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Appointment Dental fear test OHIP test with evaluation

Gentle help with dental fear
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Form

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Step 1 of 2

50%

1. My teeth are embarassing

Yes No

2. I don´t talk to anyone about my teeth

Yes No

3. I am afraid that I will be humiliated because of my teeth

Yes No

4. I feel helpless with the condition of my teeth

Yes No

5. I have a feeling that my bite isn't right

Yes No

Presumed causes of my dental anxiety

6. Bad experiences with the dentist

Yes No

7. Extreme nausea or gag reflex

Yes No

Which statements do you find yourself in?

8. In my head it's all about my teeth

Yes No

9. My professional success is interfered by my dental anxiety

Yes No

10. My dental problems are stealing my sleep

Yes No

11. My sex life is negatively affected by my dental anxiety

Yes No

12. Dental anxiety reduces my self-esteem

Yes No

13. My fear of the dentist leads me into a certain social isolation and to the loss of my social reputation

Yes No

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