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Dry Mouth Quiz

SECTION 1: Medical Risk Factors

1. Do you have any of these medical conditions?

(Select all that apply)

(Select all that apply)

SECTION 2: Medications (Top Dry Mouth Triggers)

2. Do you regularly take any of the following medications? (Select all that apply)

SECTION 2: Medications (Top Dry Mouth Triggers) 2. Do you regularly take any of the following medications? (Select all that apply)

SECTION 3: Symptoms

3. Do you experience any of the following?

SECTION 3: Symptoms 3. Do you experience any of the following?

4. Do you have difficulty swallowing dry foods (like crackers)?

4. Do you have difficulty swallowing dry foods (like crackers)?

SECTION 4: Lifestyle Risks

6. Do you use any of the following?

SECTION 4: Lifestyle Risks6. Do you use any of the following?

7. Do you breathe through your mouth (especially at night)?

7. Do you breathe through your mouth (especially at night)?
A
B
C

SECTION 5: Dental Impact

8. Do you frequently get cavities or need dental work replaced?

SECTION 5: Dental Impact8. Do you frequently get cavities or need dental work replaced?
A
B
C

Do you have sensitive teeth (cold, sweet, air)?

Do you have sensitive teeth (cold, sweet, air)?
A
B
C

10. Have you noticed white spots, staining, or enamel changes?

10. Have you noticed white spots, staining, or enamel changes?
A
B
C

11. Do you wear a dental appliance?

11. Do you wear a dental appliance?
A
B
C
D
E

SECTION 6: Hydration & Habits

12. How much water do you drink daily?

SECTION 6: Hydration & Habits 12. How much water do you drink daily?
A
B
C

13. Do you consume acidic drinks? (Select all)

13. Do you consume acidic drinks? (Select all)

SECTION 7: Final Perception

14. Do you feel your mouth is dry?

SECTION 7: Final Perception 14. Do you feel your mouth is dry?
A
B
C

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