1.4 Modifying Factors
 Previous Caries Experience
Previous caries experience is a strong predictor of future caries experience. For example, adolescents who had caries in their primary teeth are at higher risk for caries in permanent teeth than those without previous caries.
Age
Adults, in general, have a more stable oral environment than children do. Newly erupted first and second permanent molars are particularly susceptible to caries development even in children and adolescents at low risk for dental caries.
Many children and adolescents have newly erupted permanent teeth with deep and/or uncoalesced pits and fissures that may need to be sealed. The factors that modify their risk levels are also prone to change; therefore, older children and adolescents need to be monitored more closely than adults. For example, children and adolescents may spend less time at home than they did in the past, change peer groups, receive orthodontic treatment, or change their eating or oral hygiene habits. These changes can affect their risk for dental caries.
As social structures stabilize following adolescence and young adulthood, adults usually tend toward fewer social-exposure contacts with others who may transmit caries-causing bacteria. Additionally, adult enamel has had an opportunity to mature, absorbing salivary minerals and adjusting to salivary dynamics. These factors all contribute to a general decrease in carious activity after young adulthood.
Family Behaviors
Families tend to have similar caries experience. Family members frequently share dietary practices and home health care practices and have similar health-care-access patterns, which can be a modifying factor. Food and toothbrush sharing is not uncommon in many families; this creates an opportunity to spread caries-causing bacteria.
Diet
A cariogenic diet is one that is high in fermentable carbohydrates. MS and other bacteria feed on carbohydrates and thrive when fed. The higher the intake of cariogenic foods and the higher the frequency of the intake of cariogenic foods, the greater the risk for caries. A diet high in starchy foods, dairy products, fruit, and vegetables is protective against dental caries.
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