Check Your Risk!

1. 1 I brush my teeth

   After each meal
   1x day
   2x day
   Weekly  
2. 2 I floss my teeth

   After each meal
   1x day
   2x day
   Weekly  
3. 3 I use a fluoride toothpaste when I brush my teeth

   Yes
   No  
4. 4 I visit my dentist

   Regularly
   Rarely or Never  
5. 5 The last time I had a cavity filled was

   Within the last year
   Within the last 12-36 months
   Over five years ago
   As a kid or never  
6. 6 The water I drink is fluoridated.

   Yes
   No  
7. 7 I have sealants on my teeth.

   Yes
   No  
8. 8 I wear braces or partial dentures.

   Yes
   No  
9. 9 I eat or drink sugary foods (hard or chewy candy, antacids, breath mints, dried fruit, cakes, caramel, soda, energy drinks, juices, non-dairy creamer, flavored yogurt, etc.)

   1x day
   Often between meals
   Rarely  
10. 10 I regularly eat or drink acidic items like citrus fruits or sports/energy drinks.

    1x day
    Often
    Rarely  
11. 11 My gums are puffy, sensitive, and bleed when I brush my teeth.

    Yes
    No  
12. 12 I think my gums are receding (shrinking).

    Yes
    No  
13. 13 I have diabetes.

    Yes
    No  
14. 14 I take prescriptions or over-the-counter medications.

    Yes
    No  
15. 15 I smoke cigarettes/a pipe/cigars or I chew tobacco.

    Yes
    No  
16. 16 I am pregnant.

    Yes
    No  
17. 17 I use products with Xylitol (chewing gum, mints, rinse).

    Daily
    Occasionally
    Never  
18. 18 I have lost a tooth because of decay or gum disease.

    Within the last year
    12-26 months
    More than 3 years ago
    Never