Transcript - The Cavity Predictor

When it comes to cavities, the past is the single best indicator of what can happen in the future. If your child has had a cavity, he or she is at risk of getting more. The more cavities your child has had, the more likely he or she is to get cavities in the future. It means that your child has the bacteria necessary to make cavities and that conditions are right in your child's mouth for cavities to form.

"Whether or not your child has had cavities in the past is a marker for your child's ability to develop cavities in the future," says Burton Edelstein, D.D.S., M.P.H., a pediatric dentist at the Columbia University College of Dental Medicine. "If children are particularly good at creating cavities — because of their oral bacteria and high-sugar diet — their decay process will continue to damage new teeth as they come into the mouth."

2. Does your child have any white spots on his or her teeth?

No - Low risk
Yes - Moderate to high risk

A chalky white spot, especially along the gum line, is the first visible sign that a tooth may be beginning to develop a cavity. The white spot forms when minerals begin leaching out of the tooth's outer surface (enamel). This happens when bacteria in the mouth, after being exposed to carbohydrates, including sugars, make acid that attacks the enamel surface of the teeth.

At this stage, the decay process can be reversed. At home, you can apply fluoride to the white spots, using over-the-counter fluoride rinses or toothpastes, and you can reduce the number of times your child eats, snacks or drinks fluids that contain carbohydrates throughout the day. This can help the tooth to repair itself.

If you see a white spot on one of your child's teeth, you should have your child's dentist take a look. Ask your child's dentist what changes you can make to prevent further decay and to protect your child's teeth in the future. Because there are other conditions that can cause white spots, it is important that your child see a dentist.

3. Does your child have any visible plaque on his or her teeth?

No - Low risk
Yes - Moderate to high risk

Plaque is the sticky, yellowish / white film that forms on teeth, especially along the gum line. It is a mixture of bacteria and other debris. Unless it is cleaned off regularly and completely, plaque can remain active and lead to cavities and gum inflammation.

Children who have plaque on their upper front teeth are at high risk of developing cavities. You can check this by gently scraping a fingernail along the gum line of these four teeth. If anything comes off, it is plaque. You should talk to your child's dentist about this. .

4. How often are your child's teeth brushed?

Twice a day - 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 the teeth and mouth. Without the carbohydrates found in many foods, cavities can't form. This is because the 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 debris and remove plaque from teeth. Plaque is the soft, gooey substance that sticks to teeth a bit like jam sticks to a spoon. It is, in fact, colonies of bacteria and other organisms, clumping together along with food debris. Plaque begins to form immediately after a tooth is brushed or cleaned. This is why it is important to brush teeth regularly.

5. Are your child's teeth brushed with fluoride toothpaste?

Yes - Low to moderate risk
No - High risk

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. Be cautious about how your child uses fluoride toothpaste because young children are more likely to swallow it after brushing instead of spitting it out. You should use only a small amount of toothpaste (the size of the child's pinky fingernail) and encourage your child to spit out as much as possible. Avoid flavored toothpastes that might encourage swallowing.

It's a good idea to talk to your child's dentist about whether your child is getting the right amount of fluoride. If not, the dentist can suggest the best way to change your child's fluoride intake. Your dentist may suggest additional fluoride if your child has other factors that put your child at high risk of developing cavities.

6. Does your child drink mainly water that does not contain fluoride?

No - Low to moderate risk
Yes - High risk

Fluoride is important for developing strong teeth that are more resistant to cavities. Since a main source of fluoride for many children is tap water, it is important for parents to know if the water they use is fluoridated. The easiest way to find out if your water is fluoridated and the concentration of fluoride in the water is to contact your local water district. Information on how to contact your water supplier should be on your water bill, or you can look in the "Local Government" section of your phone book. Your dentist or pediatrician also should be able to give you this information.

Children also can get fluoride from toothpaste. Children who are at high risk of decay may need additional fluoride from mouth rinses, fluoride gels or fluoride supplements prescribed by a dentist, or from fluoride treatments in a dental office.

It's a good idea to talk to your child's dentist about whether your child is getting the right amount of fluoride. If not, the dentist can suggest the best way to change your child's fluoride intake.

7. Has your older child had sealants placed on his or her teeth by a dental health care professional?

Yes - Low risk
No - Moderate risk

Sealants are clear or tinted plastic protective coatings that are painted onto the chewing surfaces of the back permanent teeth (molars and premolars). This is a cavity-prone area because these teeth have grooves and crevices, which dentists call pits and fissures. Food gets stuck in these crevices easily, and the crevices are harder to clean. This makes pits and fissures a perfect environment for bacteria to grow and cause cavities.

Sealants cover the pits and fissures and make the chewing surface smoother, so it's harder for food to remain on the teeth. Applying sealants is a procedure that can be done during a routine dental visit. Talk to your dentist about getting sealants for your child's teeth.

8. How often does your child visit a dentist or dental hygienist?

One or two times a year - Low risk
Never - High risk

One of the best ways to keep your child's teeth healthy and to prevent cavities is to take your child to a dentist or dental hygienist regularly. The dentist or dental hygienist can check your child's teeth and mouth, suggest changes that can keep your child's mouth healthier, and tailor a fluoride program as needed. The dentist or dental hygienist also can give you and your child tips about brushing, flossing and other tooth-healthy habits.

Even if your child's teeth seem fine, it's a good idea to take him or her to the dentist every six months, or at least once a year. The dentist can provide guidance about your child's growth and development and assess his or her risks for cavities, injuries, bite problems (malocclusion) and other oral problems. Experts recommend that an infant visit a dentist either within six months after the first tooth emerges through the gum or by his or her first birthday.

