Caries-Prone Patients: Prevention, Assessment, and Interventions, 3rd Edition __________________________
NUTRITIONAL QUESTIONNAIRE AND FOOD LOG This form is intended to gain information about habits that may promote tooth decay. When answering the following questions, please choose the answer that fits best and provide as much information as possible. Feel free to provide any additional information you feel is important. Please bring this completed form to your appointment on _________________________ . 1. What are your favorite drinks and how often do you consume them? ________________________________________ ______________________________________________________________________________________________ 2. How often do you eat fast food? Daily 2–3 times a week Less than once a week 3. How often do you skip meals? Daily 2–3 times a week Less than once a week 4. Do you chew gum? Yes No If yes, how often? Daily 2–3 times a week Less than once a week If yes, what kind? _________________________________________________________________________________ 5. Do you consume antacids, breath mints, or hard candies regularly? Yes No If yes, how often? Daily 2–3 times a week Less than once a week Do you make an effort to choose sugar-free antacids, breath mints, or hard candies? Yes No 6. Please list your favorite snacks and how often you eat these items. ___________________________________________ ______________________________________________________________________________________________ ______________________________________________________________________________________________ 7. Do you buy food or drinks from vending machines? Yes No 8. Is your drinking water fluoridated? Yes No Don’t know Use the following chart to record your food and drink intake for three days. Meals and snacks should be recorded. Choose days that you are eating normally (not dieting) and include at least one weekday and one weekend day. If possible, record the carbohydrate and sugar content of foods eaten. Time Food Eaten Grain Fruit Vegetable Protein Dairy Fat Sugar _______ __________________ ________ _________ __________ _________ _______ _______ _______ _______ __________________ ________ _________ __________ _________ _______ _______ _______ _______ __________________ ________ _________ __________ _________ _______ _______ _______ _______ __________________ ________ _________ __________ _________ _______ _______ _______ _______ __________________ ________ _________ __________ _________ _______ _______ _______ _______ __________________ ________ _________ __________ _________ _______ _______ _______ _______ __________________ ________ _________ __________ _________ _______ _______ _______ _______ __________________ ________ _________ __________ _________ _______ _______ _______
Source: Author
Table 1
SODA/SOFT DRINKS Within the United States, the median annual per capita consumption of sugar-sweetened beverages (SSB) in 2021 was 37.1 gallons, with the annual per capita consumption of SSB the lowest in Hawaii (23.5 gallons) and the highest in Missouri (51.8 gallons) [25]. Most people are unaware of the sugar con- tent of their favorite sugar-sweetened beverage or soda, and they are not aware of the daily recommended maximum amount of sugar. The World Health Organization has recommended
that for children the maximum daily consumption of sugar is 3 teaspoons. A 20-ounce bottle of soda contains about 16 teaspoons of sugar, while a 12-ounce can contains about 10 teaspoons of sugar [26]. Many nutritional experts and health organizations believe that soda and SSB in general are a major contributing factor to the escalation of childhood and adult obesity [27]. The consumption of soda doubles the risk of the development of carious lesions in children and increases the potential for the development of carious lesions in adults [26].
53
EliteLearning.com/Dental
Book Code: DPA1525
Powered by FlippingBook