Dental History Form

Your Mouth Works Hand in Hand with Your Body

Dental care is just one part of total health care. Because of that, we need to keep current with your entire health history, the good and the bad. Be sure to tell us if you…

  • have experienced any new allergies or sensitivities
  • have quit smoking (or started)
  • are taking any new medications, even over-the-counter drugs
  • have had any accidents or injuries
  • have been diagnosed with any illness or other medical condition
  • have had a baby

We may need to use an alternative local anesthetic, for example, or to administer an antibiotic before treatment, depending on what you tell us.

In turn, we’ll alert you to possible problems for you to discuss with your physician. Over 40 serious diseases—including bulimia, tumors and diabetes—can be detected in the mouth. The texture, color and condition of your tongue and gums give us clues to high blood pressure or osteoporosis.

That’s why we encourage you to make at least two dental appointments every year, especially if you don’t get annual physical exams. We’re here to make sure your teeth stay in great shape, along with the rest of your body.