| Name: |
| Surname: |
| Age: |
| 1. What sports do you participate? |
| 2. Did you practice as a professional athlete or amateur? |
| . Professional |
| . Amateur |
| 3. Do you wear a mouth guard? |
| . Yes |
| . No |
| 4. If yes, which type of mouthguard do you own? |
| . Stock |
| . Mouth-formed |
| . Custom-fabricated |
| 5. If you have a mouthguard when do you use it? |
| . Games only |
| . Games and exercises |
| 6. Have you suffered any kind of dental trauma during sport activities? |
| . Yes |
| . No |
| What kind of? |
| …… |
| 7. If you had, were you wearing a mouthguard at that time? |
| . Yes |
| . No |
| 8. Do you have any complaints while using a mouthguard? What kind of? |
| . Speech |
| . Breathing |
| . Dry mouth |
| . Bad taste and odor |
| . Nausea |
| . Other … |
| 9. What are the reasons for not wearing a mouthguard? |
| 10. Is it necessary to make the use of a mouthguard mandatory in your sport? |
| . Yes |
| . No |
