouble flossing with their fingers. I prefer the disposable floss holders that have the floss already attached. They are available in bright colors and smaller sizes for children.

What’s the best time to floss?

The ideal time to floss is before bed. As stated before, it is imperative that your mouth is clean before sleep because the levels of bacteria in the mouth rise during sleep. I encourage my patients with periodontal disease to floss at night to gain the greatest benefit. But if your teeth are relatively healthy, you can be flexible about when you floss. You don’t even have to floss at the same time as you brush. The important thing to remember is that you should floss once within a 24-hour period. Remember, plaque will start to calcify and form calculus within that time frame.

How do you floss?

Proper flossing is a skill that takes time and practice to master. You will need perseverance and patience if you are just beginning, but the end result is worth the effort. If you have never flossed before, it will probably take about two weeks of daily practice to get the hang of it. Make the commitment to yourself to try flossing at least once a day for two weeks. If you are having trouble with a particular area, don’t give up on the rest of your teeth. At your next dental appointment, tell your hygienist where you are having trouble. She may have a flossing tool to recommend. I encourage patients to call me during office hours if they have any questions or concerns regarding their oral hygiene. The dental staff at your office is there to assist you, don’t be afraid to ask questions.

Flossing technique

While flossing, keep in mind that you are not cleaning the space between the teeth or the gum. You are cleaning the tooth itself. The floss should hug the tooth when being inserted. Use a back and forth motion to guide the floss down the tooth. When you feel a slight resistance, stop, and slide the floss in an up-and-down motion to clean the tooth. The floss should always be in contact with the tooth surface. Notice how the gum tissue fills in the space between the teeth. If you pop the floss straight down, you will hit the gum, causing injury and pain.

Choosing Oral Hygiene Products

We have already discussed how to select a manual toothbrush and dental floss, but there are numerous other products that might be useful. Walking down the dental supply aisle at your favorite store shouldn’t leave you feeling overwhelmed. A good starting point is to look for the ADA Seal of Approval. This is not a guarantee that the product will work, but at least you are assured it won’t harm you. I have listed the products most asked about by my patients.

Anti-plaque rinses

Most mouth rinses will change the bacterial level in your mouth. Even rinsing with water will have a benefit to some degree. The majority of rinses contain a percentage of alcohol. Sometimes, these rinses can cause a burning feeling, but for the most part the burning is harmless. There are times when rinses that contain alcohol should be limited. If you are pregnant, or if you suffer from limited saliva flow (dry mouth), then it would be beneficial to use a non-alcohol-based rinse. In my opinion, it is better to use rinses after flossing and brushing, not before. A good antimicrobial rinse (Listerine) used daily can help control early gum disease. Your dentist may recommend a prescription mouth rinse in cases of acute or advanced periodontal disease. They are only used as an adjunct to periodontal treatment and good brushing and flossing. Keep in mind, rinsing will not remove bacterial plaque.

Automatic toothbrushes

Using an automatic toothbrush can give you an advantage in your war on bacterial plaque. They are easy to use and are sold everywhere. Most of them have a two-minute timer (the optimum amount of time). The handles are easy to hold, especially for those affected by arthritis or diseases that limit motor skills. The cleansing action is greater overall and anyone can benefit, especially the lazy brusher. Sonic brushes are the latest to appear on the market. I have seen the greatest improvement in the oral hygiene of patients who use a sonic brush. They are generally more expensive, but the results are worth it.

Take care with medications

If you are medicated (taking antibiotics) before dental treatment, then these brushes might not be for you. It is imperative that you check with your physician, cardiologist or orthopedist before using any automatic toothbrush.

For kids with braces

Parents, if your children have braces, do them a favor and buy them an automatic toothbrush. You can’t imagine how difficult it is to adequately clean teeth with braces using a manual toothbrush.

Oral irrigation

Water piks have come into favor again after years of sitting under the sink. The new models are compact and easy to use. Some units come with attachments (Pik Pocket) that make flushing the periodontal pockets feasible. You can get rid of food debris in hard-to-reach areas (around and under bridges, orthodontic braces), but water piks will not remove plaque. They should only be used in conjunction with brushing and flossing. I have seen a decrease in bleeding gums in patients who use an oral irrigator regularly. Again, if you need to be premedicated before dental visits, consult with your physician before using these products.

