Periodontitis Screening
1.
How old are you?
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2.
What is your gender?
Male
Female
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3.
Are you a smoker?
Yes
No
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4.
Do you visit a dentist or oral hygienist at least once a year?
Yes
No
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5.
Do you still have any teeth of your own?
Yes
No
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6.
Do you think you might have gum disease?
Yes
No
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7.
Overall, how would you rate the health of your teeth and gums?
Excellent
Very good
Good
Fair
Poor
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8.
Have you ever had treatment for gum disease such as scaling and root planing, sometimes called “deep cleaning”?
Yes
No
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9.
Have you ever had any teeth become loose on their own, without an injury?
Yes
No
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10.
Have you ever been told by a dental professional that you lost bone around your teeth?
Yes
No
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11.
During the past three months, have you noticed a tooth that doesn’t look right?
Yes
No
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12.
Aside from brushing your teeth with a toothbrush, in the last seven days, how many times did you use dental floss or any other device to clean between your teeth?
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13.
Aside from brushing your teeth with a toothbrush, in the last seven days, how many times did you use mouthwash or other dental rinse product that you use to treat dental disease or dental problems?
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Calculate
This is a research collaboration between
