Periodontal Self-Assessment Form

Please answer the below questions. Someone from our team will review it and get back to you.

    1) How old are you?

    The risk of developing periodontal disease increases as you get older.

    2) Which most closely describes your gender?

    Some studies suggest that there is a difference between different genders in terms of the risk of developing periodontal disease. The hormone fluctuations during a woman’s life can also cause problems to gingival health even though women tend to take more care of oral hygiene.

    3) Are you a smoker?

    Smoking is one of the risk factors most frequently associated with periodontitis. Smokers tend to form more plaque, have deeper pockets, and respond less to treatment.

    4) Do your gums often bleed when you brush your teeth?

    The presence of bleeding gums during brushing is one of the signs of this disease, especially gingivitis. Smoking can often conceal this clinical sign.

    5) Have you noticed that your teeth are becoming loose?

    Periodontitis causes a loss of bone support of the teeth. In time, this process causes teeth to become more and more mobile.

    6) Have you noticed the presence of receding gums or do your teeth seem to be "longer"?

    7) Do you have regular checkups (at least once a year) at your dentist’s for normal professional cleaning of your teeth?

    8) Do you use dental floss and/or interdental brushes on a regular basis?

    9) Do you suffer from heart disease, osteoporosis, or diabetes?

    10) Has your dentist ever told you that you suffer from gingival problems, gum infections, or inflammation?

    11) Have any of your teeth ever been extracted for periodontal reasons or because they were too loose?

    12) Does anyone in your family have, or have they had, problems with their gums (pyorrhoea)?

    13) Do you think you have, or have you been told that your breath is not pleasant?