Please take this survey!

Hi,
Please take this survey on oral health
Send in your answers to dr.niranjan@yahoo.co.uk

Answer as per example
1.Do you have bad breath
a. Yes  b. No
Your Answer 1.a

Questionnaire
Are your teeth and gums healthy
1.Have you ever noticed blood on your toothbrush, food / saliva
a. Always b.Never. C.Occasionally

2. Do you have any loose teeth or teeth that have shifted postion recently
a. yes b.No c. Dont know

3. Do you have bad breath?
a. yes b. No

4. Does food get lodged between your teeth
a. Always b.Never C.Occasionally

5. have your teeth and gums changed colour?
a. yes b.no c.don't know

6.Have your gums receded i.e do you teeth look longer?
a.yes b.no. c.Don't know

7.have you ever been told you have gum disease or had a tooth pulled out due to gum disease?
a.Yes b.No

8.Do you use any tobacco products? (Gutkha, Tobacco, Cigarette)
a.Yes b.No

9. When was you last dental appointment? Specify_________

10. Do you know the right way to brush and floss ?
a. yes b.no

11. How many times do you brush in a day?
a.once b.twice c.thrice

12.How often do you floss ?
a.daily b.occasionally c.never

13. Do you or any of your family members have any of the following?
a. Diabetes b/heart disease c.Hypertension d.others e.None

14. Have any of your family members had gum disease?
a.yes b.No c.don't know

15. Whom would you ask if you wanted to know about oral health?
a,Dentist b.Friends c.Relatives d.Internet

16. How interested are you in knowing about gum disease and how it affects general health?
a.Very interested b.Not interested

Send in your answers to dr.niranjan@yahoo.co.uk