NIDCR/CDC
Dental, Oral and Craniofacial Data Resource Center
Fluoride
Residential History, NIDR Prevalence, 1979–1980
Is your current residence served by a public water supply?
Yes
No
Residential History, NIDR Prevalence, 1979–1980
Has your child lived at this residence since birth?
Yes
No
Residential History, NIDR Prevalence, 1979–1980
If "No," please list all places where this child has lived for more than 6 months as well as the dates when s/he lived there. Start with your current address and go back in time. Also please indicate whether the place was served by a public water supply, that is, a supply used by most people that lived in the city, town, or place rather than an individual supply, such as a private well. Use the additional space if necessary.
CITY, TOWN, OR STATE DATE LIVED THERE PUBLIC WATER SUPPLY
MILITARY BASE (Check box if Yes)
________________ ______ From ___/___ to ___/___
MO YR MO YR
Q.1, NIDR Children, 1986–1987
Has your child ever received prescription fluoride drops?
1 Yes -> From ____age to ____age
2 No
Q.2, NIDR Children, 1986–1987
Has your child ever received prescription fluoride tablets?
1 Yes -> From ____age to ____age
2 No
Q.3, NIDR Children, 1986–1987
Has your child ever received prescription fluoride treatments, such as liquids or gels, at the dentist's office?
1 Yes -> From ____age to ____age
2 No
Q.4, NIDR Children, 1986–1987
Has your child ever received fluoride treatments in a school program?
1 Yes -> From ____age to ____age
2 No
Q.6, NIDR Children, 1986–1987
Please list all places (city/town/military base and state) where this child has lived for more than 6 months, and the dates when s/he lived there. Start with your current residence a go back in time. If additional space is needed, use the other side of this page.
CITY, TOWN, OR STATE DATE LIVED THERE PUBLIC WATER SUPPLY
MILITARY BASE Yes No
________________ ______ From ___/___ to ___/___
MO YR MO YR
Q.C4, HHANES, 1982–1984
Has ______ ever received fluoride treatments that were applied to _____ teeth during a visit to the dentist or someone else _____ saw for dental care?
1 Yes
2 No
9 DK
Q.C7, HHANES, 1982–1984
Does _____participate in a fluoride program at school? This is a program in which fluoride tablets or rinses are given to children to use at school.
1 Yes
2 No
9 DK
Q.N4a, b, c, NHIS, 1983
a. Does anyone in the family use toothpaste with fluoride?
1 Yes
2 No
9 DK
b. Who is this? __________
c. Anyone else?
1 Yes
2 No
Q.N5a, b, c, NHIS, 1983
a. Does anyone in the family use fluoride drops, tablets, or any other fluoride supplements which are not swallowed?
1 Yes
2 No
9 DK
b. Who is this? ___________
c. Anyone else?
1 Yes
2 No
9 DK
Q.N6a, b, c, NHIS, 1983
a. Does anyone in the family use a fluoride mouth rinse which is not swallowed?
1 Yes
2 No
9 DK
b. Who is this? ___________
c. Anyone else?
1 Yes
2 No
Q.O8a, b, c, NHIS, 1986
Some MOUTHRINSES contain FLUORIDE to reduce tooth decay. Others do not. ACT, Fluorigard, Listermint with Fluoride, StanCare and some prescription brands are examples of mouthrinses that contain FLUORIDE.
a. Does anyone in the family now use a FLUORIDE mouth rinse at home?
1 Yes
2 No
9 DK
b. Who is this? ____________
c. Anyone else?
1 Yes
2 No
Q.O8d, NHIS, 1986
What brand did (- - /you/child's name) use most often during the past 2 weeks?
Some schools have fluoride MOUTH RINSE programs.
Does (- -/child's name) now take part in a fluoride MOUTH RINSE program at school?
1 Yes
2 No
9 DK
Q.O10a, b, c, NHIS, 1986
Sometimes doctors or dentists prescribe or provide pills or drops with fluoride in them. Sometimes these are given at school.
a. Does anyone in the family now take vitamins with FLUORIDE in them or any other kind of FLUORIDE drops, pills, or tablets, either at home or at school?
1 Yes
2 No
9 DK
b. Who is this? ______________
c. Anyone else? _____________
Q.O1, NHIS, 1986
As you understand it, what is the purpose of adding FLUORIDE to the public drinking water?
1 Prevent tooth decay, protect teeth, or related response
8 Other, Specify ___________
9 DK
Q.O2a, b, NHIS, 1986
a. Does the water that you drink at home come from a public water system or is it from another source, such as a well?
1 Public water system
8 Other source
9 DK
b. Does this drinking water have FLUORIDE in it?
1 Yes
2 No
9 DK
Q.P6a, b, c, NHIS, 1989
a. In the past two weeks has anyone in the family used a mouthwash or mouthrinse at home?
1 Yes
2 No
9 DK
b. Who is this? _____________
c. Anyone else?
1 Yes
2 No
QP6d, e, NHIS, 1989
d. What brand did (- - /you/child's name) use most often during the past 2 weeks?
Some schools have fluoride MOUTH RINSE programs.
Does (- -/child's name) now take part in a fluoride MOUTH RINSE program at school?
1 Yes
2 No
9 DK
Q.P8, NHIS, 1989
{Doctors or dentists may prescribe or provide tablets, drops, or supplements with fluoride in them. (Sometimes these are given at school.)}
Does --now take vitamins with FLUORIDE in them or any other kind of FLUORIDE tablets, drops, or supplements?
1 Yes
2 No
9 DK
Q.Z1, NHIS, 1990
As you understand it, what is the purpose of adding FLUORIDE to the public drinking water?
1 Prevent tooth decay, protect teeth, or related response
2 To purify the water or related response
8 Other, Specify __________
9 DK
Q.PAJ.010; PCB.050, NHIS, 1998
In the past two weeks, have {you/child's name} used a mouthwash or mouth rinse at home?
1 Yes
2 No
7 Refused
9 DK
Q.PAJ.020, Q.PCB.060, NHIS, 1998
What brand did (you/child's name) use most often during the past two weeks?
Some schools have fluoride mouth rinse programs.
Does (child's name) now take part in a fluoride mouth rinse program at school?
1 Yes
2 No
7 Refused
9 DK
Q.PCB.100, NHIS, 1998
Doctors or dentists may prescribe or provide tablets, drops, or supplements with fluoride in them. (Sometimes these are given at school.)
Does {child's name} now take vitamins with FLUORIDE in them or any other kind of FLUORIDE tablets, drops, or supplements?
What did (person) have done during this visit? Probe: What else was done?
1 General exam, checkup or consultation
2 Cleaning, prophylaxis, or polishing
3 X-rays, radiographs, or bitewings
4 Fluoride treatment
5 Sealant (plastic coatings on back teeth)
6 Fillings
7 Inlays
8 Crowns or caps
9 Root canal
10 Periodontal scaling, root planing, or gum surgery
11 Periodontal recall visit (periodic or regular)
12 Extraction, tooth pulled
13 Implants
14 Abscess or infection treatment
15 Other oral surgery
16 Fixed bridges
17 Dentures or removable partial dentures
18 Relining or repair of bridges or dentures
19 Orthodontia, braces, or retainers
20 Bond, whiten, or bleach
21 Treatment for TMD or TMJ
99 Other
-7 Ref
-8 DK
