How often do your gums bleed during brushing or flossing?

Never

Sometimes

Often

Almost every time

Question 2

How frequently do you experience swollen, red, or tender gums?

Never

A few times a month

Weekly

Daily

Question 3

Have you noticed bad breath or a bad taste in your mouth that doesn't go away?

Occasionally

Yes, regularly

Constantly

Question 4

How often do you get professional dental cleanings?

Every 6 months

Once a year

Every few years

Rarely or never

Question 5

Do you or a family member have a history of heart disease, stroke, or high blood pressure?

Yes, in extended family

Yes, in immediate family

Yes, and I’ve been diagnosed too

Question 6

Do you floss or use a water flosser daily?

Yes, everyday

3 - 4 times per week

Occasionally

Rarely or never

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