Patient name ____________________________________________ date___________________

PATIENT NAME ____________________________________________ DATE___________________
Primary reason for this dental appointment
Do you have a specific dental problem? __________________________________________________________________ Do you have dental examinations on a routine basis? Last visit_______________________________________________ Do you think you have active decay or gum disease?_______________________________________________________ Do you brush and floss on a routine basis?__________________________________________________________________ Do your gums ever bleed? Discuss__________________________________________________________________________ Do you like your smile? Why________________________________________________________________________________ Yes No Does food catch between your teeth?Any loose teeth?_____________________________________________________ Do you want to keep your remaining teeth?________________________________________________________________ Do you ever have clicking, popping or discomfort in the jaw joint?___________________________________________ Have your past experiences in a dental office always been positive?________________________________________ Do you smoke or chew? Any sores or growths in your mouth? Discuss________________________________________ Name of Previous Dentist(optional)_________________________________________________________________________ Date of last full mouth x-rays (16 small films or panoramic):___________________________________________________ Are you under a physician’s care now?Why_________________________________________________________________ Yes No y Have you ever been hospitalized or had a major operation? Discuss _________________________________________ Yes No Have you ever had a serious injury to your head or neck? Discuss____________________________________________ Are you taking any medications, pills or drugs? What?_______________________________________________________ Yes No Are you on a special diet? Discuss__________________________________________________________________________ Are you allergic to any medications or substances? Please check below _____________________________________ Have you ever taken bisphosphanate medication(such as Actonel, Aredia, Boniva, Fosamax, Zometa, Bonefos, Ostac, Skelid, Didronel) ___________________________________________________________________________ Do you now have or have you ever had any of the following? Please check appropriate boxes. *If yes to any of the starred conditions, please call prior to your appointment… premedication may be required Have you ever had any other serious il ness not checked above? Discuss ________________________________________Yes No Do you wish to talk to the dentist privately about any problem? __________________________________________________Yes No To the best of my knowledge, all of the preceding answers are correct. If I have any changes in my health status or if my medicines change, I shall inform the dentist and staff at the next appointment without fail. X ________________________________________________________________________________ Date _____________________________ Reviewed by Doctor______________________________________________________________ Date ______________________________ History Review and Significant Findings: ________________________________________________________________________________ ______________________________________________________________________________________________________________________ ______________________________________________________________________________________________________________________ DENTAL AND MEDICAL HISTORIES


Microsoft word - sammanfattning studier alfa - eng.doc

Studies including alpha-hemolytic streptococci The scientists Eva Grahn Håkansson, Kristian Roos and Stig Holm and others have spent many years studying the naturally occurring bacteria and their health benefits in the throat. In several clinical trials they have shown that it is possible to decrease the risk of recurrence of tonsillitis and otitis after antibiotic treatment by strengthe

Microsoft word - fö - sammanfattning strukturerat omh 131011_v4

STRUKTRURERAT OMHÄNDERTAGANDE För tredje året i rad arrangerades ett symposium kring strukturerat omhändertagande vid förmaksflimmer. Mötet var välbesökt med många givande föreläsningar. Nedan följer ett kort referat av innehållet i respektive programpunkt. Ytterligare material från mötet kan beställas på Program fredag 11 oktober 2013

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