Step 2: Review the Patient’s Dental History

While the presence of active carious lesions at the time of examination is clear evidence of caries, a comprehensive dental history is critical for understanding a patient’s long-term risk. Past caries experience, including the number of restorations, extractions due to caries, or episodes of rapid lesion progression, is the single strongest predictor of future caries development.^16,17 Sudden changes in caries activity such as going from years of low risk to multiple new restorations can signal underlying changes, like the introduction of xerogenic medications or shifts in salivary flow, diet, or behavior.^1,7 Understanding these patterns helps clinicians identify modifiable risk factors and tailor preventive strategies more effectively.

In addition to past restorative history, it’s essential to assess current oral hygiene behaviors and dietary habits. Ask how often the patient brushes and flosses, what type of toothbrush and toothpaste they use, and whether they use fluoride-containing products. Inquire about how they rinse after brushing since excessive rinsing can diminish the effects of fluoride. Also, assess whether their water supply is fluoridated, especially in communities without public water fluoridation.¹⁸

A dietary history should explore frequency and type of sugar exposure. Frequent snacking on fermentable carbohydrates, sipping sugary beverages, or nighttime bottle feeding (in children) are major contributors to caries risk. Recognizing these patterns allows dental professionals to offer targeted nutritional counseling and behavior-change strategies.^19,20