For Parents: Is My Child At Risk for Tooth Decay?

You can protect your child's teeth from tooth decay.

Tooth decay continues to be a problem for many children and adults. Tooth decay is caused by a disease called dental caries that occurs when certain bacteria in the mouth combine with sugar that we eat or drink to produce acids that dissolve minerals (calcium, phosphate) from the outer layers of our teeth. If enough minerals are lost, the tooth structure breaks down producing a "cavity" or hole in a tooth.

For most children, teeth can be protected from decay by twice daily brushing with fluoride toothpaste, limiting the amount of snacks, beverages and chewing gum containing sugar between meals, and having regular dental check-ups and preventive services (e.g., sealants and fluoride treatments). However, some children remain at high risk to develop tooth decay because of an imbalance between factors that promote dental caries and factors that protect teeth from decay.

The questions in this guide will help identify things that may place your child at higher risk for developing tooth decay. Please answer all the questions and be honest — remember, you can't fool the Tooth Fairy!

Understanding your child's risk factors can help us take steps to reduce his or her risk for tooth decay and keep his or her teeth healthy and looking good for a lifetime! There is no passing grade or formula that can predict exactly who will get tooth decay and who will not. However, more risk factors generally mean higher risk for developing decay. Likewise, more protective factors generally mean a lower risk for developing decay.

Questions 1 through 8 and 15 through 17: Factors that can help increase your child's risk for developing tooth decay. A "Yes" response to any of these questions means you may need to take action to lower your child's decay risk. These same factors generally increase your risk for decay, too!

Questions 9 through 14: Factors that can help reduce your child's risk for tooth decay or help protect his or her teeth. A "No" response to any of these questions means that you may need to take action to lower your child's decay risk or increase his or her protective factors. These same protective factors generally can help lower your risk for decay, too!

