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[p. 169]

Section O. DENTAL HEALTH
Person 1


Now I'm going to ask you some questions about WATER FLUORIDATION.

1. As you understand it, what is the purpose of adding FLUORIDE to the public drinking water?
Do not read answer categories, circle the ONE that best fits respondent's answer.

1 [] Prevent tooth decay, protect teeth, or related response
8 [] Other (Specify) ____
9 [] Don't know


2a. Does the water that you drink at home come from a public water system or is it from another source, such as a well?

1 [] Public water system
8 [] Other source
9 [] DK


b. Does this drinking water have FLUORIDE in it?

1 [] Yes
2 [] No
9 [] DK


HAND CALENDAR.
These next questions are about receiving dental care.

3a. During the 2 weeks (outlined in red on that calendar), beginning Monday (date) and ending this past Sunday (date), did anyone in the family go to a dentist? Include all types of dentists, such as orthodontists, oral surgeons, and all other dental specialists, as well as dental hygienists.

[] Yes
[] No (4)

b. Who was this? ____
Mark "Dental visit" box in person's column.

1 [] Dental visit

c. During those 2 weeks, did anyone else in the family go to a dentist?

[] Yes (Reask 3b and c)
[] No


Ask for each person with "Dental visit" in 3b:
d. During those 2 weeks, how many times did -- go to a dentist? ____


Mark box if under two years old.
4a. During the past 12 months (that is, since (12-month date) a year ago), how many visits did -- make to a dentist?
(Include the (Number in 3d) visit(s) that you already told me about.)

998 [] Under 2 (NP)
Visits ____
000 [] None


Mark "2-week dental visit" box in person's column if visit(s) reported in 3d.
b. How long has it been since -- LAST went to a dentist?

1 [] Past 2 weeks not reported (Mark 3b, ask 3d)
2 [] 2--week dental visit
3 [] Over 2 weeks, less than 6 months
4 [] 6 months, less than 1 year
5 [] 1 year, less than 2 years
6 [] 2 years, less than 5 years
7 [] 5 years or more
0 [] Never


O1
Refer to 4b.
1 [] Less than 2 years in 4b (5)
8 [] Other (NP)


(Some people go to the dentist because they think they have a problem; other people go to the dentist for a check-up or to have their teeth cleaned. Sometimes when people go for a check-up the dentist discovers a problem that needs to be treated.)

5. What was the MAIN REASON -- last went to the dentist?
Do not read answer categories, circle the ONE main reason.

1 [] Went in on own for check-up, examination or cleaning.
2 [] Was called in by the dentist for check-up, examination or cleaning.
3 [] Something was wrong, bothering or hurting --
4 [] Went for treatment of a condition that dentist discovered at earlier check-up or examination.
8 [] Other (Specify) ____
9 [] Don't know ____

[p. 170]


6a. Is there anyone in the family who has lost ALL of his or her natural teeth?

[] Yes
[] No (7)

b. Who is this? ____
Mark "Lost all teeth" box in person's column.

1 [] Lost all teeth

c. Anyone else?

[] Yes (Reask 6b and c)
[] No

O2
Refer to 6b for all family members.

1 [] "Lost all teeth" marked in 6b for all family members (Section P)
8 [] Other (7)

Do not ask for persons with "Lost all teeth" in 6b.
7a. (Now I am going to ask about some things that people may be doing to take care of their teeth.)
What does -- use when [he/she] brushes [his/her] teeth -- toothpastes, tooth powder, or something else?

1 [] Toothpaste (7b)
8 [] Other (Specify) ____ (NP)


b. What brand did -- use most often during the past two weeks?
Do not read answer categories, circle ONE brand.

1 [] Crest
2 [] Crest Tartar Control
3 [] Colgate
4 [] Dentagard
5 [] Aquafresh
6 [] Aim
8 [] Other (Specify) ____
9 [] Don't know


Some MOUTHRINSES contain FLUORIDE to reduce tooth decay. Others do not. ACT, Fluorigard, Listermint with Fluoride, StanCare and some prescription brands are example of mouthrinses that contain FLUORIDE.
8a. Does anyone in the family now use a FLUORIDE mouthrinse at home?

[] Yes
[] No (O3)
[] DK (O3)

b. Who is this? ____
Mark "Fluoride mouth rinse" box in person's column.

1 [] Fluoride mouthrinse

c. Anyone else?

[] Yes (Reask 8b and c)
[] No


Ask for each person with "Fluoride mouthrinse" in 8b:
d. What brand did -- use most often during the past 2 weeks?
Do not read answer categories, circle ONE brand.

1 [] ACT
1 [] Flourigard
1 [] Listermint with Flouride
1 [] StanCare
2 [] Prescription fluoride rinse
8 [] Other (Specify) ____
9 [] Don't know


O3
Refer to age.

1 [] Under 17 (9)
2 [] 17 and over (NP

(Some schools have fluoride MOUTHRINSE programs.)
9. Does -- now take part in a fluoride MOUTHRINSE program at school?

1 [] Yes
2 [] No
9 [] DK


Sometimes doctors or dentists prescribe pills or drops with fluoride in them. Sometimes these are given at school.
10a. Does anyone in the family now take vitamins with FLUORIDE in them or any other kind of FLUORIDE drops, pills, or tablets, either at home or at school?

[] Yes
[] No (11)
[] DK (11)

b. Who is this? ____
Mark "Fluoride Supplements" box in person's column.

1 [] Fluoride Supplements

c. Anyone else?

1 [] Yes (Reask 10b and c)
2 [] No


11a. Dental SEALANTS are special plastic coatings that are painted on the tops of the back of teeth to prevent tooth decay. They are put on by a dentist or dental hygienist. They are DIFFERENT from fillings, caps, crowns and fluoride treatments. Has anyone in the family had dental SEALANTS placed on their teeth?

[] Yes
[] No (Section P)
[] DK (Section P)

b. Who is this? ____
Mark "Dental Sealants" box in person's column.

1 [] Dental Sealants

c. Anyone else?

[] Yes (Reask 11b and c)
[] No