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, your mouth contains very high levels of bacteria called Streptococcus mutans. These bacteria can cause cavities. 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, 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 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. If found early, tooth decay can be treated or possibly reversed.

Some people visit the dentist only when they have a toothache or a visible problem. But by then, the problem could be very advanced.

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

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.

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. Life changes during these years 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, your risk of cavities in the crowns of the teeth declines if you have not already had a cavity. In older adults, gums often recede. This exposes the roots of the teeth. Gums can recede because of periodontal (gum) disease or incorrect brushing.

When a tooth root is exposed, decay is more likely to develop on its surface. Tooth roots have a softer protective surface than the crowns do. Decay-causing bacteria in your mouth can get into these softer layers more easily.

For several reasons, older adults tend to produce less saliva. This can cause dry mouth (xerostomia), which increases the chance of developing cavities. Fillings also can start to break down over time and may have to be replaced.

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. Saliva washes away food and plaque. It also helps to neutralize acids in your mouth that decay teeth. 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. Brush twice a day with fluoride toothpaste and floss daily.

6. Do you have a dry mouth?

Yes — High risk
No — Low risk

Saliva is a natural cavity fighter. It washes away food and plaque. It also helps to neutralize acids in your mouth. Without this natural protection, you are more likely to develop cavities.

A dry mouth (xerostomia) 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.

Keep your mouth moist to help prevent cavities. You can sip water, 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. Talk to your dentist about whether you need extra fluoride.

You can get fluoride treatments in the dental office, or buy prescription fluoride gels or rinses that you can use at home. Prescription products contain more fluoride than over-the-counter rinses.

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 can help to reduce your chance of developing decay around fillings, crowns or bridges. If receding gums have exposed the roots of your teeth, fluoride also will help to protect the roots from decay.

If you do not use a fluoride rinse, consider asking your dentist whether you need extra fluoride. Your dentist may suggest an in-office fluoride treatment, an over-the-counter fluoride rinse, or a prescription gel or rinse.

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. The more often you eat, the more often you provide food for bacteria. In your mouth, carbohydrates break down into simple sugars. Bacteria then feed on these sugars and produce acid, which dissolves the tooth's outer layer, the enamel. The decay process continues for about 20 to 30 minutes after eating or drinking. It lasts even longer if bits of food 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. Sugary foods aren't the only foods that can help to cause tooth decay. Foods such as breads, cereals and rice contain carbohydrates, too.

The good news is that some foods can protect against decay. These foods include vegetables, fruits, milk, cheese, meat, fish and beans. They help to make teeth and gums strong and healthy. Fruit and raw vegetables also can help to clean the teeth by increasing the amount of saliva in the mouth. Ask your dentist or dental hygienist 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. Some food and candy makers use it as a sweetener.

Xylitol is tooth-friendly for two reasons. First, the decay-causing bacteria in your mouth are not able to feed on xylitol like they do on simple sugars. This means the bacteria can't produce acids that can cause tooth decay. Second, xylitol slows the growth of the bacteria that lead to tooth decay and helps to keep them from sticking to teeth. Chewing gum or sucking mints or candies that contain xylitol also helps you produce saliva. This acts as a natural rinse for your teeth.

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

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

Cavities can't form without the carbohydrates found in many foods. Bacteria need the sugar in carbohydrates to produce acid, which decays teeth.

Plaque is the soft, gooey substance that sticks to teeth a bit like jam sticks to a spoon. It contains bacteria and other organisms, clumping together with bits of food. Plaque begins to form right 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 bits of food and plaque from your teeth. Brush carefully with fluoride toothpaste at least twice a day.

If it's hard for you to hold your toothbrush, or you 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.

Some brushes 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. You can buy these toothbrushes 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.

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 bits of food from between the teeth. They may not 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.

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.

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. 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. Exposed roots are more likely to decay. This is especially likely in people with 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 top part of the tooth (the crown). It's easier for acid from bacteria to penetrate these softer layers and cause cavities.

To reduce decay-causing bacteria in your mouth, brush gently and thoroughly with fluoride toothpaste at least twice a day. Always use a toothbrush with soft or extra soft bristles.

Visit a dentist regularly. Your dentist might also recommend extra fluoride to strengthen teeth. You can get fluoride treatments in the dental office or use prescription gels or rinses at home. These products contain more fluoride than over-the-counter rinses.

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. Your dentist or dental hygienist can give you a device that will allow you to reach under a bridge and clean it properly. Crowns and bridges can last a lifetime if maintained well.

Crowns and bridges often are made to replace a tooth that has been lost to decay. Other teeth can decay 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

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, 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.