Dental History

Dental care

Head injury

Single choice

Have you ever had a serious injury to your head or mouth?

🔘 Yes

🔘 No

🔘 Don't know

note

Serious head and mouth injuries occur as a result of trauma to the head, face and mouth resulting in serious injuries such as fractures of the jaws and facial bones, avulsions and luxation injuries of the teeth, as well as injuries to the temporomandibular joint.

These injuries, caused in the past, can lead to permanent damage to the teeth and jaws, and their consequences are very important in dental diagnosis.

Orthodontic treatment

Single choice

Have you ever had orthodontic treatment?

🔘 Yes

🔘 No

🔘 Don't know

note

Have you ever used mobile or fixed orthodontic appliances to correct malocclusion or tooth position?

Information on previous orthodontic therapy is of great importance in the evaluation of the current state of occlusion and the diagnosis of certain conditions that may occur as a result of orthodontic treatment.

Removable dental appliance

Single choice

Do you wear removable dental appliances?

🔘 Yes

🔘 No

🔘 Don't know

note

Information on wearing removable dental appliances such as complete and partial dentures or nightguards is useful in diagnosing certain conditions that may occur as a result of their use, for example, mechanical irritation, ulceration and denture stomatitis.

Dental treatment problem

Single choice > Short text

Have you had a serious/ difficult problem associated with any previous dental treatment?

🔘 Yes > short text

🔘 No

🔘 Don't know

note

Complications related to dental treatment may occur during and after treatment. Complications during the dental treatment include: allergic and toxic reaction to the local anesthetic, injuries to the teeth, soft tissues and jaws, fractures of instruments and needles, as well as bleeding. Complications after dental treatment include: pain and swelling, dry alveoli, bleeding, osteomyelitis and osteonecrosis of the jaw.

Knowing the complications associated with previous dental treatments may be of diagnostic value.

Last dental exam

Date 📆 (MM.YYYY)

When was your last dental exam?

note

The answer to this question gives insight into the regularity of attendance for dental care and the patient’s attitude towards dental professionals and towards treatment. The answer to this question gives insight into recent dental problems.

Last dental procedure

Multiple choice > Short text

What dental procedure was done at that time?

⬜️ Dental examination

⬜️ Teeth cleaning

⬜️ Filling

⬜️ Root Canal Treatment

⬜️ Teeth scaling

⬜️ Crown, bridge or veneers

⬜️ Something else > short text

note

The answer to this question gives insight into the most recent dental problems that the patient had.

Last xrays

Date 📆 (MM.YYYY)

When was the last time you took dental x-rays?

note

The answer to this question provides the information necessary to determine the diagnostic value of existing x-rays and whether there is a need for new images.

Teeth appearance

Single choice

How do you feel about the appearance of your teeth?

🔘 Satisfied

🔘 Mostly satisfied

🔘 Mostly unsatisfied

🔘 Unsatisfied

note

The answer to this question provides information about the patient's satisfaction with the appearance of his teeth.