Let's Get to Know You!

What does your daily oral hygiene routine look like? (Check all that apply)

• Toothbrushing

• Flossing

• Mouthwash

• Tongue Scraper

• Nothing

Do you have bleeding when you brush or floss?

• Always

• Sometimes

• Never

How many times have you been to the dentist in the last 12 months?

• 1

• 2

• 3+

• Not at all

Do you have any orthodontic appliances?

• Braces

• Retainer

• Expander

• Nothing

• Other

What sports do you play?

What do you usually eat in a day?

• Mostly healthy foods (ex: fruit/veggies, beans, nuts, meat, milk, whole grain bread)

• Mostly junk food (ex: chips, candy, fast food, ice cream)

• A mixture of healthy and junk foods

Do you usually eat sweet snacks and drinks between meals?

• Always/Everyday

• Sometimes

• Never

In your own words, explain what a cavity is.

What causes cavities? Choose all that apply.

• Bacteria

• Drinking lots of water

• Not regularly brushing your teeth

• Sugar

• Not sure

Have you ever had a cavity?

• Yes

• No