The Cavity Predictor: Are You at Risk?

1. Have you had any teeth extracted, other than your wisdom teeth or in preparation for braces?

No teeth extracted — Low risk
Four or fewer teeth extracted — Moderate risk
Five or more teeth extracted — High risk

If you have had teeth removed because they had cavities, this indicates that your mouth contains very high levels of a type of bacteria that can cause cavities. These bacteria are called Streptococcus mutans. They live in the sticky material known as dental plaque that builds up on your teeth. If you have had cavities in the past, you are more likely to get cavities in the future.

2. Have you had any cavities in the last three years?

No cavities or one cavity — Low risk
Two cavities — Moderate risk
Three or more cavities — High risk

When it comes to cavities, your past experience is the single best indicator of what can happen in the future. If you have had cavities recently, your mouth still contains the type of bacteria that cause them. The more cavities you have had recently, the more likely you are to get cavities in the future.

3. How often do you visit a dentist or dental hygienist for a routine checkup or a cleaning?

One or two times a year — Low risk
Every one to three years — Moderate risk
Less often than every three years — High risk

One of the best ways to keep your teeth healthy and to prevent cavities is to visit a dentist or dental hygienist regularly. He or she can check your teeth and mouth, and suggest changes that can keep your mouth healthier. Most important, the dentist can find signs of problems early. At this stage, they can be treated or possibly reversed.

Some people visit the dentist only when they have a toothache or a visible problem. But by the time you can see something or a tooth starts to hurt, the problem could be very advanced.

Your dentist can recommend how often you should visit for checkups. Many people visit the dentist every six months. You may need to visit less often or more often, depending on the health of your teeth and mouth.

4. What age are you?

16 to 21 — High risk of cavities in tooth crown
22 to 40 — Low risk of any cavities
41 to 59 — Moderate risk of cavities in tooth roots
60 or older — High risk of cavities in tooth roots

Thanks to better at-home care and in-office dental treatments, more people than ever before are keeping their teeth throughout their lives. Some diseases and conditions can make cavities and tooth loss more likely. However, most of us have a good deal of control over whether we keep our teeth into old age.

Between ages 16 and 21, you are more likely to develop cavities in the crowns of your teeth. This is the part of the tooth that you can see in the mouth. You are at greater risk because at this age many people go through life changes that often lead to changes in eating habits. For example, when people leave home for the first time, they often eat more foods that are high in sugar and starches (carbohydrates).

With age, the risk for dental cavities in the crowns of the teeth declines if the tooth has not already experienced a cavity. In older adults, gums often recede and expose the root of the tooth. The reasons for this recession include periodontal (gum) disease and incorrect brushing. Bad brushing habits include brushing too vigorously, brushing with a toothbrush that has hard bristles, or using poor brushing technique.

When a tooth root is exposed, decay is more likely to develop on the root surface. Tooth roots are covered by layers called cementum and dentin. They are softer than the hard, protective enamel that covers the top part of the tooth (the crown). The decay-causing bacteria in your mouth can get into these softer layers more easily. This can cause sensitive teeth and eventually root cavities.

Fillings can start to break down over time. Sometimes they develop cracks, or spaces can appear between the filling and the tooth. If this happens, bacteria can get into the tooth and cause decay. This is the most common reason that fillings have to be removed and replaced.

The older you are, the more likely it is that you will produce less saliva. You are also more likely to be taking medicine for a health condition. Many medicines can decrease the amount of saliva in your mouth. This can cause dry mouth (xerostomia), which increases the chance of developing cavities.

5. Do you have diabetes?

Yes — Moderate to high risk
No — Low risk

People with diabetes have an increased risk of developing dry mouth. This is also called xerostomia. They also have a higher risk of cavities. Cavities form when decay-causing bacteria produce acids that weaken and destroy the hard, protective surface of the tooth (the enamel). Bacteria make these acids when they come in contact with carbohydrates in food and drinks. Saliva is a natural cavity fighter. It washes away food and plaque from tooth surfaces. It also helps to neutralize acids in your mouth. Without this natural protection, you are more likely to develop cavities.

