Please answer the following questions:
How many times a day do
you drink?:
1. Coffee or tea with sugar?
2. Pop, Cool-aid, lemonade, fruit juice, rice milk or iced tea with sugar?
How many times a day do
you?
1. Chew regular gum? (gum with sugar)?
2. Eat mints, lozenges, candies, candy bars, breath mints?
3. Eat sweetened baked goods (cookies, pastries) between
meals?
Do you have a habit of
sipping a sweetened drink (coffee, cola) or eating a sweet snack over an
extended periods of time, 45 minutes or more?
Here is a sample food and
dental care record for you to keep track of what you eat; how often you eat; and
your mouth care routine Please record any food, drinks, candy, medicine
with sugar, lozenges, etc and the time you consumed them. Keep this record
for three days, please make one of these days a weekend or day off.
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TIME
DAY
1
DAY
2
DAY 3
AM 6:00
7:00
8:00
9:00
10:00
11:00
PM 12:00
1:00
2:00
3:00
4:00
5:00
6:00
7:00
8:00
9:00
10:00
11:00
AM 12:00
1:00
2:00
3:00
4:00
5:00
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Brushed?
When?
How long?
Flossed?
How many times?
Mouth
rinse? Kind?
Sample:
7:00 -coffee with 2 tsp
sugar and 1 sugar donut (forgot to brush)
9:00 -1 king size candy bar
and coke 20oz (swished with water)
11:00- gum with sugar
12:00 -16 oz milkshake,
cherry turnover (used a toothpick)
2:00 -breath mints (10)
with sugar
4:00 -l oz package M&M
6:00 -12 oz coke with
dinner (thought about flossing but didn't)
8:00 -4 chocolate chip
cookies
9:00 -1 chocolate brownie
with hot fudge and ice cream
10:00 -raisins and nuts
Brushed: 1x p.m. for 30
sec.; forgot to floss, no mouth rinse
(courtesy of Elm Tree
Dental Clinic)
Calculate the nutritional value
of your dietary intake plans with
Nutrihand
April 07, 2007
Food History Resources
The colorful 2007
Keep the Beat Calendar for healthy heart and exercise
record.
View
the full calendar