No matter how old you are, you need to take care of your teeth and mouth. When your mouth is healthy, you can eat the foods you need for good nutrition. You will also feel better about smiling, talking and laughing. Teeth are meant to last a lifetime. By taking good care of your teeth and gums, you can protect them for many years.

Tooth Decay
Teeth are covered in a hard, outer coating called enamel. Everyday a thin film of bacteria builds up on your teeth. Over time the bacteria can cause holes in the enamel. These holes are called cavities. Brushing and flossing your teeth can protect you from decay, but once a cavity appears, a dentist has to fix it.

Gum Disease
Gum disease begins when plaque builds up along and under the gum line. This plaque causes infections that hurt the gum and bone that hold teeth in place. Sometimes gum disease makes your gums tender and more likely to bleed. This problem, called gingivitis, can often be fixed by daily brushing and flossing.

To prevent gum disease:

• Brush your teeth 2 times per day with fluoride toothpaste
• Floss once per day
• Visit your dentist regularly for a checkup and cleaning
• Quit smoking. Smoking increases your risk for gum disease.

Oral health problems to report to your dentist

• Red, tender or swollen gums
• Gums that bleed when you brush or floss
• Gums that begin pulling away from your teeth
• Loose teeth
• Changes in the way your top and bottom teeth align with each other
• Unusual sensitivity to hot or cold

Cholesterol is one of the main contributors to heart and vascular disease in the world. The Framingham Study showed us several decades ago that there was a link between high cholesterol and heart disease. High cholesterol remains one of the major risks for heart attacks and stroke. Although it appears to be mostly the bad cholesterol (LDL) or a lack of the good cholesterol (HDL) that leads to artery hardening, the total cholesterol remains the number most people think of when discussing the this issue.

Unfortunately, most of the cholesterol in our body is made by our liver rather than related to the amount of cholesterol we eat. Foods high in saturated fats (usually fats from animal products) are the main building blocks of cholesterol. Our genetic makeup triggers the production of the total amount and the sub-components. Although we don’t have control over what is in our genes, we have new medicines that can block the production in our liver or reduce our absorption from our intestines. Many products are made for this problem, but none work as well as “statin” drugs like Lipitor, Zocor, Crestor, Mevacor, or Pravachol. This group of drugs not only reduces cholesterol more effectively that other groups or diet, but there are added reductions in heart attack rates not fully explained by the cholesterol reduction alone. Generic forms of these drugs are often available and work about as well as the brands they replace. The differences among these are potency and small differences in outcome, but they all work really well.

For reading more on The Web about treating, testing, and evaluating your cholesterol SBFMG recommends WEBMD.COM and the NCEP (National Cholesterol Education Program) sponsored by The National Institute of Health and The American Heart Association.

Immunizations are one of the most effective ways to prevent serious illness in children and adults. Pediatric immunization programs in the US have been quite successful in reducing the number of children affected by a range of highly contagious diseases, including Measles, Mumps, Rubella, Diphtheria and Polio.

Hepatitis B
Inflammation of the liver (hepatitis) can be caused by toxic drugs, chemical agents and certain viral infections including Hepatitis B virus (HPV). Although Hepatitis B infection often resolves or causes no symptoms, HBV can cause chronic liver disease that leads to progressive scarring (cirrhosis) or liver cancer. HBV is transmitted by contact with an infected individual’s body fluids. It can be transmitted from an infected pregnant woman to her baby.
Hepatitis B vaccine is recommended for all children beginning at birth but can be started at a later time. It requires 3 doses.

Hepatitis A
Hepatitis due to infection with Hepatitis A virus (HAV) is one of the most common viral infections in children and adolescents in the US. HAV infection often causes few or no symptoms in younger children. By contrast, infection in adults can vary in severity from mild flu-like illness to rapidly progressive severe liver disease. HAV is found in the stool of infected individuals. A person can become infected with HAV by consuming contaminated food or water or by touching the mouth, nose or eyes after touching a contaminated surface.
Hepatitis A vaccine is recommended in all children 12-23 months. Older children and adults also can consider being immunized. In all age groups, 2 doses of the vaccine are required at least 6 months apart.

Diphtheria, Tetanus, Pertussis
Diphtheria is a highly contagious disease caused by a bacterial toxin. It is usually transmitted via droplet particles that are coughed or sneezed into the air. The toxin can lead to damage of the kidneys, brain, nervous system or heart.
Tetanus is an infection cause by a bacterial toxin. Bacteria reside in the soil and intestinal tracts of certain mammals. It enters the body through an open wound, multiplies and produces a toxin that can affect nerves controlling muscle activity. A common symptom of tetanus infections is stiffness of the jaw muscles (“lockjaw”).
Pertussis, or whooping cough, is an upper respiratory infection caused by a bacterial organism that is highly contagious. It spreads easily and can cause serious illness, especially in infants.
Combined DTaP is recommended for all children in the US. A total of 5 separate doses are recommended. The first 3 doses are at 2 months, 4 months, and 6 months. The 4th dose is at 15-18 months and the 5th dose is at 4-6 years. Subsequent doses are recommended at 10 year intervals throughout life.

