Dental Cavities Risk Assessment

Kigo Dental - Self Assessment form for risk of developing dental caries.

The following is a self-assessment to help you identify factors that indicate you may develop dental caries in future. 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.

Dental cavities

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. Do you have a family history of dental cavities? Do you have a dry mouth or reduced saliva flow?
Yes No

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

3. How often do you consume sugary foods or drinks (juices, carbonated or non-carbonated soft drinks, energy drinks, medicinal syrups)?

Never Once in a while On a regular basis

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

5. How often do you brush your teeth?

Two or more times a day One time a day Less than one time a day

6. Do you have any medical conditions that may affect your dental health, such as diabetes, heart disease, or immune system disorders?

No Yes, but it is well-controlled Yes, and it is not well-controlled

7. How often do you get dental cleanings done?
Once a year
Twice a year
Every three months
It has been two or more years since my last dental cleaning
Never got dental cleaning done

8. Have you ever been told by any healthcare provider that you have hand dexterity or motor coordination issues?
Yes No

9. Do you smoke or use any tobacco products, alcohol or recreational drugs?
Yes No

10. Do you have any teeth extracted or missing due to dental caries in the past 36 months?
Yes No

11. Do you have any visible plaque or discolouration on your teeth?
Yes No

12. Do you experience difficulty flossing or cleaning around some areas in your mouth due to irregular tooth morphology or other reasons?
Yes No

13. Do you have two or more restorations in your mouth?
Yes No

14. Have you noticed your teeth appearing longer than before? Have you ever been told that you have gum recession or exposed tooth roots?
Yes No

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

Dental Cavities Risk Assessment

Kigo Dental - Self Assessment form for risk of developing dental caries.

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