ORAL HYGIENE QUESTIONNAIRE

réponse obligatoire

Question 1

Merci d'entrer ici votre pseudonyme

Question 2

Sex

Question 3

Age

Question 4

Occupation

Question 5

Where do you live ?

Question 6

Socio-economic status

ORAL HYGIENE HABITS

Question 7

Do you visit a dentist, how often ?

Question 8

Frequency of denture brushing

Question 9

Do you use tooth brush with tooth past ?

Question 10

Do you use tooth past with fluor ?

Question 11

Do you change your brush ?

How often ?

Commentaires

Question 12

Do you use interdental aids ?

if yes, response to questions 12 to 14

Question 13

Use of dental floss ?

Question 14

Use of interdental brush ?

Question 15

Use of wooden toothpick?

Question 16

Do you use a mouth-wash ?

Question 17

Do you clean your tongue ?

EXPERIENCE OF ORAL HEALTH PREVENTION

Question 18

Oral health prevention during school years ?

Question 19

Oral health prevention by the dentist ?

Question 20

Oral health prevention by other health professional ?

Question 21

Choose 2 bests ways to prevent dental health :

GENERAL HEALTH

Question 22

Do you have any diseases ?

if yes, specify

Commentaires

Question 23

Do you have medication treatment ?

if yes, specify

Commentaires

Question 24

Do you think your general health influe your oral hygiene habits ?

Why ?