1. Are there days when your child forgets or doesn't have time to brush?
Yes      No 
Bacteria (germs) that produce acid can build up as plaque in your child's mouth within 24 hours. Children need to brush their teeth to remove plaque every day to reduce the bacteria's ability to cause decay. It is best if they brush at least twice a day (for example, when they get up in the morning and before going to sleep at night). Preschool children should be encouraged to brush their own teeth to develop healthy habits, but need help from their parents or caretakers to make sure they do a good job of removing plaque.
2. Are there days when your child doesn't use fluoride toothpaste?
Yes      No 
Frequent applications of even small amounts of fluoride can help prevent tooth decay by reducing the loss of calcium and other minerals and help "repair" damaged teeth during the early stages of decay. Therefore, children should brush their teeth with fluoride toothpaste every day (preferably at least two times a day).
3. Do your child's gums bleed after brushing?
Yes      No 
Bleeding gums or visible plaque (soft, white material) on your child's teeth are signs that they or you are not removing bacteria next to the teeth when brushing. The good news is that if they or you start brushing properly every day, the bleeding (and infection) should stop within two weeks!
4. Has your child had a cavity, decayed tooth, toothache or filling in the past two years?
Yes      No 
Previous decay is one of the best predictors of future decay (unless your child creates a healthy balance between risk factors and protective factors). If your child has had decay, cavities or fillings in the past two years, it means that one or more risk factors are overpowering the protective factors. You need to take action to reduce your child's risk for decay and see a dentist to get additional preventive services.
5. Does your child snack on candy or other sugary foods, drink beverages with sugar (e.g., soda, juice) or chew gum between meals more than twice a day?
Yes      No 
Frequent exposure to foods, beverages and gums that contain high levels of sugar — especially between meals — can increase acid production and contribute to mineral loss and tooth decay. Limit your child's use of sugary foods, drinks and gum between meals to no more than twice a day (ideally followed by tooth brushing with fluoride toothpaste). Gum or mints that contain xylitol can help reduce the damaging effects of acid on teeth and may be used when tooth brushing is not practical.
6. Does your child wear braces, a space maintainer, retainer or orthodontic appliances?
Yes      No 
Braces, space maintainers (spacers), retainers and other dental or orthodontic appliances often trap plaque and make it difficult to remove acid-producing bacteria. Children with these devices generally are at higher risk for decay. You need to make sure your child can clean around braces, retainers or "spacers" really well and make sure he or she brushes with fluoride toothpaste at least twice a day.
7. Does your child have a disability or medical condition that makes it hard to brush his or her teeth, requires frequent doses of liquid medicines, makes his or her mouth dry or makes it hard to get dental care?
Yes      No 
Some children have disabilities, medical conditions or special health care needs that make it difficult for them or their caretakers to clean their teeth. Likewise, some children take medicines that produce a "dry mouth" or contain high levels of sugar. Such conditions generally make these children at higher risk for tooth decay. More frequent dental check-ups and preventive services generally are recommended for these children
8. Do you have other children that get cavities or do you still get cavities?
Yes      No 
Cavities or untreated decay in a child's mother can expose her child to high levels of decay-causing bacteria. Likewise, decayed teeth in other family members is a signal that eating practices or preventive habits need to be improved. Make sure that you're doing the right things to lower the risk of decay for yourself and any other family members.
9. Does the water your child drinks most often contain fluoride?
Yes      No 
10.Does your child take fluoride drops or tablets every day?
Yes      No 
Fluoride in water can help reduce the risk of tooth decay, but may not totally prevent cavities in all children, especially those with multiple risk factors. You may need to use fluoride drops or supplements if your child lives in an area where the drinking water does not contain adequate amounts of fluoride. Your child's dentist, pediatrician or someone at the local health department can help you determine whether your water has adequate amounts of fluoride.
11. Does your child have his or her teeth checked by a dentist at least once a year?
Yes      No 
The process that causes tooth decay or cavities (dental caries) can occur within a few months in children at high risk. Regular examinations (with X-rays if needed) can help find decay in its early stages when preventive measures are most effective. Your child's dentist will recommend how often he or she should get a check-up depending or his or her risk factors; but make sure to have children's teeth checked regularly.
12. Does your child get fluoride treatments from a dentist or dental hygienist every year?
Yes      No 
Regular professional fluoride treatments can provide protection against cavities and promote "repair" of teeth damaged by the early stages of decay, especially if your child is at high risk for decay. Your child's dentist will recommend how often he or she should get these treatments based on his or her risk factors.
13. Has your child had dental sealants placed on his or her teeth?
Yes      No 
Dental sealants are usually placed in the pits and grooves on the biting surfaces of the "back teeth" to keep plaque out and help prevent decay.
14. Does your child use gum or mints that contain xylitol?
Yes      No 
Some gums and mints contain xylitol which helps to protect teeth against the acids that can cause tooth decay. Using gum or mints with xylitol instead of gums or candy that contain sugar can help lower your child's risk of tooth decay. Using xylitol doesn't take the place of regular tooth brushing and fluoride toothpaste, but can be used after meals or snacks when your child doesn't have a toothbrush or toothpaste.
15. For parents of preschoolers: Does your child sleep with a bottle containing something other than water?
Yes      No 
Young children who are fed bottles containing liquids with sugar (e.g., soda, juices) are at increased risk for tooth decay, especially if they are put to sleep with these bottles. Bottle feeding generally should be discontinued by one year of age. Water (unsweetened) in the bottle will not cause cavities.
16. For parents of preschoolers: Have you noticed plaque or white material on your child's teeth near the gums?
Yes      No 
Visible plaque means bacteria that can cause cavities or infection of the child's gums are not being removed regularly and you need to pay more attention to brushing your child's teeth on a regular basis (i.e., daily).
17. For parents of preschoolers: Are there days when you forget or don't have time to help your child brush?
Yes      No 
Preschool children should be encouraged to brush their own teeth to develop healthy habits, but need help from their parents or caretakers to make sure that they do a good job of removing plaque when brushing. Parents or caretakers also need to make sure that preschool children only use a very small amount of fluoride toothpaste and be sure they spit it out rather than swallow.

Print this page and show your answers to your child's dentist or dental hygienist.

This guideline was developed by James J. Crall, DDS, ScD, with input from the MetLife Dental Advisory Council. Members of the Council consist of practicing and academic dentists.

© 2018 MetLife, Inc.