Capital Prosthodontics

Please tick the applicable conditions

Do you visit the dentist regularly?

Yes No

Do you have any abnormal reaction with dental injections?

Yes No

Are you a mouth breather?

Yes No

Have you had gum treatment in the past?

Yes No

Do you gums bleed?

Yes No

Have you noticed any loose teeth?

Yes No

Have you noticed any odours or bad taste?

Yes No

Do you clench/grind you teeth?

Yes No

Do you experience any pain in the jaw joints?

Yes No

Do you have any pain/discomfort in your mouth?

Yes No

Have you had abnormal bleeding after extraction?

Yes No

Have you had orthodontic treatment?

Yes No

Do you wear a denture/plate?

Yes No

Do you floss everyday?

Yes No

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