Dental Information Center
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.
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
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Richard B Knight, DMD
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Portland, OR 97213
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