Periodontal Risk AssessmentHow healthy are you? Your overall health may be linked to the health of your gums and teeth. Print out and take this self assessment, and talk to your dentist or Dr. Bonner to learn more. |
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| 1. How old are you? | <40_______ 40-65_______ >65_______ |
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| 2. Do you have heart disease? | No_______ Yes_______ |
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| 3. Have you ever had a stroke or TIA? | No_______ Yes_______ |
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| 4. Are you at risk for osteoporosis or have you been diagnosed with it? | No_______ Yes_______ |
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| 5. Are you diabetic? | No_______ Yes_______ |
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| 6. Are you prone to respiratory conditions? | No_______ Yes_______ |
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| 7. Have you ever had cancer? | No_______ Yes_______ |
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| 8. Have you been under higher than normal or constant stress? | No_______ Yes_______ |
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| 9. Do your gums ever bleed? | No_______ Yes_______ |
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| 10. Do you smoke or use tobacco products? | No_______ Yes_______ |
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| 11. Have you seen a dentist in the last two years? | No_______ Yes_______ Don’t Know_______ |
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| 12. How often do you floss? | Daily_______ Weekly_______ Seldom_______ |
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| 13. Have you ever been told that you have gum problems, gum infection or gum inflammation? | No_______ Yes_______ |
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| 14. Have any of your family members had gum disease? | No_______ Yes_______ |
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| 15. Have you had any adult teeth extracted due to gum disease? | No_______ Yes_______ |
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| 16. Are your teeth loose? | No_______ Yes_______ |
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| 17. Have your gums receded, or do your teeth look longer? | No_______ Yes_______ Don’t Know_______ |
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| Click Here to Check Your Risk of Gum Disease | |