ACID EROSION RISK QUESITONNAIRE

1. I prefer to snack all day long or between meals

• Yes
• No

2. How many fruit juices or carbonated beverages do you drink on an average day?

• 1
• 2
• 3
• More than 4

3. How do you drink these beverages?

• Swirl around my mouth before swallowing
• Take small sips or drink it quickly
• With a straw

4. When do you brush your teeth?

• Straight after eating my meals/snacks
• Usually 30 minutes after eating
• Before I eat or at least one hour after eating

5. What do you typically drink with your meals

• Wine/beer/soda/fruit juice/coffee
• Water
• Milk

6. How often do you eat dairy products (eg. milk, cheese, yoghurt)

• I do not eat dairy products normally
• I eat some dairy products once and a while
• I eat dairy products daily

7. How many times do you eat spicy foods in a week?

• Never
• 1-3 times per week
• More than 3 times per week

8. When eating salads do you regularly eat it with dressing?

• Yes
• No

9. How many glasses of water (8 oz) do you consume in an average day?

• None
• 1-3
• 3-5
• 5-8

10. How many cups of tea and/or coffee would you drink in an average day?

• None
• 1-2
• More than 3

11. Do you regularly chew sugarless gum?

• Yes
• No