New Patient Step 5

Ultrasmile/New Patient Step 5

Bite and jaw joint

Do you have any problems chewing gum?
YesNo

Do you have any problems chewing baguettes or other hard foods?
YesNo

Have your teeth changed in the last 5 years, become shorter, thinner or worn?
YesNo

Are your teeth crowding or developing spaces?
YesNo

Do you have more than one bite or do you clench (squeeze) to make your teeth fit together?
YesNo

Do you have any problems with sleep or wake up with an awareness of your teeth?
YesNo

Do you have problems with your jaw joint? (pain, sounds, limited opening, locking, popping)
YesNo

Do you have tension headaches or sore teeth?
YesNo

Do you wear or have you ever worn a bite appliance?
YesNo

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