He was in his late 40s, happily married, with 2 healthy children and a thriving dental practice. Dentistry was his whole life, and unfortunately, it was also his death. He was a busy dentist, so busy that he had neither the time nor the energy to eat right, exercise, and relax. One late afternoon, he came home, greeted his wife and children, sat down in his favorite chair, closed his eyes, and never woke up - a victim of a massive heart attack. (Note: This is based on a real dentist known by the author, one of several dentists who had a similar fatal outcome.)
Recently, the author reviewed the death records of New Jersey dentists.1 The results of that survey are discussed in this article. In Part 2 of this article, the relevant lifestyle diseases - cardiovascular disease, cancer, type II diabetes, and AlzheimerÌs disease - are considered, and methods of prevention are examined.
SURVEY MATERIALS AND METHODS
The premise for examination of mortality of New Jersey dentists is that this could be used as an estimate of the mortality rate of American dentists. The New Jersey Dental Association maintains a record of all New Jersey dentists who have died in the last 25 years and were members of the association. Since most New Jersey dentists are, or were, members of the association, these records are an accurate estimate of the mortality rate of New Jersey dentists. The association receives the information from newspaper obituary columns and notices sent by relatives of the deceased. In November 2005, all of the obituary listings were categorized.
Number and Etiology: From January 1980 through November 2005, 1,123 dentists had died. However, most of the notices did not report death etiology. Nevertheless, in 16.4% of the total (184/1,123), the cause of death was listed. It was considered that this was a representative sample.
Mortality by Gender: Although currently many women are dentists and about 50% of dental students are female, the population for this study was overwhelmingly male, with only 3 women dentists having died (3/1,123 or about 0.3%). Therefore, no separation by gender was done.
Mean, Median, and Mode: The mean age of death was 76.9 years. The median age of death was 78.2 years. The mode age of death was 82 years.
Mortality by Age Cluster: The mean age of death (76.9 years) was slightly less than the current general American population mean (77.7 years).2 However, when the 3 female deaths are excluded, the mean remains 76.9 years, which is better than the current American male mean of 74.9 years. Mortality of dentists can also be considered by examining the median and age clusters. The median of 78.2 years shows that half of the dentists died earlier than that age and half died later. Almost 49% of the dentists died at age 80 or higher (548/1,123). The largest number of any age cluster was the 80s (415/1,123 or 37%), with age 82 showing the most deaths (58, almost 6% of the total deaths). A relatively large number (127/1123 or 11.3%) died in their 90s, and 6 dentists (0.6%) died in their 100s. Nevertheless, more than 51% (575/1,123) of the dentists died from ages 30 through 79. Twenty-six percent (292/1,123) died in their 70s, 13.6% (153/1,123) died in their 60s, and 7.7% (86/1,123) died in their 50s. The remaining breakdown showed that 2.7% (30/1,123) died in their 40s and 1.2% (14/1,123) died in their 30s. See Table 1 for a summary of mortality by age groups.
One interesting finding was that more dentists died in the year 1985 (73, about 6.5% of the total deaths) than any other year. In the other years, the number ranged from 34 (2004) to 65 (1988). The mean age of death for 1985 was 75.5, the median was 77.5, and the mode was 82. The mean (75.5) was slightly lower than the general mean (76.9), and the mode (82) was identical. The median (77.5) was also a little lower than the general median (78.2). The sample also showed that dentists in the year 1985 died from the same diseases as the general population (cardiovascular disease, cancer, and type II diabetes). The increased mortality of 1985 was either related to some environmental occurrences that year in New Jersey, or it was just a coincidence.
Breakdown of Etiology Sample: Most of the dentists in this sample (Table 2) died from the same major lifestyle diseases and conditions prevalent in the US population (to be discussed in Part 2 of this article).
Close to 50% of the dentists in this survey died in their 80s and older. However, more than 50% died in their 70s and younger. Similar to other professions, many dentists want to practice through their 70s, and many more want to enjoy their retirement years. However, this is impossible if they die early because of their lifestyle. Methods to reverse this trend are considered in Part 2 of this article.
Until recently, heart disease was the number one killer of Americans under the age of 85. This has recently been replaced by cancer.3 Stroke is the third leading killer.4 Considering all ages, heart disease remains the leading killer.5 The results of this sample show similar results. Under the age of 85, there were 63 deaths from cancer and 56 from cardiovascular disease (heart disease and stroke). From 85 and older, there were 16 deaths from cardiovascular disease and 7 deaths from cancer.
Although chronic obstructive pulmonary disease (COPD) is the fourth leading American cause of death,4 in this sample only 1 death was from COPD. COPD is related to chronic asthma, bronchiectasis, chronic bronchitis, and emphysema. Cigarette smoking is a leading cause of cardiovascular disease, cancer, and COPD. Apparently, many of the dentists who died in this study had been cigarette smokers and had eaten red meat and other foods high in saturated fat. From personal experience of attending many dental meetings over the course of 40 years, until the last 15 years ashtrays were found at all tables, and many dentists smoked cigarettes during their meals. In addition, the main course was usually steak or roast beef. Fortunately, this meeting style has changed drastically for the better.
