Abnormal swallowing (tongue thrust)?
Apprehensive about dental care?
Bad taste or mouth odor?
Bleeding gums?
Chipped or injured permanent teeth?
Clench or grind teeth?
Discomfort from teeth or gums?
Fluoride treatments?
Frequent canker sores or cold sores?
Frequent headaches?
Have wisdom teeth been removed?
Injury to face, jaw, teeth, or mouth?
Jaw fractures, cysts, or mouth infections?
Mouth breathing?
Oral habits (thumb or finger sucking, lip or nail biting)?
Other periodontal (gum) problems?
Pain, tenderness, or noise in either jaw?
Problems with food trapped between teeth?
Snores during sleep?
Speech problems or therapy?
Teeth sensitive to hot or cold?
Teeth that irritate tongue, cheek, lip, etc?
Thumb or finger habit as a child?
Is all dental work completed at this time?