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Abstract : One of the most common and informative methods of collecting medical information was and still remains a variety of questionnaire options in the form of filling a special questionnaire by the respondents. Literature analysis allowed the authors of the study to stop their choice on the "Dental Health Questionnaire for Adults", which was developed by the WHO. The purpose of the study was to analyse the results of survey carried out with the help of the adapted “Dental Health Questionnaire for Adults” among the patients residing in Poltava region of Ukraine, with the focus on the respondents’ age factor. The pilot questionnaire was carried out on the basis of the department of propaedeutics of orthopedic dentistry of Poltava State Medical University. It was conducted among 132 patients, aged from 22 to 80 years. The survey included data on the population age distribution, patients’ dental status, their treatment needs and individual hygiene care. The study employed a translated and adapted “Dental Health Questionnaire for Adults” according to the 5th edition of the World Health Organization bulletin from 2013. The interdependence of the age factor and the number of natural teeth was predicted, F (2, 126) =7.55, p=0.0001; the correlation between the patients’ age and the use of complete removable orthopedic structures is also stable F (1, 126) =4.29, p=0.0404. There is a clear correlation between the respondents’ age and the characteristics of their gum state, i.e., in the older subgroups of the sample, there is a proportional increase in the number of the patients who rate their gum condition as “average” F (6, 125) =4.35, p= 0.0005. At the same time, it turned out that the correlation between the factor of presence of partial removable orthopedic structures and the age of patients is not stable F (1, 125) =2.43, p=0.1214, taking into account the facts of the use of similar structures by people in different age groups, starting with 33 years. The factors of pain and discomfort in the oral cavity, as well as problems noted within the last year, also have no correlation with the age of the interviewees F (2, 125) =0.08, p=0.9198, F (4, 125) =1.00, p=0.4126, respectively. The results of Poltava region residents’ pilot survey demonstrated certain statistical regularities, the main of which are the correlations between the patients’ age and the factors of the available natural teeth number, the fact of using complete removable prostheses and the gums state.