Step 2: Note the Patient's Dental History

While the presence of active carious lesions at the times of examination is clear evidence of caries, it is also important to get a sense of previous caries history. A history of multiple restorations will indicate high caries risk, because a history of previous caries is the single best predictor of future caries development.6 It is also useful to ask about dramatic changes in caries activity, for example, if there were no dental problems for years and then a sudden increase in infection that led to multiple restorations. This may help the dental practitioner identify the relevant change, such as taking a medication that caused dry mouth.2

Questions about a patient’s dental history should also gather information about current oral hygiene practices and proficiency, including how often teeth are cleaned, what type of brush and interdental cleaning aids are used, which toothpaste is used and how it is cleared from the mouth, and if the patient’s water supply is fluoridated. Asking a patient about their diet is especially important if he or she presents with active carious lesions or a history of multiple restorations. This way, it is possible to uncover caries-causing habits, such as frequent sipping of sugary drinks, swishing soda in the mouth, or frequent snacking on sugary or sticky candies.2