With many medical diseases, researchers find strong risk factors and then determine how the risk factor is associated with the disease. Occasionally, risk factors are directly linked to disease by cause and effect, such as infectious diseases. Other diseases are more difficult and are proven over time when multiple risk factors are in play.

The latter is true of cardiovascular diseases — commonly called heart attacks and strokes.

For example, a 50-year-old normal man — no abnormalities whatsoever — has a 10-year risk of heart attack or stroke of 3.4 percent. However, if that man has high cholesterol, his risk is 6.3 percent, an 85 percent increase. If that same man has normal cholesterol but smokes, his risk is 7.5 percent, a 120 percent increase. If the high cholesterol man also smokes, his risk is 13.6 percent.

I tell my patients, if you had to choose one, it is healthier and cheaper for you to stop smoking than to treat your cholesterol. Or, as the lead cardiologist said during residency, “There is one word to describe people who take cholesterol meds and keep smoking: stupid.”

What you probably didn’t know, I learned from my dog. Or, more accurately, from her veterinarian. If that same otherwise healthy man has gingivitis/bad teeth, defined as being severe enough to increase inflammation in the body, his 10-year risk is about 5.1 percent, a 50 percent increase! That is a lot of lost life for not following your dentist’s advice.

When my next student rotates through my clinic, I may have to paraphrase that cardiology professor and say there is one word to describe people who take cholesterol medication and don’t go to their dentist.

Don’t be that word. See your dentist regularly.

ALLAN P. FRANK,

Alpena