1. Lifestyle and Oral Health
DR. Sudeep C B

2. Contents Introduction Lifestyle and oral health Conclusion References
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
Conclusion
References

3. Introduction
Lifestyle is a concept describing value-laden, socially conditioned behavioral patterns.
Diffuse concept often used to denote "the way people live", reflecting a whole range of social values, attitudes and activities.
It is composed of cultural and behavioral patterns and lifelong personal habits (e.g., smoking, alcoholism) that have developed through processes of socialization.

4. The Principal Oral Diseases affecting are "Dental Caries and Periodontal Diseases" with etiological factors of sugar in the diet and bacterial dental plaque.
Among the others,
Oral cancer is a major concerning disease that affects although a minority, but the prevalence is increasing in some countries because of the classical risk factors of smoking, pan chewing and alcohol.

5. Definition
Refers to any combination of specific practices and environmental conditions reflecting patterns of living, influenced by family and social history, culture, and socio-economic circumstances.
‘A general way of living based on the interplay between living conditions in the wide sense and individual patterns of behavior as determined by socio-cultural factors and personal characteristics’. (Kickbush,1986 )

6. Life-style is defined in terms of diet-pattern, social class, income, education, habits, culture, and environment.
Oral diseases are closely linked to lifestyle. Dental health encompasses the likelihood of making healthy choices in relation to diet, smoking, tobacco, oral hygiene and utilization of dental health services.
The concept of lifestyle makes it possible to study behavior in a broader sense.

7. Lifestyle and Dental Health Behavior
Dental health behaviors are multidimensional and that individuals have different motives for their behaviors.

8. 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 don’t use any other aids for cleaning the teeth.
differences in the prevalence of tooth brushing.

9. 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 child’s lifestyle.

10. 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).

11. Reflection of poor techniques.
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.
Reflection of poor techniques.

12. 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).

13. 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.: CD

14. 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
may be more effective in removing or reducing salivary pellicle, which has been shown to protect teeth from dental erosion
Millward et al., 1994a; Zero, 1996; Moss, 1998; Shaw and Smith, 1999
Meurman and Frank, 1991; Kuroiwa et al., 1993; Amaechi et al., 1999

15. 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 children’s 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.

16. 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.

17. 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 prevalence and incidence.
Vipeholm study by Gustaffson et al., 1954, 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 University press

18. 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 University press

19. 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),

20. Confectionery workers(Peterson PE, 1983).
There is an evidence to show that groups of people with a habitually high intake of sugars also have higher levels of caries. For Ex: -
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
For Ex: -
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),

21. 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 starch/high-sugars diet have high caries levels.
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.
Turku Sugar study by Scheinin, 1975, Tristan da Cunha study, Fischer FJ 1968, Hopewood House study by Harris, 1963, Newbrun,1980
Murray JJ. Prevention of dental diseases. Oxford University press
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),

22. Pacifier usage and Dental Caries
The association between certain nonnutritive suction habits, particularly pacifier use, and the development of dental caries has been documented in diverse studies [Ollila et al., 1998; Levine, 1999].
There are several possible mechanisms through which pacifier use favors dental caries development.
source of infectious processes in oral cavity tissues [Adair, 2003].
reservoir of microbes such as Staphylococcus, Candida and salivary lactobacilli. (Ollila et al. [1997] and Comina et al. [2006])

23. 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.
Progressive depletion of the protective elements ( Auerbach KG, 1990)

24. 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)

25. Type of diet
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).
persons with periodontitis and tooth loss changed their diets as a consequence of missing teeth. (Copeland, 2004)

26. 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 a 39% excess risk compared to vegetarian diet.

27. 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].

28. 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.

29. 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; López 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.

30. 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 adolescent’s 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.

31. Maternal education and oral health
Studies have also shown that maternal education is an important predictor of dental caries in adolescents [Ferrazzano et al., 2006 and Perera et al., 2008].
In the developing countries, maternal level of education has a significant positive influence on the wellbeing of the child [Boyle et al., 2006].
It is likely that an educated mother would be able to inculcate health-promoting behaviours in her children, which in turn would reduce the risk of disease.

32. In the absence of adequate dental knowledge and health beliefs, younger single mothers may adopt other high-risk behaviours compared to older mothers in two parent families. (Reisine S, 1994, 1998, Chen, 1995).
Dental care habits and dental health status of children improved when the mothers undertake regular dental care themselves (Gratrix, 1990).
Positive oral health attitudes in parents and emotional support to children are considered important to dental socialization.

33. 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 a 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 (Chestnutt IG et al., 2003).

34. SES and Early Childhood caries
Epidemiological data of ECC confirm that the disease is prevalent among disadvantaged children from lower socio-economic, immigrant and indigenous community groups (Hallett KB 1998, 2000, 2002).
The reasons for increased ECC risk could be

35. 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.
innate differences in the composition and morphology of dentition among blacks and non-blacks

36. 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
Different life styles, habits and customs, poor socio-economic status, dietary habits and poor oral hygiene

37. Occupation and Oral Health
Swimmers Erosion: seen in professional swimmers. It is a painful, costly, irreversible condition which can be caused by inadequately maintained gas-chlorinated swimming pools.( Centerwall BS, 1986) 

38. Erosion in athletes: In general, all the in vitro studies and animal studies have shown that sports drinks caused dental erosion due to their low pH
On the other hand O’Sullivan & Curzon, 2000 reported no relationship between dental erosion & consumption of sports drinks & other dietary history related to sport using 103 pairs of children.
[Birkhed, 1984; Rytömaa et al., 1988; Grenby et al., 1989; Sorvari, 1989; Meurman et al., 1990; Lussi et al., 1993].