9. Is your child undergoing orthodontic treatment?

No - Low to moderate risk
Yes - High risk

Braces make it harder for your child to clean his or her teeth and provide more niches for plaque to remain undisturbed. If food gets stuck under the braces or in between teeth, the plaque that forms can lead to cavities.

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

It's also important that your child learn how to clean teeth with braces, and that you check how he or she is doing. It can take longer to clean teeth with braces, and it is more difficult.

Ask your orthodontist to show you and your child the best way to brush and floss around braces.

10. Does your child have special health care needs or routinely take medication?

No - Low to moderate risk
Yes - High risk

Special situations can make your child more likely to develop cavities. Children with physical or mental challenges may have a harder time cleaning their teeth and may need more help or supervision. You can use oral-hygiene devices such as toothbrushes with enlarged handles that make them easier to grip. In addition, consider the use of battery-operated toothbrushes. These do not require back and forth arm movement to clean the teeth. Floss holders allow one-handed flossing and make it easier to floss hard-to-reach spots in the mouth. Oral irrigators can be used to remove larger food particles. All these devices should be considered for children who have pain or movement limitations that can limit their ability to clean their mouth and teeth. It is advisable to ask your dentist or dental hygienist for advice and instruction on which devices and products to use.

Some medications can make it more likely that your child will get cavities. Many medications, for instance, contain sugar and/or sweeteners that can increase the risk of cavities. It is difficult to determine if a sweet-tasting medication contains sugar or not, so it is a good idea to brush the child's teeth after giving medicine.

11. If your child is over the age of 3, is he or she still using a bottle?

No - Low to moderate risk
Yes - High risk

Children who are over the age of 3 and still using a bottle are at an increased risk of developing cavities if the bottle they are given contains a liquid other than water. When a child's teeth are continually exposed to drinks that contain carbohydrates, such as fruit juice or milk, bacteria start feeding on the sugars. The bacteria produce acid, which can cause teeth to decay. The more times a child's teeth are covered by a sugary drink throughout the day, the higher the risk of serious decay.

In addition, there is an increased possibility that a child who is 3 or older and still using a bottle will be put to bed for the night, or put down for a nap with the bottle, further exposing his or her teeth to carbohydrates.

Encourage infants to drink from a cup as they approach their first birthday. Infants should be weaned from the bottle at 12 to 14 months of age.

12. Does your child fall asleep while nursing or with a bottle with juice or milk in it?

No - Low to moderate risk
Yes - High risk

When a liquid that contains carbohydrates, such as fruit juice or milk, is allowed to sit in the mouth, bacteria start feeding on the sugars. In the process, the bacteria produce acids, which can cause teeth to decay.

The more time your child has liquids other than water in his or her mouth, the higher the risk of serious decay.

In addition, saliva, which does a good job of cleaning and rinsing the teeth, is greatly reduced during sleep. The lack of saliva production when a child sleeps leads to less protection from the harmful acid that bacteria produces.

13. Is your child a gulper or a grazer?

(Answer gulper if your child eats three to five times per day and does not frequently snack or have drinks other than water in between.

Answer grazer if your child frequently eats small amounts during the day, snacks or has a drink other than water more than five times per day.)

Gulper - Low risk
Grazer - Moderate to high risk

When it comes to preventing cavities, how often your child eats can be just as important as the type of food (sweet or sticky) he or she eats. 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. 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.

If your child grazes throughout the day, including sipping on juice or soft drinks, bacteria are able to produce acid almost constantly. This makes tooth decay more likely. Studies have shown that those who eat sweets as snacks between meals have higher incidences 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. These foods are considered "tooth-protective" foods because they provide the body with the necessary minerals, vitamins and protein that help to make teeth and gums strong and healthy. Some foods, such as fruit and raw vegetables, can also help to clean the teeth by increasing the amount of saliva that is produced in the mouth and by removing particles of food that may be trapped between the teeth. Saliva does a good job of cleaning and rinsing the teeth. Chewing sugarless gum also helps to increase saliva flow.

Talk to your child's dentist or dental hygienist about what you can do to make your child's eating habits more tooth-healthy.

14. Does your child chew gum or suck on mints or candies that contain xylitol?

No - High Risk
Yes - Low to Moderate Risk

Xylitol is a natural sweetener 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 in their products. Xylitol is a tooth-friendly sweetener for two reasons. First, the decay-causing bacteria in your mouth are unable 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 such as sugarless gum or candy that contain xylitol can help to protect teeth against decay. Xylitol has been found to hinder the growth of the bacteria that are responsible for tooth decay and 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 rather than sugar can help reduce your child's chances of developing tooth decay.

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

No - High Risk
Yes - Low to Moderate Risk

Xylitol is a natural sweetener 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 in their products. Xylitol is a tooth-friendly sweetener for two reasons. First, the decay-causing bacteria in your mouth are unable 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 such as sugarless gum or candy that contains xylitol can help to protect teeth against decay. Xylitol has been found to hinder the growth of the bacteria that are responsible for tooth decay and 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 rather than sugar can help reduce your child's chances of developing tooth decay.

16. If your child is under the age of 5, how many cavities have you or his or her caregiver had in the past three years?

None or one - Low risk
Two - Moderate risk
Three or more - High risk

The number of cavities that you have is directly related to the number of cavity-causing bacteria in your mouth. These bacteria are called Streptococcus mutans. When a parent or caregiver has a high level of these bacteria, it is more likely that they will be transferred to the child during common activities. Parents and caregivers who have had one or no recent cavities will usually have a low level of cavity-causing bacteria.