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Michigan Oral Health Coalition Adult Community Needs Assessment

Tell Us About Your Teeth

The Michigan Oral Health Coalition will use this survey to learn more about barriers people have to good oral health. Completing this survey is voluntary. Your information will be kept confidential. Please answer the questions in your own way. There are no right or wrong answers.  By answering these questions, we can provide you with connections to local services. Depending on availability, many of these services are low-cost or free of charge.
1.What is your age?
2.What is your race and ethnicity? (check all that apply)
3.What county do you live in?
4.How would you describe the condition of your teeth and mouth? (check all that apply)
5.If you have untreated dental issues, what are the reasons that they remain untreated? (check all that apply)
6.Describe your homecare routine. (check all that apply)
7.What makes it hard for you to have good oral health? (check all that apply)
8.When was your last visit to the dentist?
9.Do you have dental insurance?
10.During the past year, have you missed work or other important life activities due to problems with your teeth?