Step 2: Dental History

Although we primarily treat the area in and around the mouth, your mouth is a part of your entire body. Health problems that you may have, or medication that you may be taking, could have an important interrelationship with the dentistry you will receive. Thank you for answering the following questions honestly and completely.

    DATE OF LAST DENTAL CARE

    DATE OF LAST DENTAL X-RAYS

    ARE YOU HAVING OR HAVE YOU HAD ANY OF THE FOLLOWING:

    Pain in TeethSensitivity to SweetsSensitivity to BitingSensitivity to HotSensitivity to ColdBroken Teeth or FillingsPeriodontal or Gum DiseaseBleeding GumsLoose TeethBad BreathFood Collection Between TeethDifficult/Surgical ExtractionsFrequent HeadachesGrinding or ClenchingClicking or Jaw PoppingHead, Neck or Jaw InjuriesSore or Growths in or Around the MouthOrthodontic Treatment

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