Tooth Loss Risk Assessment

The following questionnaire is based on a 2013 study by the CDC, which identified risk factors related to tooth loss. The income figure has been adjusted for inflation, but otherwise the factors are as determined by the CDC.

Have you already lost one or more teeth?*
Why are we asking this
Do You Have Dental Insurance?*
Why are we asking this
Do You Have a Disability?*
Why are we asking this
Do You Have Diabetes?*
Why are we asking this
Is your annual income more or less than $27,000 a year?*
Why are we asking this
Do You Regularly Participate in Physical Activity?*
Why are we asking this
What Is Your BMI?*
Don't know what your BMI is? Click here!

Why are we asking this
Are You a Smoker?*
Why are we asking this
What Is Your Age?*
Why are we asking this
What Is Your Education Level?*
Why are we asking this
Your Score
Your Score
Your score will display here when you start answering the questions above.
Your Score
3 points or less = Low Risk of Tooth Loss
4-6 points = Average Risk of Tooth Loss
7-12 points = Elevated Risk of Tooth Loss
13+ points = High Risk of Tooth Loss
I would like Dr. Nancy Nehawandian to follow up with me about my results
- I would like Dr. Nancy Nehawandian to follow up with me about my results
Email the results to me*
- Yes
- No
Name*
First Last
Email Address*
Phone Number*
Name
This field is for validation purposes and should be left unchanged.

Note: This questionnaire/website is not intended to replace the services of a doctor. It does not constitute a doctor-patient relationship. Information in this questionnaire/website is for informational purposes only & is not a substitute for professional advice. Please do not use the information contained herein for diagnosing or treating any condition.

Monday	8:30AM – 5:30PM
Tuesday	8:30AM – 5:30PM
Wednesday	7:30AM – 4:30PM
Thursday	8:30AM – 4:30PM

Your Score

Your score will display here when you start answering the questions above.

Your Score

3 points or less = Low Risk of Tooth Loss 4-6 points = Average Risk of Tooth Loss 7-12 points = Elevated Risk of Tooth Loss 13+ points = High Risk of Tooth Loss

3 points or less = Low Risk of Tooth Loss
4-6 points = Average Risk of Tooth Loss
7-12 points = Elevated Risk of Tooth Loss
13+ points = High Risk of Tooth Loss