Caries-Prone Patients: Prevention, Assessment, and Intervention _____________________________________
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
Food Availability and Convenience As the number of Americans who are eating meals prepared outside of the home continues to increase, food availability and convenience have become factors that greatly influence food choices. The majority of foods that are considered “convenient” are high in sugar, refined or fermentable carbohydrates, and fat [17; 18]. These foods are therefore unhealthy choices for oral and systemic health. Examples of convenience foods include hamburgers, chips, vending machine snacks, and candy bars. The prevalence of vending machines gives people access to many low-nutrient, energy-dense snacks on a daily basis [33; 34]. The Smart Snacks school nutrition standards became effective at the beginning of the 2014–2015 school year and
Sports drinks and fruit juices also tend to be acidic and contain high amounts of sugar [29; 30]. The use of these products should be limited. Milk and water remain the best drink options for healthy teeth. The development of flavored, unsweetened water gives patients another drink option that is not detrimental to their teeth. FACTORS INFLUENCING DIET It is important for dental professionals to study the factors influencing patients’ diet choices to understand the motiva- tions behind them and to offer healthy alternatives. Factors influencing diet include food availability, family structure, con- venience, parental influence, habit, cost, and media [31; 32].
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