Polio
During the first half of the 20th century, Polio was a major cause of serious illness and death throughout the world. It is still a significant health problem in some developing countries. Primary signs of Polio include muscle weakness, pain and fatigue. Ultimately, the illness can lead to paralysis and even death.
Vaccination of all children is recommended to avoid new outbreaks.
IPV series in the US consists of 4 doses. The first 2 doses are given at 2 and 4 months. The 3rd dose is given at 6-18 months and the 4th dose at 4-6 years.

Rotavirus
Rotavirus is the single most important cause of severe diarrhea and dehydration in infants and young children. Immunization against Rotavirus is recommended for all infants in the US.
The vaccine is in a liquid form and is given by mouth. Three doses are recommended at 2, 4, and 6 months. The third dose should be given by 8 months.

Haemophilus influenzae B (Hib)
Until the mid-1990s, Hib was the most common cause of bacterial meningitis in children. It was also responsible for other serious bacterial infections, including skin, throat and joint infections. Despite its name, Hib is not actually related to the influenza virus.
The vaccine is given at 2, 4, and 6 months and a booster at 12-15months.

Pneumococcal
Streptococcus pneumoniae can cause serious infections, including meningitis and pneumonia that can be fatal in young children;
Children receive a total of 4 doses at 2, 4, 6, and 12-15 months of age.

Influenza
Commonly known as flu, influenza is a highly contagious viral infection that occurs in outbreaks world wide.
Annual immunization against influenza is recommended for all children ages 6 months to 18 years.

Measles, Mumps and Rubella (MMR)
Measles, Mumps and Rubella are illnesses that may be transmitted by airborne droplets released during coughing or sneezing.
Measles (rubeola) is a highly contagious viral illness of the respiratory tract that primarily affects children. It causes a distinctive rash, fever, and cough and may result in complications including infection of the middle ear, lungs and brain.
Mumps is an acute, usually mild viral infection of childhood that causes painful swelling of salivary glands. Mumps complications can develop including inflammation of the brain (encephalitis), protective membranes of the brain (meningitis), and in males after puberty, swelling and tenderness of one or both tests (orchitis).
Rubella (aka German measles), a mild viral infection, causes fever, swelling of lymph nodes in the neck and a distinctive rash. However, it can cause severe birth defects if a woman becomes infected during early pregnancy.
The first MMR vaccine is given at 12-15 months and the second at 4-6 years.

Varicella (chicken pox)
Varicella is a highly contagious viral illness caused by infection with Varicella Zoster virus. The disease causes fever, sore throat and a distinctive, itchy rash with fluid filled blisters that later form scabs. It is transmitted via spread of airborne droplets or direct contact with skin lesions. Complications include bacterial infections of the skin, pneumonia or less commonly inflammation of the brain.
The vaccine is recommended at 12-18 months and at 4-6 years.

For those of us with a relative who has had a heart attack or stroke, or for those of us who may worry we may be at risk for the same, there is a now a test available to help determine our risk. Carotid Intima Media Thickness (CIMT) is an ultrasound protocol that has been around as a research tool for over 20 years and in clinical practice since 2002. This is a simple non-invasive test that takes 10 – 20 minutes and involves measuring the thickness of the two innermost layers of the common carotid artery. The thickness of these two layers has been shown to correlate very well with cardiovascular risk.

You may ask “Who says that this is a good test and why?” Well, The American Heart Association and the American College of Cardiology have recommended this test for those of us with cardiovascular risks. Many research studies have been conducted using this technique. There is an accepted opinion that with CIMT there is a 96% correlation with the amount of disease found in the common carotid artery and with the disease found elsewhere in the body, such as the arteries in the heart and brain. Furthermore, it is equally predictive in men as in women. Large trials following populations with heart disease as well as outcome studies suggest CIMT can be used as a surrogate end point or marker to help predict clinical events such as a heart attack or stroke.

Who should consider getting this test? Any person with a family history of coronary heart disease or heart attack, stroke, tobacco use, high blood pressure, diabetes, elevated LDL cholesterol, low HDL cholesterol, elevated triglycerides or the Metabolic Syndrome may want to consider having this test. Generally, we suggest this test for those of us at risk and over the age of 40. CIMT may also be used monitor life style changes and treatments suggested to modify cardiovascular risk.