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DentalHistoryRecord

D1516,Training(488)
10/1/2013
2177(DentalHistoryRecord)
AdultDentalHistory
WestVirginiaUniversitySchoolofDentistry
DentalHistoryRecord
Pain 10/01/2013 ChiefComplaint(reasonforseekingcare)
Yes 10/01/2013 Doyouwanttochangetheappearanceofyourteeth?
Whiter 10/01/2013 Comments:
Yes 10/01/2013 Woulditupsetyoutolooseyourteethandweardentures?
Couldnteat 10/01/2013 Comments:
No 10/01/2013 Doyouhaveaprivatedentist?(lfreferred,nameofdentist)
3monthsago,prophy 10/01/2013 Comments:(Lasttimeseen,howoften,typeofcarereceived,etc.)
PreviousDentalTreatments
Yes 10/01/2013 Regularpreventivedentalcare
06/13/2013 10/01/2013 Dateoflastprophy:
Yes 10/01/2013 Periodontal(gum)treatment
Comments:
Yes 10/01/2013 Extraction(s)
Comments:
Yes 10/01/2013 Otheroralsurgerytreatment
Comments:
Yes 10/01/2013 Bite(occlusion)treatment
Comments:
Yes 10/01/2013 Jawjointtreatment(TMJ)
10/01/2013 Comments:
Yes 10/01/2013 Orthodontic"braces"care
Date:
Yes 10/01/2013 Rootcanaltreatment
Comments:
Yes 10/01/2013 Denture(s)
Comments:
Yes 10/01/2013 Crown,Bridge,orlmplant
Comments:
Yes 10/01/2013 lnjurytoteethorface
Comments:
CurrentProblemsandConcerns
Yes 10/01/2013 Difficultyswallowingeffectively
Comments:
Yes 10/01/2013 Bleedinggums
10/01/2013 Comments:
Yes 10/01/2013 Gingival"gum"painorswelling
10/01/2013 Comments:
Yes 10/01/2013 Frequentcoldormouthsores
Comments:
1 Printed:10/1/20133:07:06PM
DentalHistoryRecord
D1516,Training(488)
10/1/2013
2177(DentalHistoryRecord)
Yes 10/01/2013 Whitepatchesinthemouth
Comments:
Yes 10/01/2013 Drymouthproblems
Comments:
Yes 10/01/2013 Badbreath
Comments:
Yes 10/01/2013 Toothaches
Comments:
Yes 10/01/2013 Sensitiveteeth
Comments:
Yes 10/01/2013 Painuponbitingand/orchewing
Comments:
Yes 10/01/2013 Loseormovingteeth
Comments:
Yes 10/01/2013 Teethbreakorfractureeasily
Comments:
Yes 10/01/2013 Foodcatchingbetweenyourteeth
Comments:
OralHabitsandPreventivePractices
Yes 10/01/2013 Brushdaily
Nimbus 10/01/2013 Typeofbrush:
Yes 10/01/2013 Flossdaily
Yes 10/01/2013 Comments:
Yes 10/01/2013 Cleanteethinotherways
Comments:
Yes 10/01/2013 Usetoothpaste
Comments:
Yes 10/01/2013 Usefluorideproductsinadditiontotoothpaste
Comments:
Yes 10/01/2013 Usemouthwash
Comments:
Yes 10/01/2013 Drinkfluoridatedwater
Comments:
Yes 10/01/2013 Chewgum,eatcandyor"junkfood"
Comments:
Yes 10/01/2013 Weararetainerormouthappliance
Comments:
Yes 10/01/2013 Breathethroughyourmouth
Comments:
Yes 10/01/2013 Snoreexcessively
Comments:
TMDEvaluation
Yes 10/01/2013 Jaw,neck,ear,orfacialpain
Comments:
2 Printed:10/1/20133:07:06PM
DentalHistoryRecord
D1516,Training(488)
10/1/2013
2177(DentalHistoryRecord)
Yes 10/01/2013 Noisesinthejawjoint
Comments:
Yes 10/01/2013 Clenchingorgrindingofteeth
Comments:
Yes 10/01/2013 Bitechangesorproblems
Comments:
Yes 10/01/2013 Difficultychewingorchewingmostlyononeside
Comments:
Yes 10/01/2013 Lockingofjawjointopenorclosed
Comments:
Yes 10/01/2013 FURTHERTMDEXAMlNATlONORREFERRALlS
lNDlCATED
Comments:
3 Printed:10/1/20133:07:06PM

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