Toothpastes

Like mouth rinses, there isn’t much difference between pastes in their effectiveness. Paste or gel is a personal preference. Gels are preferred when using an automatic toothbrush, to reduce splattering and foam. The main question should be: Does it contain fluoride?

Tartar-control pastes

Tartar-control toothpastes are very popular and are billed as pastes that will reduce calculus (tartar) formation. The fact is, they will reduce calculus, but only above the gumline. Calculus that forms above the gumline is strictly cosmetic. Tartar-control pastes do not affect calculus formation below the gumline where gum disease starts. Therefore, they have not been proven to reduce gingivitis.

Tooth-whitening pastes

Tooth-whitening pastes in general have little lasting effect on the teeth. I have never seen anyone’s teeth get whiter using an over-the-counter tooth-whitening product. Stain reduction is possible, but any paste can achieve this with good brushing. Due to the added chemicals in tartar-control and whitening pastes, some of my patients have experienced increased sensitivity in their teeth and/or gums. For this reason, I do not recommend these products to my patients.

Desensitizing toothpastes

Desensitizing toothpastes can be helpful in decreasing root sensitivity, but the relief is usually temporary. The active ingredient varies in the different pastes. So if one paste doesn’t work, it might be worth trying another brand. It could take up to several weeks before you will know if the paste is working. Read the label and follow the instructions to gain the maximum benefit.

Fluoride

Fluoride toothpastes and mouth rinses, used in conjunction with brushing and flossing, can reduce tooth decay as much as 40 percent. Regular fluoride use can also help desensitize and prevent decay on root surfaces in adults. In cases of excessive decay and extreme sensitivity, your dentist may write a prescription for a toothpaste that contains a higher dosage of fluoride. Children who receive fluoride from many sources (vitamins, water, foods, rinses, and toothpastes) should be monitored to avoid fluoride overdosing. Only a pea-sized dab of fluoride toothpaste is necessary for any child.

Interproximal toothbrushes

Interproximal toothbrushes are tiny brushes that clean between your teeth. The brushes come in various shapes and sizes that can be attached to a handle. As the brushes wear out they can be replaced. Some disposable pocket versions come with the brushes attached. These are great tools, and valuable in removing plaque and food from wide spaces between the teeth. Still, they do not replace flossing. These brushes should only be used in areas where they easily fit between the teeth. Applying force could lead to trauma to the gum and tooth. Toothpicks should be avoided. Since they are made of wood, they can break and become lodged under the gum causing pain and trauma. Sometimes it takes a trip to the dentist to remove them.

Rubber tips

Rubber tips are used to massage and stimulate the gums. They can be useful in decreasing red swollen gums. Rubber tips can sometimes be found on the end of your toothbrush or they are sold separately. Place the tip gently against the gums between the teeth and massage. Only use a light pressure, just enough to see the gum tissue blanch.

See Your Dentist Regularly

Even with good daily brushing and flossing, it is difficult to remove all the bacterial plaque that leads to calculus. Hardened calculus must be removed by your dentist or hygienist on a regular basis to help prevent gum disease. How often you need to have your teeth professionally cleaned depends on how long you can stay healthy between visits. If you have a normal level of health, six months is the suggested length of time between visits. Your dentist/hygienist may vary the interval from time to time to suit your needs. People with periodontal disease will need shorter intervals, three to four months, indefinitely. Others may temporarily need closer visits (like
pregnant women, patients with braces, and lazy brushers/flossers). Controlling periodontal disease is not only important to your teeth, it is important for your overall health. New research indicates there is a link between gum disease and certain heart disease. Additionally, doctors are currently researching a potential link between gum disease in pregnant women and low-birth-weight babies.

Conclusion

It is necessary to take an active role in your dental health, and your dentist/hygienist can assist you in keeping a healthy mouth. Fighting bacterial plaque with good oral hygiene is an integral part in keeping your teeth for a lifetime. An appealing and healthy smile is a great asset. A smile can communicate ideas and feelings. It can build your confidence in business and social situations. Good digestion depends on strong healthy teeth to chew food effectively. If you have loose or missing teeth, your health could be compromised by a limited diet and insufficient digestion. A clean mouth will have fewer dental problems, and your dental work will last longer and look better. The need for new treatment and painful emergency situations will decrease. All this will save you time and money at the dentist’s office.

So stay healthy and keep smiling!