If you have diabetes, it is very important that you visit your dentist for regular checkups. You also should take especially good care of your teeth and gums at home. Daily brushing with fluoride toothpaste and flossing will help to reduce the level of decay-causing bacteria in your mouth.

6. Do you have a dry mouth?

Yes — High risk
No — Low risk

Cavities form when bacteria in your mouth make acids that eat away at tooth enamel. This is the outer protective surface of the tooth. Bacteria make these acids when they come in contact with carbohydrates in food and drinks.

Saliva is a natural cavity fighter. It washes away food and plaque from tooth surfaces. It also helps to neutralize acids in your mouth. Without this natural protection, you are more likely to develop cavities. You also may be more likely to develop conditions that affect the soft tissues in your mouth, such as thrush.

A dry mouth is a common side effect of many medicines. It also is caused by some diseases. Examples include diabetes, rheumatoid arthritis and anemia. If your dry mouth is related to a medicine, ask your doctor if another medicine is available that does not have the same side effect.

There are ways to keep your mouth moist and help prevent cavities. You can sip on water frequently, suck on sugar-free candies, chew sugarless gum, and use an over-the-counter oral moisturizer or saliva substitute. Also, talk to your dentist. He or she may suggest fluoride rinses or treatments to help lower your risk of cavities.

7. Do you currently use fluoride toothpaste?

Yes — Low to moderate risk
No — High risk

Many people think fluoride is mainly for children, to help them develop strong and healthy teeth. But fluoride helps adults, too.

Cavities form when bacteria in the mouth produce acids that cause minerals to leach out of teeth. This breaks down the tooth's outer layer, the enamel. Fluoride helps replace the minerals that are lost, and strengthens teeth.

It's important to use toothpaste that contains fluoride every day. Then talk to your dentist about whether you need additional fluoride. Your dentist may suggest extra fluoride if you have other factors that put you at high risk of developing cavities.

You can get fluoride treatments in the dental office, or buy prescription fluoride gels or rinses that you can use at home. Fluoride mouth rinses are available over the counter as well, but they don't contain as much fluoride as the prescription products.

8. Do you use an over-the-counter fluoride rinse, such as ACT, Phos-Flur or Fluorigard?

Yes — Low to moderate risk
No — High risk

Fluoride is best known for strengthening teeth as they develop in children. But it can help adults, too.

If you have fillings, crowns or bridges, fluoride can help to reduce your chance of developing decay in these areas. In addition, if you have receding gums that expose the roots of your teeth, fluoride will help to protect the roots from decay.

If you do not use a fluoride rinse, consider talking to your dentist about whether you need additional fluoride. Your dentist may suggest an in-office fluoride treatment or an over-the-counter fluoride rinse. Your dentist can also prescribe a fluoride gel or rinse that you can use at home. Prescription products contain more fluoride than the fluoride rinses available over the counter.

9. How many meals do you eat per day?

Three meals — Low risk
Three meals plus a couple of snacks — Moderate risk
Eating or snacking throughout the day — High risk

When it comes to preventing cavities, how often you eat can be just as important as what you eat. That's because food affects teeth long after you swallow.

Many carbohydrates break down in the mouth into simple sugars. Bacteria in the mouth feed on these simple sugars and produce acid, which dissolves the tooth's outer layer, called the enamel. Saliva is the body's natural cavity fighter. That's because it can neutralize the acids in your mouth and repair some of the damage the acid caused. But when the bacteria have a continual supply of carbohydrates from snacking, they produce too much acid for your saliva to neutralize. These acids start to break down your tooth enamel. This decay process continues for about 20 to 30 minutes after eating or drinking. It lasts even longer if food particles get caught between the teeth.

