CUENTA GRATIS

Oral Health Survey Template

Oral health survey questions and examples can be used to obtain information about the oral health condition of the respondents, the oral health related behaviors, the factors that facilitate behaviors that are conducive to good oral health and barriers which prevent people from adopting positive behaviors. This sample survey can be customized according to the details required of the audience. A questionnaire such as this, can enable the oral health centers to understand the current oral health problems faced by the audience and appropriate decisions can be taken to promote better oral health accordingly.


Spanish (Español) translation missing for : Considering your knowledge about the benefits of oral health care, how likely are you to promote it to your friend/colleague?
Very Unlikely
Very Likely
Spanish (Español) translation missing for : How satisfied are you with the health of the following?
Spanish (Español) translation missing for : Very Dissatisfied
Spanish (Español) translation missing for : Not satisfied
Spanish (Español) translation missing for : Neutral
Spanish (Español) translation missing for : Satisfied
Spanish (Español) translation missing for : Very Satisfied
Spanish (Español) translation missing for : Teeth
Spanish (Español) translation missing for : Gums
Spanish (Español) translation missing for : Tongue
Spanish (Español) translation missing for : Jaws
Spanish (Español) translation missing for : overall
Spanish (Español) translation missing for : How often during the last year, have you had discomfort in the following parts of your mouth?
Spanish (Español) translation missing for : Very Often
Spanish (Español) translation missing for : Fairly often
Spanish (Español) translation missing for : Occasionally
Spanish (Español) translation missing for : Hardly Ever
Spanish (Español) translation missing for : Never
Spanish (Español) translation missing for : Teeth
Spanish (Español) translation missing for : Gums
Spanish (Español) translation missing for : Tongue
Spanish (Español) translation missing for : Jaws
Spanish (Español) translation missing for : When was the last time you got a oral health checkup?
Spanish (Español) translation missing for : What was the main reason for your last visit to a oral health care centre?
Spanish (Español) translation missing for : If you were unable to get oral health care, what was the reason?
Spanish (Español) translation missing for : How often during the last year, have you been self conscious or embarrassed because of your oral health problems?
Spanish (Español) translation missing for : Are you aware about the benefits or the importance of the following?
Spanish (Español) translation missing for : Yes
Spanish (Español) translation missing for : No
Spanish (Español) translation missing for : Don't Remember
Spanish (Español) translation missing for : Benefits of quitting cigarettes or other type of tobacco products
Spanish (Español) translation missing for : Benefits of checking your blood sugar?
Spanish (Español) translation missing for : Importance of examination for oral cancer
Spanish (Español) translation missing for : Have you visited an oral healthcare center for the following in the past 12 months?
Spanish (Español) translation missing for : Yes
Spanish (Español) translation missing for : No
Spanish (Español) translation missing for : Don't Remember
Spanish (Español) translation missing for : Treatment for gum disease such as scaling and deep cleaning
Spanish (Español) translation missing for : Treatment for teeth ever becoming loose without an injury
Spanish (Español) translation missing for : Treatment for any tissue abuse habit like using toothpicks or anything else
Spanish (Español) translation missing for : Treatment for any cavities in your teeth
Spanish (Español) translation missing for : What type of health care professional gave you an oral health check up?
Spanish (Español) translation missing for : What do you use for cleaning your teeth?
Spanish (Español) translation missing for : How often do you do the following?
Spanish (Español) translation missing for : Never
Spanish (Español) translation missing for : Once a day
Spanish (Español) translation missing for : Twice a day
Spanish (Español) translation missing for : More than twice a day
Spanish (Español) translation missing for : Brush your teeth
Spanish (Español) translation missing for : Use dental floss
Spanish (Español) translation missing for : Clean your tongue
Spanish (Español) translation missing for : Rinse your mouth
Spanish (Español) translation missing for : How much do you think the following factors increase the risk for oral health problems?
Spanish (Español) translation missing for : 0%
Spanish (Español) translation missing for : 100%
Spanish (Español) translation missing for : Eating a lot of sugar products
Spanish (Español) translation missing for : Not brushing teeth
Spanish (Español) translation missing for : Eating or drinking frequently
Spanish (Español) translation missing for : Not rinsing after a meal
Spanish (Español) translation missing for : Smoking or using tobacco based products

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