PATIENT DENTAL HISTORY
Do you feel pain in any of your teeth?
Yes
No
Are your teeth sensitive to hot or cold Liquids / foods?
Yes
No
Are your teeth sensitive to sweet or soar liquids / foods?
Yes
No
Do you notice some blood while brushing or flossing?
Yes
No
Have you had any head, back or jaw injuries?
Yes
No
Have you ever experienced any of the following?
1.Problems in your lower jaw?
Yes
No
2.Clicking in your lower jaw?
Yes
No
3.Pain in your lower jaw joint?
Yes
No
4.Difficulty in opening or closing
Yes
No
Do you bite your lips or check frequently?
Yes
No
Have you ever had any difficult in tooth extractions in the past?
Yes
No
Have you ever had prolonged bleeding following extractions?
Yes
No
Have you ever had instructions on the care of your gum?
Yes
No
Have you undergone any tooth filling or crowns/ bridges in the past?
Yes
No
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