If you graze throughout the day, including sipping on juice or soft drinks, bacteria are able to produce acid almost constantly. This makes tooth decay more likely. Carbohydrates that can create acid in the mouth include not just sugary foods like cakes and candy, but non-sweet foods like bread, cereal, rice and bananas.

Studies have shown that those who eat sweets as snacks between meals have higher rates of decay than those who eat the same amount of sweets with their meals.

The good news is that some foods can actually protect against decay. These include vegetables, fruits, milk, cheese, meat, fish and beans. They are considered "tooth-protective" foods because they help to make teeth and gums strong and healthy. Some foods, such as fruit and raw vegetables, also can help to clean the teeth by increasing the amount of saliva in the mouth. Saliva does a good job of cleaning and rinsing the teeth. Talk to your dentist about what you can do to make your eating habits more tooth-healthy.

10. Do you chew gum or suck on mints or candies that contain xylitol?

Yes — Low to moderate risk
No — Moderate risk

Xylitol is a natural sweetener. It is found in fruit such as strawberries, plums and pears. Because Xylitol looks and tastes like sugar, some food and candy manufacturers use it as a sweetener.

Xylitol is a tooth-friendly sweetener for two reasons. First, the decay-causing bacteria in your mouth are not able to feed on xylitol like they feed on simple sugars. This means the bacteria can't use xylitol to produce acids that can cause tooth decay. Second, research has shown that using products that contain xylitol, such as sugarless gum or candy, can help to protect teeth against decay.

Xylitol has been found to hinder the growth of the bacteria that lead to tooth decay. Xylitol also makes it difficult for these bacteria to stick to the surfaces of the teeth, where they begin the decay process. Chewing gum or sucking mints or candies that contain xylitol also promotes the production of saliva. This acts as a natural rinse for your teeth and neutralizes acid.

11. How often do you brush your teeth?

Twice a day or more — Low risk
Once a day — Moderate risk
Less than once a day — High risk

The main way to prevent cavities is to clean food debris and plaque from your mouth. Without the carbohydrates found in many foods, cavities can't form. Bacteria in the mouth need the sugar found in carbohydrates to produce acid, which then dissolves the tooth's outer layer, called the enamel.

Dentists recommend brushing teeth at least twice a day to clean away food and plaque from your teeth.

Plaque is the soft, gooey substance that sticks to teeth a bit like jam sticks to a spoon. It contains colonies of bacteria and other organisms, clumping together with food debris. Plaque begins to form immediately after a tooth is brushed or cleaned. This is why it is important to brush your teeth regularly.

12. How long do you brush your teeth each time you brush?

Two minutes or more — Low risk
One to two minutes — Moderate risk
Less than one minute — High risk

Research shows that it takes two minutes of brushing to remove plaque from the teeth. If you brush for less time than this, you probably aren't removing all the plaque. Brushing for longer than two minutes doesn't add much benefit.

13. Do you have difficulty holding a toothbrush to brush your teeth?

Yes — Moderate to high risk
No — Low risk

One of the best ways to prevent cavities is to make sure you remove food particles and plaque from your teeth. Plaque is a sticky film containing bacteria and other debris that forms on teeth.

The most effective way to clean your teeth is to brush carefully with fluoride toothpaste at least twice a day. Brush for two minutes each time. If you brush for less time than this or have difficulty holding your toothbrush and can't reach all the surfaces of your teeth, you may not be removing all of the plaque. This greatly increases your chance of developing cavities.

If you find it difficult to hold a toothbrush, you can try using a brush specially designed to be easier to hold. Some have large handles and angled heads to make them easier to use. You also can try a battery-operated brush that has a rotating or vibrating head. This kind of brush doesn't need much hand, wrist, shoulder or arm movement to use. These toothbrushes can be purchased in most drugstores. If you are not sure what kind of brush would work best for you, ask your dentist or dental hygienist for advice.

It is also very important that you visit your dentist regularly for a checkup and any necessary treatment.