39. Erosion in battery and galvanizing workers:
Three to five times higher risk for erosion in manufacturers working closest to the acid source than for other acid workers.(Chikte et al, 1998 and Chikte and Josie-Perez, 1999)
Erosion is higher in battery and galvanizing workers than in controls.
Mostly confined to the labial and incisal surfaces of the anterior teeth. (Fukayo S, 1999 and Gamble J 1984)

40. Dental erosion in other occupations
Ten Bruggen Cate,1968 reported dental erosion in munition manufacturers, soft drink manufacturers and dyestuff container cleaners.
Gray A, 1998, Chaudhry SI, 1997 and Ferguson1996 reported dental erosion in wine tasters which was predominantly located in upper anteriors. 

41. Considering erosion as a work-related condition, measures to promote occupational health are required.

42. Dental caries in confectionery workers:
Increase in caries experience with increase in duration of employment among confectioners was observed by Rekha R and Hiremath SS, 2002.
Two studies comparing caries experience of confectionery industry employees with similar group’s employees reported a higher percentage in caries prevalence in confectionery workers.
They also reported a higher caries experience in production line workers compared with non production line workers in the confectionery workers.
airborne sugar particles rather than by actual consumption
Murray JJ. Prevention of dental diseases. Oxford University press

43. Caries in Sugar cane Chewers:
6 surveys of caries experience in habitual sugarcane chewers and the results are equivocal.
The two studies on Bantu workers showed a very low caries prevalence. In contrast the three Caribbean studies all reported higher caries experience in workers of sugar plantations in Cuba and Jamaica.
In Tanzania (Frencken et al., 1989) concluded that chewing sugarcane over a long period promotes dental caries.
Murray JJ. Prevention of dental diseases. Oxford University press

44. Alcohol and oral health
Effects on the oral cavity, such as oropharynx cancer, caries, missing/ loss of teeth, and a greater risk for developing periodontal problems, have been identified by 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).

45. 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).

46. 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.

47. 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).
Studies have reported an
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.

48. The reported associations between smoking and periodontal disease among young people have been contradictory showing higher levels of gingival bleeding, periodontal attachment damage, gingival recession and alveolar bone loss among young smokers compared with young non-smokers (Gunsolley et al. 1998, Hashim et al. 2001, Al-Wahadni & Linden 2003).
Other studies, however, have found no significant association among young individuals (Lopez et al. 2001, Muller et al. 2001, 2002).

49. 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.

50. 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 was shown to interact synergistically for cancers of oral cavity.

51. Studies showed the relationship between betel quid chewing and periodontal disease (Mehta et al. 1955, Choudhury 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).

52. 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

53. 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).
A 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.

54. 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.

55. 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

56. 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)

57. 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.
Prabhu SR, Wilson DF, Daftary DK, Johnson WN, Oral diseases in Tropics, 1993,

58. Tooth mutilations
Tooth mutilation practices have been recorded for inhabitants of non-tropical environments and largely confined to societies which have been able to maintain their geographical or cultural isolation.
These practices include
Basic reasons for tooth mutilations
Prabhu SR, Wilson DF, Daftary DK, Johnson WN, Oral diseases in Tropics, 1993,

59. 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.
The enucleation of unerupted deciduous teeth is considered to confer therapeutic benefit upon children.
Ritual tooth evulsion
Prabhu SR, Wilson DF, Daftary DK, Johnson WN, Oral diseases in Tropics, 1993,

60. Mutilations of the tooth crown
Patterns of tooth crown mutilation generally involve from 2 to 12 permanent anterior teeth.
Complications includes
Prabhu SR, Wilson DF, Daftary DK, Johnson WN, Oral diseases in Tropics, 1993,

61. 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.
Prabhu SR, Wilson DF, Daftary DK, Johnson WN, Oral diseases in Tropics, 1993,

62. 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.
Prabhu SR, Wilson DF, Daftary DK, Johnson WN, Oral diseases in Tropics, 1993,

63. 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.

64. Conclusion:
Lifestyle is associated with clinically measured oral health.
Lifestyle, as measured by dental health behavior, smoking, alcohol consumption, dietary habits, socio-economic status, occupation, and stress, which are associated with dental caries, periodontitis, erosion and oral cancer.
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.

65. Thus, controlling lifestyle is essential when studying the biological influences of oral health on general health.
The impacts of a health-oriented lifestyle on discrete dental health behaviors may differ in magnitude. Some dental health behaviors seem to be promoted by motives other than merely health.
Health care providers should bear in mind the restrictions a person’s lifestyle may have on the improvement of individual behavior.

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