What brand did you use most often during the past two weeks?
FR: DO NOT READ ANSWER CATEGORIES. CHOOSE ONLY ONE BRAND.

(1) ACT, Fluorigard, Kolynos, Listermint, Reach, StanCare (PAJ.040)
(2) Prescription fluoride rinse (END_PAJ)
(3) PLAX (PAJ.040)
(4) Scope, Listerine, Lavoris (PAJ.040)
(5) Other (PAJ.030)
(7) Refused (PAJ.040)
(9) Don't know (PAJ.040)

FR: SPECIFY THE BRAND NAME OF THE MOUTH WASH OR RINSE

ORWB_1 Name: ______________________

What brand did {child name} use most often during the past two weeks?

FR: DO NOT READ ANSWER CATEGORIES. CHOOSE ONLY ONE BRAND.

(1) ACT, Fluorigard, Kolynos, Listermint, Reach, StanCare (PCB.080)
(2) Prescription fluoride rinse (PCBCCI03)
(3) PLAX (PCB.080)
(4) Scope, Listerine, Lavoris (PCB.080)
(5) Other (PCB.070)
(7) Refused (PCB.080)
(9) Don't know (PCB.080)

FR: SPECIFY THE BRAND NAME OF THE MOUTH WASH OR RINSE

CORWB_1 Name: _____________________________