14. How often do you floss?

Daily — Low risk
Sometimes — Moderate risk
Never — High risk

Many people think the main purpose of flossing is to remove food particles from between the teeth, so they don't floss unless they feel something stuck in there. However, the main purpose of flossing is to remove plaque from areas where a brush can't reach.

Plaque is the soft, gooey substance that sticks to teeth a bit like jam sticks to a spoon. It contains colonies of bacteria and other organisms, clumping together with food debris. If you don't remove all the plaque from your teeth, the bacteria in the plaque will continue to produce acids that attack your teeth and cause cavities.

15. Do you have braces?

Yes — High risk
No — Low risk

Braces make it harder for you to clean your teeth properly. If food gets stuck under the braces or in between teeth, it can lead to cavities.

Because braces put you at higher risk of cavities, your orthodontist may recommend that you use a fluoride rinse or apply a fluoride gel each day. This can help strengthen the teeth and defend against cavities.

It's also important that you learn how to clean teeth with braces. It can take longer to clean teeth with braces, and it is more difficult. Ask your orthodontist to show you the best way to brush and floss around braces.

16. Have you had periodontal (gum) surgery?

Yes — High risk
No — Low to moderate risk

Periodontal (gum) disease and some of the surgeries needed to treat it can cause gums to recede. This exposes the roots of teeth. A tooth root normally is covered and protected by gum tissue. When the root is exposed in the mouth, decay is more likely to develop on the root surface. This is especially likely if you have a history of cavities.

A tooth root is covered by layers called cementum and dentin. They are softer than the hard enamel that covers the part of the tooth you can see (the crown). Because the root surface is relatively soft, the decay-causing bacteria can penetrate it more easily. This can cause sensitive teeth and eventually root cavities.

If you have receding gums and exposed roots, it is important that you reduce the number of decay-causing bacteria in your mouth. To do this, brush carefully and thoroughly with fluoride toothpaste at least twice a day. Always brush gently with a toothbrush that has soft or extra soft bristles.

It is also important to visit a dentist regularly. The dentist can check your teeth and mouth, and suggest changes that can keep your mouth healthier. Your dentist might also recommend additional fluoride, which helps to strengthen teeth. You can get fluoride treatments in the dental office or use prescription fluoride gels or rinses at home. Fluoride mouth rinses are also available over the counter, but they don't contain as much fluoride as the prescription products.

17. Do you have crowns or bridges in your mouth?

No — Low risk
One crown — Moderate risk
More than one crown or a bridge — High risk

Having crowns or bridgework in your mouth makes it more difficult for you to clean your teeth and maintain your oral health. Plaque builds up around crowns and bridges. Regular tooth brushing may not be enough to remove it all. If you have a bridge, for example, you need to clean under the bridge. A toothbrush can't reach there. Your dentist or dental hygienist can give you a device that will allow you to reach under the bridge and clean it properly. Crowns and bridges can last a lifetime if maintained well.

Keep in mind that crowns and bridges are often made to replace a tooth that has been lost to decay. The decay process can continue if you don't change your diet and take better care of your teeth and gums at home. Regular visits to a dentist and dental hygienist are essential if you have crowns or bridges.

18. Do you have a removable partial denture?

Yes — High risk
No — Low to moderate risk

A partial denture replaces teeth that are missing from your mouth. The partial denture is typically kept in place by metal clasps. Saliva is your body's natural defense against cavities. But saliva can't flow around teeth that are close to a denture. New cavities can occur in these teeth. The denture is kept in place for many hours during the day. Some people sleep with their dentures. This also limits how well saliva can bathe and protect the teeth. If you have a partial denture, you should clean it often. Be sure to brush and floss the teeth next to the denture in the same way as teeth that are farther away. Regular visits to the dentist and dental hygienist are essential. They can help you to maintain your denture and keep your remaining teeth healthy and cavity-free.