Nutrition and Oral Health Screening
The foods you eat can affect the health of your teeth and gums. This
evaluation will help determine if your diet and nutrition is
adequate to help you keep your mouth healthy for a lifetime.
Nutritional Health Checklist Below:
Read the statements below. Total the numbers in the yes
column for all statements that apply to you. This will give you your
nutritional score.
| |
Yes |
| I have an illness or
condition that made me change the kind and/or amount of food I
eat. |
2
|
| I avoid eating one or more
food groups, i.e., meat, dairy, vegetables, or fruit.
|
2
|
| I have two or more drinks
of beer (12 oz. serving), liquor (1.5 oz. 86 proof), or wine
(5 oz. serving) almost every day. |
2
|
| I use tobacco products
daily. |
1
|
| I have tooth pain or mouth
sores that make it hard to eat or make me avoid certain foods.
|
2
|
| I snack or drink sweetened
beverages two or more times per day between meals.
|
2
|
| I had three or more new
cavities at a recent dental check-up. |
2
|
| I don't always have enough
money to buy the food I need. |
4
|
| I eat alone most of the
time. |
1
|
| I have a dry mouth which
causes me to drink (something other than water) or use gum,
hard candy, cough drops, or mints to moisten my mouth two or
more times per day. |
2
|
| I take three or more
different prescription or over-the-counter drugs daily.
|
1
|
| Without wanting to, I have
lost or gained ten pounds in the last six months. |
2
|
| I am not always physically
able to shop, cook, and/or feed myself. |
2
|
| Total |
Total Your Nutritional Score: If it's
| 0-2 |
Good! Recheck your
nutritional score in 6 months. |
| 3-5 |
You are at moderate
nutritional risk. See what can be done to improve your
eating habits and lifestyle. |
| 6 or more |
You are at high
nutritional risk. You may need referral to your physician
and/or a registered dietitian for more in depth nutritional
intervention. |
Adapted from the Nutrition Screening Initiative, Washington, DC:
1992.
9/98 OHSU School of Dentistry Department of Periodontology
Linda D. Boyd, MS, RDH, RD, Theresa E. Madden, DDS, PhD
|
