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First Name*
Last Name*
Email*
1. What fun can be had with braces?
Collecting plaque
Changing colors for holidays, your favorite sports team, your school, etc.
Poking wires
Eating hard candy
2. What’s your oral hygiene first line of defense?
Cleaning your teeth and braces every day, and using a Dr. recommended fluoride rinse
An army tank
Neighborhood ice cream truck
Not eating
3. How often should you brush and proxy brush your teeth and braces?
Once a week
Just before you visit us
After every meal
In the morning
4. Do you need fluoride?
Yes
No
5. How often should you floss?
Once a month
Every night before brushing
When your mother says so
After eating popcorn
6. What food is harmful to your braces?
Yogurt and smoothies
Scrambled eggs and oatmeal
Anything hard, crunchy, sticky, chewy or sugary
Mashed potatoes and pasta
7. What do you do if you loosen a bracket or band?
Just wait until your next appointment to get it fixed
Throw them away
Call us, have your parent call, or leave us a message so a repair appointment can be scheduled as soon as possible
Save them for gifts for your friends
8. Do you need a mouth guard when you are playing sports?
Yes
No
9. What are the most important factors in achieving good results and completing your orthodontic treatment on time?
Following our instructions and wearing your elastics, headgear or removable appliances
Excellent oral hygiene
Not missing appointments
All of the above
10. I’ve …
Read the hand outs
Listened to the assistant
Answered the questions correctly
All of the above and earned additional wired reward punches!
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