The Five Questions We Ask at Every Single Check-Up. And Why They Matter.

John Barclay
Jun 7
4 min read

Updated: 6 days ago

By Dr John Barclay | DRJB Smile Clinic, Ruabon, North Wales

A check-up isn't just a look around. We ask the same five questions at every single appointment. Not out of habit. Because the answers tell us more about what's happening in your mouth than the examination alone.

1. Do You Smoke?

Smoking is one of the most significant risk factors for gum disease and oral cancer — and it masks the signs of both. Nicotine reduces blood flow to the gums, which means they bleed less than they should when disease is present. That's not a good sign. It means things can be worse than they look.

Smokers also have a significantly higher rate of implant failure, slower healing after extraction, and a meaningfully elevated risk of oral cancer. We ask every time because circumstances change — people start, stop, cut down. The answer affects how we examine you and how often we want to see you.

2. How Much Alcohol Do You Drink?

This isn't a judgement. It's a cancer screening question.

Alcohol is an independent risk factor for oral cancer — and the combination of alcohol and tobacco multiplies that risk significantly rather than simply adding to it. The oral cancer risk in someone who drinks heavily and smokes is not the sum of the two. It is many times higher.

We're also interested in late-night drinks, wine with dinner, the sugar content of mixers. These have direct implications for erosion and decay — particularly if there's acidic drink contact with teeth and then immediate brushing.

3. How Often Are You Snacking Between Meals?

This is the question that surprises people most. Patients assume we're going to ask about sweets. We're asking about everything.

Every time you eat or drink anything other than water, the pH in your mouth drops and the environment becomes temporarily acidic. Teeth can tolerate this if it happens at mealtimes and the mouth has time to recover. It cannot tolerate it well when it happens continuously throughout the day — a biscuit at 10, a cereal bar at 11, a coffee at 12, fruit at 3. That's a mouth that never fully recovers its pH between acid attacks.

The frequency of sugar exposure matters more than the quantity. One piece of cake at lunch does less damage than five pieces of chewing gum spread across the day.

4. What Are You Drinking — And How Much Sugar Is In It?

Fruit juice, fizzy drinks, squash, energy drinks, sports drinks — these are all acidic and erosive. Most patients know this. What they don't always know is that tea and coffee with sugar sit in exactly the same category.

If you have three sugary teas across the morning, that's three separate acid attacks — no different in effect to three cans of pop spread across the day. The source of the sugar doesn't matter. The frequency and the contact time do.

Fresh orange juice. Smoothies. Flavoured sparkling water. Cordial. All of these are erosive. Enamel lost to acid erosion does not grow back. We ask because patients consistently underestimate how much acidic drink contact their teeth are getting — and because the damage it causes often arrives quietly and builds over years before it becomes visible.

If you're drinking these, we want to know when, how often, and whether you're brushing immediately afterwards. Brushing within thirty minutes of an acid exposure removes softened enamel rather than protecting it.

5. How Often Are You Brushing — And When?

Twice a day, two minutes each time, last thing at night. That's the baseline. What we're checking is whether the reality matches it.

Night-time brushing matters more than morning. Saliva flow drops during sleep, which means the mouth's natural defence against acid and bacteria is reduced for hours. If you're brushing in the morning but not before bed — or brushing before dinner and having a milky drink afterwards — you're not getting the protection you think you are.

We also want to know what you're brushing with. Electric or manual, fluoride content of your toothpaste, whether you're rinsing with water afterwards. Spitting without rinsing leaves a fluoride film that continues to work. Rinsing removes it.

This question often opens the most useful conversation of the whole appointment.

Why We Ask All of This at Every Appointment

Because things change. The person who didn't smoke last year might smoke now. The person who drank two coffees a day now drinks five because work got harder. The child who comes in with great teeth at eight can come back at twelve with significant erosion if nobody asked the right questions.

We ask because the clinical picture only makes sense with the lifestyle picture beside it. The examination tells us what is happening. The questions help us understand why — and what to do about it.

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References & Further Reading

1. Public Health England / OHID. Delivering Better Oral Health: An Evidence-Based Toolkit for Prevention. 4th ed. OHID, 2021. → Primary clinical reference for dietary, alcohol, tobacco, and lifestyle risk assessment in dental practice.

2. Sheiham A, James WPT. A reappraisal of the quantitative relationship between sugar intake and dental caries. Journal of Dental Research, 2014. → Key evidence base for frequency of sugar exposure vs. quantity as the primary determinant of caries risk.

3. Moynihan PJ, Kelly SAM. Effect on caries of restricting sugars intake: systematic review to inform WHO guidelines. Journal of Dental Research, 2014. → Supports the dietary questioning framework.

4. Lussi A, Jaeggi T. Erosion — diagnosis and risk factors. Clinical Oral Investigations, 2008. → Underpins the erosion risk assessment rationale for questions on fruit juice, fizzy drinks and brushing timing.

5. Warnakulasuriya S. Global epidemiology of oral and oropharyngeal cancer. Oral Oncology, 2009. → Evidence base for alcohol and tobacco as independent and synergistic oral cancer risk factors.