How many times per year does your child visit the dentist?
Visiting the dentist regularly can help prevent and/or treat tooth decay at an earlier stage. It also allows the dentist to diagnose other potential health problems that may have a connection to your child's oral health.
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0 times
1-2 times
more than 2 times
How many times per day does your child brush his/her teeth?
Regular toothbrushing (at least twice a day) is the most important thing your child can do to protect his/her teeth from cavities.
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0 times
1 time
2 times
more than 2 times
Do your child's gums bleed when brushing his/her teeth?
Bleeding gums could be a sign of oral problems, including bacteria build-up in your child's mouth.
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Yes
No
Does your child use toothpaste with fluoride?
Toothpaste that contains fluoride increases your child's protection against cavities.
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Yes
No
Does your child have dental sealants?
Sealants can be placed on teeth with deep grooves and pits to help prevent decay. Research shows that dental sealants not only help to protect healthy teeth, but can also stop decay in its earliest stages.
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Yes
No
Does your child's main source of drinking water contain fluoride?
Fluoride plays an important role in oral health by helping to prevent tooth decay, strengthening tooth enamel and reducing the harmful effects of plaque.
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Yes
No
Don't Know
Has your child had a cavity in the past 3 years?
Patients with a history of dental cavities have a higher risk of getting them in the future.
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Yes
No
Has anyone in the child's immediate family had cavities?
A family history of cavities could mean parents need to take extra precautions when establishing oral health routines for their children who may be prone to dental disease.
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Yes
No
How often does your child eat sugary snacks between meals?
Sugary snacks increase bacteria in your child's mouth and can cause tooth decay. Try to limit sugary treats and choose foods that are healthy, including vegetables, nuts and popcorn.
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Never
A few times a week
A few times a day
Does your child currently have orthodontic appliances (including braces)?
Orthodontic appliances may make it difficult to get all the food and plaque off of teeth, making your child more at risk for tooth decay.
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Yes
No
Does your child ever feel that his/her mouth is dry (as if there's not enough saliva)?
A dry mouth or limited saliva, can contribute to oral disease and cavities.
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Yes
No
Does your child have any special needs that may limit his/her ability to care for his/her teeth and/or gums?
If your child has special health care needs, make sure you talk to the dentist and/or caregiver about how you can make sure your child is getting proper oral care.
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Yes
No
Does your child use any products (e.g., chewing gum, mints, etc.) that contain xylitol?
Xylitol, a natural sugar substitute, can help reduce the risk of cavities when used on a regular basis.
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Yes
No
