Dental Caries Risk Assessment Survey

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| By Mcmahonfamilyden
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Mcmahonfamilyden
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Quizzes Created: 1 | Total Attempts: 204
| Attempts: 204 | Questions: 21 | Updated: Jul 18, 2025
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1. Does the patient have a dry mouth?

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About This Quiz
Dental Caries Risk Assessment Survey - Quiz

Please complete this survey in order to help us assess your risk for Dental Caries. When you are finished, we will be able to better recommend dental treatment for you.

2. Is the patient currently using any other protective rinses?

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3. Is the patient currently using Xylitol gum/mints?

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4. Is the patient currently using Fluoridated Mouthwash?

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5. Is the patient currently using Fluoridated Toothpaste?

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6. Is the patient currently using Fluoridated Water?

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7. Are there any appliances present in the patient's mouth?

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8. Are there any White Spot Lesions in the patient's mouth?

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9. Has the patient displayed any Radiographic Cavities?

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10. Does the patient display any deep pits or fissures?

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11. Does the patient have any exposed roots on any teeth?

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12. Do you currently or have you ever had GERD?

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13. Has the patient had a cavity in the last 3 years?

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14. Are there any visible cavitations in the patients teeth?

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15. Does the patient have any plaque or calculus buildup?

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16. Do you currently or have you ever consumed recreational drugs?

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17. How often do you consume soda or low pH beverages?

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18. How often do you snack between meals per day?

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19. Are you currently receiving or have you ever received Radiation Therapy?

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20. Are you currently taking or have you ever taken Hypo-salivary Medications?

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21. Do you currently have Sjogren's Syndrome?

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Does the patient have a dry mouth?
Is the patient currently using any other protective rinses?
Is the patient currently using Xylitol gum/mints?
Is the patient currently using Fluoridated Mouthwash?
Is the patient currently using Fluoridated Toothpaste?
Is the patient currently using Fluoridated Water?
Are there any appliances present in the patient's mouth?
Are there any White Spot Lesions in the patient's mouth?
Has the patient displayed any Radiographic Cavities?
Does the patient display any deep pits or fissures?
Does the patient have any exposed roots on any teeth?
Do you currently or have you ever had GERD?
Has the patient had a cavity in the last 3 years?
Are there any visible cavitations in the patients teeth?
Does the patient have any plaque or calculus buildup?
Do you currently or have you ever consumed recreational drugs?
How often do you consume soda or low pH beverages?
How often do you snack between meals per day?
Are you currently receiving or have you ever received Radiation...
Are you currently taking or have you ever taken Hypo-salivary...
Do you currently have Sjogren's Syndrome?
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