Accidents are the fifth leading cause of death in America.4 Most are from motor vehicles, and many others are home-based. In this sample, accidents, along with type II diabetes, were the third leading cause of deaths. Most were automobile accidents, a few were home-based, and one was from an airplane. To help prevent automobile accidents, when youÌre driving, donÌt drink; be wide awake; wear a seat belt; donÌt talk on a cell phone; donÌt pay attention to the radio, CDs, tapes, or TV; and donÌt watch your partner, unless he or she is in distress, sick, dying, or becoming aggressive. Also, be alert around the house and at work.
Type II diabetes is the sixth leading killer of Americans.4,6 As mentioned above, type II diabetes, along with accidents, was the third leading cause of death in this sample. Type II diabetes is related to ingesting sucrose and high-fructose corn syrup products and high-glycemic index complex carbohydrates (eg, white flour products such as white bread, pasta, pizza, and white rice). Again, relative to personal 40-year dental meeting attendance, a rich, high-fat, high-sugar dessert was usually served.
Influenza and pneumonia is the seventh leading killer of Americans.7 Pneumonia, along with AlzheimerÌs disease, kidney disease, and suicide was the next leading cause of death in this sample. Related to agerelated impaired immunity, pneumonia is a frequent cause of death in older individuals, as was also found in this sample. AlzheimerÌs disease is the eighth leading killer of Americans.8,9 In the present study, there were likely more than the 3 reported cases of AlzheimerÌs disease, but this condition often goes unreported.
Kidney disease, which includes nephritis, nephritic syndrome, and nephrosis, is the ninth leading cause of death in America.8,9 Although genetics is involved in kidney disease etiology, other preventable causes are type II diabetes, toxins, kidney stones, and adverse reactions to medications and illegal drugs.
Septicemia (serious infection of the blood stream) is the 10th leading cause of death in America.7 However, no cases of septicemia were found in this sample.
Suicide is the 11th leading cause of death in America.7 Suicide results from the following conditions and life-styles:10 depression; high levels of stress; lack of social support; life-threatening sickness or injury; monetary, romantic, or family loss; loss of self-esteem; mind-altering drugs; brainwashing; religious fanaticism; and low levels of serotonin. Serotonin, associated with poor impulse control and a tendency to be violent and aggressive, has been found to be deficient in people who have attempted suicide. Genetics might also be related to a predisposition to depression. Suicide is not often reported as the cause of death, and some accidents might also be suicidal. Some of the aforementioned factors (especially depression) were undoubtedly involved in the present sample. Drug toxicity researcher Williamson has stated, controversially, that dentists, related to mercury intoxication, have a high level of depression and suicide.11 Nevertheless, evidence for this contention is lacking.12
Parkinson's disease is a chronic, progressive, unremitting neurologic disease that usually begins after the age of 50.13 In the United States it is found in about 1 million people. Untreated patients have a mortality rate 3 times greater than nonafflicted individuals. Victims usually die from pneumonia, urinary tract infections, or CNS vascular lesions. Unfortunately, even with treatment with drugs such as Levodopa, the mortality rate is still about the same. Genetics appears to be involved, but environmental factors, such as drinking well water and being exposed to pesticides, are also implicated. The 3 dentists in the sample died in their 70s from undisclosed complications.
ALS is an often-fatal degenerative neuromuscular disease. Although exact etiology is unknown, a higher incidence was found in military personnel, football players, and cigarette smokers. In this sample, only 1 dentist died from ALS.14
Cystic fibrosis is a degenerative lung disease related to infection by Pseudomonas aeruginosa. Although it often kills people in their 30s, in this sample the dentist died in his 80s. For treatment, the antibiotic azithromycin appears to be of benefit.15
Rheumatoid arthritis (RA) is a serious, chronic disease. The prognosis is uncertain because of the prolonged nature of the disease and the wide variation in its course. Premature death usually comes from cardiovascular disease, infection, lung and kidney disease, or GI bleeding.16 There is some evidence for preventive and therapeutic benefits from dietary omega-3 oils. Doses of up to several grams per day may be necessary for therapeutic effects in long-standing cases of RA, but lower doses appear to provide benefits in reducing the mortality.17 In this sample, 1 dentist in his 80s died from cardiovascular complications of RA.
Table 2. Breakdown of Etiology Sample.
Etiology by Age Groups:
GENERAL PREVENTIVE METHODS
1. Don't take drugs unless medically necessary.
2. Don't overeat; cut down on snacks. Even overeating of healthy foods is dangerous; calories do count.
3. Eat the right foods. These include the following:
4. If you don't eat sufficient fruits and vegetables, beneficial antioxidant and anti-inflammatory supplements are as follows:
5. Exercise regularly. Exercise is generally beneficial, but if one exercises while mentally stressed, blood pressure and heart rate can increase greatly, and the immune system can be inhibited.18 (Exercise is discussed more completely in Part 2.)
6. Try to maintain a healthy weight. Metabolism slows down with aging. Hence, later in life you should reduce food intake and increase exercise. This is just the opposite of what occurs with most people.
