Perio Questionnaire


Do you brush your teeth daily?

How often you change your brush?

Do you use dental floss?

Do you use mouth wash?

Do you think bad oral hygiene affects your general health?

How often you visit your dentist for cleaning?

During tooth brushing do your gums bleed?

How would you rate your gum health?


If you answered YES to ANY of the questions above, there are often several alternatives to improve your teeth and smile. To receive a personalized response to your smile analysis, please complete the form below.

You can have the smile you’ve always wanted! contact us today to schedule an appointment.