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Healthcare & Clinical

Oral Health Habits & Dental Care Experience Survey

Measures everyday brushing and flossing habits, common symptoms like gum bleeding or sensitivity, satisfaction with dental visits, and the real barriers keeping people from care. Built for dental practices, oral care brands, and public health researchers. An AI follow-up interview digs into the specific symptom or barrier each respondent flagged, uncovering the actual reasons behind it instead of a generic checkbox.

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設問の例

テンプレートの内容をプレビューできます。すべての設問は公開前に自由に編集できます。

全14問・約7分
Q01
メッセージ

Hi! We're gathering honest input on everyday oral health habits and dental care experiences. Your responses are completely confidential and anonymized. There are no right answers — this takes about 8 minutes.

Q02
選択式必須

In the last 7 days, how often did you brush your teeth?

  • Twice a day or more
  • Once a day
  • A few times this week
  • Once this week or less
Q03
選択式必須

In the last 7 days, how often did you floss or use an interdental brush?

  • Every day
  • A few times
  • Once
  • Not at all
Q04
選択式必須

How long has it been since your last dental checkup or cleaning?

  • Less than 6 months ago
  • 6-12 months ago
  • 1-2 years ago
  • More than 2 years ago
  • I've never been to a dentist
Q05
マトリクス必須

In the past 3 months, how often have you experienced each of the following?

4行 × 5列
  • Bleeding or sore gums
  • Tooth or gum sensitivity to hot/cold/sweet
  • Bad breath you noticed yourself
  • Tooth, jaw, or mouth pain
列: Never · Rarely (a few times) · Sometimes (monthly) · Often (weekly) · Almost every day
Q06
オピニオンスケール必須

Overall, how satisfied are you with the current health of your teeth and gums?

スケール: 1 – 7
最小:Very dissatisfied最大:Very satisfied
Q07
評価スケール

Thinking about your most recent dental visit, how would you rate the overall experience?

範囲: 1 – 5
最小:Very poor最大:Excellent
Q08
選択式必須

What, if anything, keeps you from seeing a dentist as often as you think you should? Select all that apply.

  • Cost of treatment
  • Lack of dental insurance
  • Fear or anxiety about dental visits
  • Difficulty finding time
  • Trouble finding a dentist I trust
  • Bad past experience
Q09
AIインタビュー

Probe into the respondent's most frequent or severe symptom from the earlier list (e.g., bleeding gums, sensitivity, pain) — ask when it started, whether it has changed recently, and what they've tried, if anything. Then connect it to their stated barriers to dental visits: understand whether cost, fear, time, or trust is the real blocker, and what would actually get them into a dentist's chair. If they selected 'no barriers,' ask what keeps their routine consistent instead.

Q10
オピニオンスケール

If you currently have a regular dentist or dental provider, how likely are you to recommend them to a friend or family member?

スケール: 0 – 10
最小:Not at all likely最大:Extremely likely
Q11
選択式

What is your age range?

  • Under 18
  • 18-24
  • 25-34
  • 35-44
  • 45-54
  • 55-64
  • 65 or older
  • Prefer not to say
Q12
選択式

What is your gender?

  • Woman
  • Man
  • Non-binary
  • Prefer not to say
Q13
プルダウン

Do you currently have dental insurance?

  • Yes, private insurance
  • Yes, public/government insurance
  • No insurance
  • Not sure
  • Prefer not to say
Q14
メッセージ

Thank you for sharing your oral health habits and experiences! Your responses will be combined with others to help improve dental care access and everyday oral care guidance.

含まれる機能

  • AIによる深掘り

    自由回答に合わせてAIが追加で質問し、固定のフォームでは拾えない具体的な内容を引き出します。

  • 注意確認設問

    急いだ回答や質の低い回答者を除外する仕組みを標準で備えています。

  • AIが作成する設問文

    文言、設問の順序、条件分岐をAIが調査の目的に合わせて作成します。

  • 自動レポート

    回答が集まると、テーマ、引用、わかりやすい要約が自動で作成されます。

他ツールとの比較

ほかのアンケートツールで最も近いテンプレートを調べました。それぞれの優れている点と、このテンプレートがさらに踏み込んでいる点をまとめています。

このテンプレートを選ぶ理由

  • Goes beyond frequency checkboxes by including an AI follow-up interview that probes the respondent's specific flagged symptom or barrier to uncover the real reason behind it
  • Covers the full picture in one flow: brushing/flossing frequency, a symptom matrix (bleeding, sensitivity, etc.), last checkup timing, visit satisfaction and rating, and barriers to care
  • Includes a loyalty-style opinion scale on likelihood to keep seeing their current provider, useful for practices and oral care brands tracking retention
  • Built-in demographic and insurance-status questions let dental practices and public health researchers segment findings without extra custom fields

SurveySparrow

Oral Hygiene Survey Template

A ready-to-field oral hygiene survey template covering habits and satisfaction, built on SurveySparrow's conversational form format. It's a static question set rather than an interview, so answers are limited to what's pre-written. Good for quick fielding but not for digging into why a respondent flagged a specific symptom or barrier.

優れている点

  • Conversational, chat-style UI that can feel more engaging than a plain form
  • Ready-to-use template requiring no build-from-scratch effort
  • Part of a broader survey platform with reporting and distribution tools

物足りない点

  • No adaptive follow-up questioning — every respondent sees the same fixed question set
  • No mention of AI-driven probing into individual symptoms or barriers
  • No published methodology or prompt transparency for how questions were designed

QuestionPro

Oral Health Survey Questions + Sample Questionnaire Template

A sample questionnaire and question bank for oral health topics, positioned more as a reference guide with example questions than a single polished, ready-to-launch survey. Useful for researchers who want to build their own instrument, but it requires manual assembly and customization. No interview or follow-up capability is described.

優れている点

  • Broad library of sample oral health questions to draw from
  • Backed by an established survey platform with standard reporting features
  • Flexible for researchers wanting to construct a custom questionnaire

物足りない点

  • Reads as a question-bank/guide rather than a single fielding-ready template
  • No adaptive or voice AI interview to explore individual respondent context
  • No automated per-response quality scoring described

よくあるご質問

「Oral Health Habits & Dental Care Experience Survey」テンプレートにはどのような設問が含まれていますか？

すぐに使える設問が14問含まれており、最初の設問は次のとおりです：「Hi! We're gathering honest input on everyday oral health habits and dental care experiences. Your responses are complete…」・「In the last 7 days, how often did you brush your teeth?」・「In the last 7 days, how often did you floss or use an interdental brush?」。すべての設問は上でプレビューでき、自由に編集できます。

このアンケートの回答にはどのくらい時間がかかりますか？

回答者は通常、14問を約7分で回答し終えます。

テンプレートは編集できますか？

はい。公開前であれば、すべての設問、選択肢、順序を編集できます。設問の追加や削除のほか、調査の目的に合わせた作り直しをAIエディターに依頼することもできます。

このテンプレートは無料で使えますか？

はい。エディターで開けば、すぐに編集を始められます。お試しにアカウントは不要で、無料プランでアンケートを公開できます。

公開の準備はできましたか？

このテンプレートをエディターで開いてみてください。最初の回答者が目にする前に、すべてを自由に変更できます。

このテンプレートを使う無料で始める

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