The Cavity Predictor

The Cavity Predictor: Is Your Child at Risk?

1. Has your child ever had a cavity?

No – Low risk
Yes – Moderate to high risk

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, his or her mouth has the bacteria necessary to generate cavities.

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 cavity may be developing. The white spot forms when minerals begin leaching out of the tooth’s outer surface (enamel).

At this stage, the decay process can be reversible. At home, you can apply fluoride to the white spots and use over-the-counter fluoride rinses or toothpastes. These can help the tooth to repair itself. A change in your child’s eating habits also may help to avoid further decay.

`If you see a white spot on one of your child’s teeth, have your child’s dentist take a look. Ask the dentist or dental hygienist what changes you can make to prevent further decay and to protect your child’s teeth in the future. Other conditions also can cause white spots, so 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, yellow-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 inflamed gums.

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. 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

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

Be cautious about how your child uses fluoride toothpaste. Young children are likely to swallow it after brushing instead of spitting it out. Use only a small amount of toothpaste (the size of the child’s pinky fingernail). Encourage your child to spit out as much as possible. Avoid flavored toothpastes that might encourage swallowing.

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, parents need to know if the water they use is fluoridated. The easiest way to find out is to contact your local water district. Information on how to contact your water supplier should be on your water bill, or 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 extra fluoride from mouth rinses, gels or supplements prescribed by a dentist, or from fluoride treatments in a dental office.

It’s a good idea to talk to the 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 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 they can be hard to clean. They are 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. Your child can get sealants 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. He or she can check your child’s teeth and mouth and suggest changes that can keep your child’s mouth healthier. Your child can have fluoride treatments as needed. And the dentist or dental hygienist 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 help you learn about your child’s growth and development. He or she also will assess your child’s risk of cavities, injuries, bite problems 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 to clean teeth. If food gets stuck under the braces or in between teeth, the plaque that forms can lead to cavities. Your orthodontist may recommend that your child 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 your child learn how to clean teeth with braces. You also should check how he or she is doing. 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. They may need more help or supervision.

You can use toothbrushes with fat handles that make them easier to grip. Also consider battery-operated toothbrushes, which don’t require back and forth arm movement. Floss holders allow one-handed flossing and make it easier to floss hard-to-reach spots. Oral irrigators can be used to remove larger food particles. All these devices should be considered for children who have pain or movement limitations. Ask your dentist or dental hygienist which devices and products to use and how to use them.

Some medicines can make it more likely that your child will get cavities. Many medicines contain sugar or other sweeteners that can increase the risk of cavities. It is a good idea to brush the child’s teeth after giving a sweet-tasting 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 still using a bottle after age 3 have an increased risk of developing cavities if the bottle contains a liquid other than water. When a child’s teeth are constantly exposed to drinks that contain carbohydrates, such as fruit juice or milk, bacteria feed 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.

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

Bacteria feed on the sugars in liquids such as fruit juice or milk. 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.

Saliva does a good job of cleaning and rinsing the teeth. But saliva is greatly reduced during sleep. This means your child has less protection during sleep from the harmful acids that bacteria produce.

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. Many carbohydrates break down in the mouth into simple sugars. Bacteria then feed on these simple sugars and produce acid, which dissolves the tooth’s outer layer, the enamel. Sugary foods aren’t the only foods that can help to cause tooth decay. Foods such as breads, cereals and rice contain carbohydrates, too.

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.

The good news is that some foods can protect against decay. These include vegetables, fruits, milk, cheese, meat, fish and beans. They help to make teeth and gums strong and healthy. Fruit and raw vegetables can also help to clean the teeth by increasing the amount of saliva in the mouth. Talk to the dentist or dental hygienist about how 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. It is found in fruit such as strawberries, plums and pears. Some food and candy manufacturers use it as a sweetener. Xylitol is tooth-friendly for two reasons. First, the decay-causing bacteria in your mouth are unable to feed on xylitol as they feed 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. It also helps to keep them from sticking to teeth. Chewing gum or sucking mints or candies that contain xylitol also helps produce saliva. This acts as a natural rinse for your teeth.

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

No – High Risk
Yes – Low to Moderate Risk

The number of cavities that you have is directly related to the number of bacteria in your mouth that can cause cavities. These bacteria are called Streptococcus mutans. A parent or caregiver of a child under the age of 5 who has a high level of these bacteria is more likely to transfer them to the child. This can happen during common activities, such as kissing, preparing food and feeding. For example, if you taste the food first and then feed your baby with the same spoon, you will transfer the cavity-causing bacteria to your child. Of course, you want to hug and kiss your child. So it is important to reduce the number of cavity-causing bacteria and the amount of plaque in your mouth. One way you can do this is to chew on gum or suck on mints or candies that contain xylitol. This will hinder the growth of the bacteria that cause 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. A parent or caregiver who has a high level of these bacteria is more likely to transfer them to the child. Parents and caregivers who have had one or no recent cavities will usually have a low level of cavity-causing bacteria.