Cavity Risk Assessment Form
Evaluate your cavity risk factors with this straightforward assessment. Please answer each question to the best of your knowledge.
How often do you consume sugary snacks or drinks?
*
Rarely (less than once a week)
Occasionally (1-3 times per week)
Frequently (4 or more times per week)
How many times do you brush your teeth each day?
*
Once or less
Twice
Three times or more
Do you use fluoride toothpaste?
*
Yes, always
Sometimes
No
How often do you visit a dental professional for check-ups?
*
Every 6 months
Once a year
Less than once a year
Have you had cavities treated in the past 2 years?
*
Yes
No
How frequently do you consume acidic beverages (e.g., soda, sports drinks, juice)?
*
Rarely (less than once a week)
Occasionally (1-3 times per week)
Frequently (4 or more times per week)
How would you rate your daily oral hygiene habits?
*
1
2
3
4
5
Do you experience dry mouth regularly?
*
Yes
No
Does anyone in your immediate family have a history of frequent cavities?
*
Yes
No
Not sure
On a scale of 1 to 5, how motivated are you to improve your oral health habits?
*
Not motivated
1
2
3
4
Very motivated
5
1 is Not motivated, 5 is Very motivated
Submit Assessment
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