7. Have regular medical and dental checkups as well as podiatric and optometric checkups.
8. If depressed, get psychological or psychiatric help.
9. Avoid toxic agents, pollutants, and firearms.
10. Be optimistic. Research has shown that optimistic people have less chronic disabling diseases, recover quicker when sick, and live longer than pessimistic people.18
11. Consider being spiritual. Research has shown that people who are either religious or spiritual have less chronic disabling diseases, recover quicker when sick, and live longer than nonreligious or nonspiritual people.18
12. Be humorous. Research has shown that people who regularly use humor have less chronic disabling diseases, recover quicker when sick, and live longer than people who rarely use humor.17
13. Take frequent vacations. Research has shown that people who take frequent vacations have less chronic disabling diseases, recover quicker when sick, and live longer than people who rarely take vacations.19
In Part 2 the major lifestyle diseases cardiovascular disease, cancer, type II diabetes, and Alzheimer's disease are examined, and methods for their prevention are considered.
1. Obituary records of the New Jersey Dental Association. One Dental Plaza, North Brunswick, NJ 08902. Reviewed October and November, 2005.
2. The World Factbook: United States Ò Life expectancy at birth, total population (2006 est). Central Intelligence Agency Web site. Available at: http://www.cia.gov/cia/publications/factbook/geos/us.html. Accessed October 5, 2005.
3. Gardner A. Cancer now the leading killer of Americans: displaces heart disease for top spot, new report finds. HealthDay News; January 19, 2005. Available at: https://www.healthforums.com/library/1,1258,article~11452,00.html. Accessed April 28, 2006.
4. Study reveals trends in U.S. death rate, leading causes of death over 30 years. [Summary of article published in JAMA. 2005;294:1255]. Available at: http://www.emaxhealth.com/8/3191.html. Accessed October 5, 2005.
5. American Cancer Society. Cancer Facts and Figures 2005. Atlanta, Ga: American Cancer Society; 2005. Available at: http://www.cancer.org/ docroot/STT/content/STT_1x_Cancer_Facts__Figures_2005.asp. Accessed April 28, 2006.
6. Diabetes: Type 2 Diabetes. WebMD Web site. Available at: http://my.webmd.com/content/article/59/66844?z=1667_00000_0000_rl_03. Accessed October 6, 2005.
7. Arias E, Smith BL. Deaths: preliminary data for 2001. Nat Vital Stat Rep. 2003;51:1-44.
8. Prevalence and incidence of AlzheimerÌs disease. Available at: http://www.wrongdiagnosis.com/a/alzheimers_disease/prevalence.htm. Accessed October 4, 2005.
9. Prognosis of kidney disease. Available at: http://www.wrongdiagnosis.com/k/kidney_disease/prognosis.htm. Accessed November 24, 2005.
10. Suicide: etiology of suicide. SparkNotes Web site. Available at: http://www.sparknotes.com/psychology/abnormal/suicide/section1.html. Accessed November 20, 2005.
11. OÌBrien J. Mercury amalgam toxicity. Life Extension. May 2001. Available at: http://www.lef.org/magazine/mag2001/may2001_report_mercury_1.html. Accessed November 20, 2005.
12. Alexander RE. Stress-related suicide by dentists and other health care workers. Fact or folklore? J Am Dent Assoc. 2001;132:786-794.
13. Conley SC, Kirchner JT. ParkinsonÌs disease Ò the shaking palsy. Under-lying factors, diagnostic considerations, and clinical course. Postgrad Med. 1999;106:39-50. Available at: http://www.postgradmed.com/issues/1999/07_99/conley.htm. Accessed November 2005.
14. Weisskopf MG, McCullough ML, Calle EE, et al. Prospective study of cigarette smoking and amyotrophic lateral sclerosis. Am J Epidemiol. 2004;160:26-33.
15. Conova S. Pivotal new drug for cystic fibrosis. Columbia University Health Sciences Web site. Available at: http://www.cumc.columbia.edu/news/in-vivo/Vol2_Iss17_oct27_03/cystic_fibrosis.html. Accessed October 2005.
16. Federman R. What is the effect of rheumatoid arthritis on mortality? About.com Web site. Available at: http://arthritis.about.com/od/mortality/f/mortalityra.htm. Accessed November 21, 2005.
17. Cleland LG, James MJ. The role of fats in the lifecycle stages. Adulthood Ò prevention: rheumatoid arthritis. Med J Aust. 2002;176(suppl 11):S119-S120. Available at: http://www.mja.com.au/public/issues/176_11_030602/S119-S120.pdf.
18. Morse D. Surviving Stress: Simple, Safe, Strategic Solutions. College Station, Tex: Virtualbookworm.com Publishing; 2004.
19. Gump BB, Matthews KA. Are vacations good for your health? The 9-year mortality experience after the multiple risk factor intervention trial. Psychosom Med. 2000;62:608-612.
Dr. Morse is professor emeritus from Temple University and adjunct professor at Camden County College, where he teaches stress management and health and wellness. In addition to his dental degree he has graduate degrees in endodontics, microbiology, clinical psychology, and clinical nutrition. He has written more than 250 scientific articles and 16 books, i