Dental Caries Assessment Form

Kigo Dental -Self Assessment form for dental caries.

The following is a self-assessment to help you identify factors that may indicate you have dental caries. The assessment is meant to be informative but does not substitute for a comprehensive evaluation by your dentist or endodontist to determine your actual risk and condition.

Self-assessment form for dental caries.

Be sure to answer all the questions honestly to obtain an accurate score. Hereafter "you" can be related to you, your child, or any person in need of taking this test.

1. Have you noticed any persistent pain or sensitivity in a tooth, especially when biting or chewing?
Yes No

2. Have you noticed any visible signs of tooth decay, such as black or brown spots on your teeth?
Yes No

3. Have you noticed any bad taste or odour in your mouth?
Yes No

4. Do you have any difficulty brushing or flossing certain areas of your mouth?
Yes No

5. Have you had any previous dental work, such as fillings or crowns, that may need to be examined for decay?
Yes No

6. Do you experience pain, discomfort or sensitivity when consuming sweet, sour, or hot/cold foods and drinks?
Yes No

7. Do you have any visible pits, holes, jagged edges or rough spots on your teeth?
Yes No

8. Are you experiencing so much pain around a tooth/teeth that your sleep or usual tasks are getting affected?
Yes No

9. Have you experienced any swelling or tenderness in your gums?
Yes No

10. Have you had any recent dental x-rays that showed cavities or decay in your teeth?
Yes No

11. Have you noticed any changes in your teeth’s shape, size or texture of your teeth?
Yes No

12. Are you taking any medications that may affect your dental health, such as chemotherapy? Have you undergone chemotherapy or radiation therapy?
Yes No

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Note: Please note that this self-assessment form does not intend to provide a definitive diagnosis if you have dental caries or other health conditions; it is developed to give you approximate knowledge about dental caries so that you can get appropriate consultation. Consulting with a qualified healthcare professional is mandatory to get a definitive diagnosis.

Dental Caries Assessment Form

Kigo Dental -Self Assessment form for dental caries.

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