Journal of Dental Rehabilitation and Applied Science:eISSN 2384-4272 pISSN 2384-4353

Table. 1.

Table. 1.

A questionnaire for tooth wear risk factors

How old are you?
  ① 10 -29 ② 30 -49 ③ over 50
What is your occupation? Are your occupation dealing with gas or acid materials?
① Yes ② No
How many times do you eat acid fruits?
  ① everyday ② 2 -4 times per week ③ 0 -1 time per week
How many times do you drink fruit juice, ion drinks, soft drinks?
  ① everyday ② 2 -4 times per week ③ 0 -1 time per week
Do you intake medications like Aspirin, Vitamin C, Anti-depressant, proton-pump inhibitor?
  ① Yes ② No
Do you have gastroesophageal reflux disease or vomiting habits?
  ① Yes ② No
Do you have habits like bruxism or clenching?
  ① Yes ② No
J Dent Rehabil Appl Sci 2019;35:113-22 https://doi.org/10.14368/jdras.2019.35.3.113
© 2019 J Dent Rehabil Appl Sci