Global oral health assessment |
Overall, how would you rate the health of your teeth and gums? |
Excellent |
Very good |
Good |
Fair |
Poor |
OHIP-5 |
In the last month: |
Never |
Hardly ever |
Occasionally |
Fairly often |
Very often |
Have you had difficulty chewing any foods because of problems with your teeth, mouth, dentures, or jaw? |
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Have you had painful aching in your mouth? |
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Have you felt uncomfortable about the appearance of your teeth, mouth, dentures, and jaws? |
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Have you felt that there has been less flavor in your food because of problems with your teeth, mouth, dentures, or jaws? |
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Have you had difficulty doing your usual jobs because of problems with your teeth, mouth, dentures, or jaws? |
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Dental symptoms |
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Yes |
No |
Do you think you might have gum disease? (symptoms of gum disease include bad breath that won’t go away, red or swollen gums, tender or bleeding gums, painful chewing, loose teeth, sensitive teeth, and receding gums or longer appearing teeth). |
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Have you ever had any teeth become loose on their own, without an injury? |
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Do your gums bleed after you brush your teeth? |
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Do you have dry mouth? |
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Dental habits |
Do you have removable dentures? |
Yes |
No |
If yes, are your dentures: |
Partial denture |
Full denture |
How often do you brush or clean your teeth or dentures? |
Never |
<1x per day |
1x per day |
2x per day |
>2x per day |
How long has it been since you last saw a dental specialist (dentist or orthodontist)? |
<6 months ago |
6–12 months ago |
1–2 years ago |
>2 years ago |
Never |
Do you use any of the following to clean your teeth or dentures? (check all that apply) |
Tooth-brush |
Dental floss |
Mouth-wash |
Denture cleanser |