Abnormal swallowing (tongue thrust)?
Angina, arteriosclerosis, stroke or heart attack?
Anemia, prolonged bleeding or excessive bruising?
Arthritis or joint problems?
Asthma, sinus problems, hayfever?
Bleeding gums, bad taste or mouth odor?
Birth defects or hereditary problems?
Bone fractures or major injuries?
Cancer, tumor, radiation treatment or chemotherapy?
Chest pain, shortness of breath, tire easily, swollen ankles?
Diabetes or low blood sugar?
Do you eat a well-balanced diet?
Food impaction between the teeth?
Frequent ear infections, colds, throat infections?
Frequent headaches or migraines?
Gonorrhea, Syphilis, Herpes, other Sexually Transmitted Disease?
Heart defects, heart murmur, rheumatic heart disease?
Hepatitis, jaundice, or liver disease?
High or low blood pressure?
History of eating disorder (anorexia, bulemia)?
History of Osteoporosis?
HIV or AIDS?
Immune system problems?
Injury to face, head, or neck?
Kidney problems?
Mental health disturbance or depression?
Polio, Mononucleosis, Tuberculosis, Pneumonia?
Ringing in ears, difficulty in chewing or opening jaw?
Seizures, fainting spells, neurological problem?
Skin disorder (other than common acne)?
Stomach ulcer, hyperacidity, acid reflux?
Thyroid or endocrine problems?
Tonsil or adenoid condition?
Vision, hearing, or speech problems?
Have you ever taken intravenous bisphosphonates such as Zomela (zolendromic acid), Aredia (pamidronate) or Didronel (etidronate) for bone disorders or cancer?
Have you ever taken oral bisphosphonates such as Fosomax (alendronate), Actonel (ridendronate), Boniva (ibandronate), Skelid (tiludronate) or Didronel (etidronate) for any disorder?