A Smile 4 U - Logan Honeycutt

Y n xare your teeth sensitive to hot cold andor sweet

Info iconThis preview shows page 1. Sign up to view the full content.

View Full Document Right Arrow Icon
This is the end of the preview. Sign up to access the rest of the document.

Unformatted text preview: N X IV+ / AIDS H Y XN Kidney Disease Y N XLow Blood Pressure Y N X upus L Y N Mitral Valve Prolapse X Y N Nervous/Anxious X Y N X re- Medication (Antibiotic before Dental) P Y N X sychiatric Care P Y N X espiratory Disease R Y N X heumatic/Scarlet Fever R Y N X hicken Pox/Shingles C Y N X exually Transmitted Disease S Y N X hortness of Breath S X Y N Sickle Cell Disease Y N Sinusitis X X Y N Smoke or use tobacco Y N X troke S Y N X hyroid Disease T Y N X uberculosis T PATIENT DENTAL HISTORY Do you currently have or have you had the following? Y N XAre your teeth sensitive to hot, cold and/or sweet Y N XFrequent fever blisters, mouth ulcers Y N XBurning of tongue and/or cracking of the corners of mouth Y N XHad permanent teeth removed (wisdom teeth) Y N X ny head, neck or jaw injuries A Y N X ny popping, clicking or soreness of the jaws A Y N X lench and/or grind teeth C Y N X o you wear night guards D Y N X ear dentures and/or partials W Y N X Concerns with teeth/fillings breaking Y N XConcerns with teeth, gums, or mouth Y N XConcerns with...
View Full Document

{[ snackBarMessage ]}

Ask a homework question - tutors are online