Can you score better than our dental team? Age*- Please Select -Under 1818-2425-3435-4445-5455+Gender- Please Select -MaleFemalePrefer not to answerI brush...*- Please Select -After very mealTwice DailyOnce DailyWhen I rememberNeverI floss...*- Please Select -After very mealTwice DailyOnce DailyWhen I rememberNeverDo you smoke?* Like a chimney Occasionally I used to but have quit Never Daily water intake* 2L or more 1L A glass here and there Does coffee count? Do your gums bleed when you brush?* Yes No Sometimes Do you have Sore gums? Toothache? Sore jaw? Loose teeth? Missing teeth? Crooked teeth? Trouble sleeping? Cracked/chipped teeth? Stains on your teeth A fear of dental treatment? When was your last visit to the dentist?*- Please Select -Less than 6 months agoPast yearA year or two agoMore than a couple of yearsNeverName* First Last Phone Email* NameThis field is for validation purposes and should be left unchanged. Don’t forget to share this via Twitter, Google+, Pinterest and LinkedIn.
