[p.179]
Section P -- Dental
Hand calendar.
These next questions are about dental care received during the 2 weeks (outlined in red on that calendar/beginning Monday (date) and ending this past Sunday (date)).
1a. During those 2 weeks 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.
[] No (2)
[] DK (2)
b. Who was this?
Mark "Dental visits" box in person's column.
c. During those 2 weeks, did anyone else in the family go to a dentist?
[] No
Ask for each person with "Dental visit" in 1b.
d. During those 2 weeks, how many times did -- go to a dentist?
Mark box if under 2.
2a. During the past 12 months (that is, since (12-month date) a year ago), about how many visits did -- make to a dentist? (Include the (number in 1d) visits) you already told me about.)
12-month dental visits ____
000[] None
Mark "2-week dental visit" box in person's column if visit(s) reported in 1d.
b. About how long has it been since -- last went to a dentist?
2[] 2-week dental visit (NP)
3[] Over 2 weeks, less than 6 months (NP)
4[] 6 months, less than 1 year (NP)
5[] 1 year, less than 2 years (3)
6[] 2 years, less than 5 years (3)
7[] 5 years or more (3)
0[] Never (3)
3. What are the reasons -- has (not visited the dentist in over 12 months/never gone to the dentist)?
Do not read categories. Circle all that apply.
02[] Nervous
03[] Needles
04[] Cost
05[] Don't know dentist
06[] Dentist too far
07[] Can't get there
08[] No problems
09[] No teeth
10[] Not important
11[] Didn't think of it
88[] Other (Specify) ____
99[] Don't know
4a. Is there anyone in the family who has lost all of his or her upper (permanent) natural teeth?
[] No (4e)
b. Who is this?
Mark "No uppers" box in person's column.
c. Anyone else?
[] No
Ask for each person with "No uppers" in 4b.
d. Does -- have an upper denture or plate?
2[] No
e. Is there anyone in the family who has lost all of his or her lower (permanent) natural teeth?
[] No (5)
f. Who is this?
Mark "No lowers" box in person's column.
g. Anyone else?
[] No
Ask for each person with "No lowers" in 4f.
h. Does -- have a lower denture or plate?
2[] No
[p. 180]
Section P -- Dental -- Continued
Check Item 1
Refer to 4b and 4f.
8[] Other (5)
5a. Dental sealants are special plastic coatings that are planted on the tops of the back teeth to prevent tooth decay. They are different from fillings, caps, crowns, and fluoride treatments. Has anyone in the family ever had dental sealants painted on their teeth?
[] No (6)
[] DK (6)
b. Who is this?
Mark "Dental sealants" box in person's column.
c. Anyone else?
[] No
6a. In the past two weeks has anyone in the family used a mouthwash or mouthrinse at home?
[] No (Check Item 2)
[] DK (Check Item 2)
b. Who is this?
Mark "Mouthrinse" box in person's column.
c. Anyone else?
[] No
Ask for each person with "Mouthrinse" in 6b.
d. What brand did -- use most often during the past 2 weeks?
Do not read answer categories. Circle one brand.
2[] Prescription fluoride rinse
3[] PLAX
4[] Scope, Listerine, Lavoris
8[] Other (Specify) ____
9[] Don't know
Ask or verify.
e. Does this mouthrinse contain fluoride?
2[] No
9[] DK
2[] 2-17 (7)
3[] 18 and over (NP)
7. (Some schools have fluoride Mouthrinse programs.) Does -- now take part in a fluoride Mouthrinse program at school?
2[] No
9[] DK
(Doctors or dentists may prescribe or provide tablets, drops, or supplements with fluoride in them. (Sometimes these are given at school.))
8. Does -- now take vitamins with fluoride in them or any other kind of fluoride tablets, drops, or supplements?
2[] No
9[] DK
[p. 181]
Section P -- Dental -- Continued
These next questions refer to the 2 weeks (outlined on that calendar/beginning Monday (date) and ending Sunday (date)).
9a. During that 2 week period, did anyone in the family miss any time from work or school because of a dental problem or dental visit?
[] No (10)
[] DK (10)
b. Who was this?
Mark "Missed time" box in person's column.
c. Anyone else?
[] No
[] DK
Ask for each person with "Missed time" in 9b.
d. How much time did -- miss because of a dental problem or dental visit?
52[] 1 hour, less than 3 hours
53[] 3 hours, less than 5 hours
54[] 5 hours, less than 7 hours
55[] 7 or more hours
OR
Days ____
11a. (Not counting the time missed form work or school) Was there any (other) time during those 2 weeks that anyone in the family cut down on normal activities for more than half of the day because of a dental problem or dental visit?
[] No (Check Item 3)
[] DK (Check Item 3)
b. Who was this?
Mark "Cut down" box in person's column.
c. Anyone else?
[] No
[] DK
Ask for each person with "Cut down" in 11b.
d. During that period, how many (other) days did -- cut down for more than half of the day because of a dental problem or dental visit?
Days ____
Check Item 3
a. Mark first appropriate box
1[] Present for all questions
2[] Present for some questions
3[] Not present
b. Enter person number(s) of respondent(s) to "Dental" section.