Dental Health History Form

Dental health is also called oral hygiene and it is as important as any other organ of the body. Our digestive tract begins from the oral cavity and digestion starts right from the teeth and tongue and the enzymes are produced to digest the food we eat through the mouth.

So, the oral cavity has a primary and first function in the digestion of food. Since the oral cavity keeps food for quite a time, it really requires a proper hygiene routine for better function and to avoid problems related to the oral cavity.

Components of the oral cavity

An oral cavity does not only include the teeth but also consists of gums, gingiva, and the mucosal membrane with underlying muscles in the buccal cavity, tongue, and its muscles, palate, oropharynx, and some glands of the oral cavity and pharynx. All the organs are important in digestion and their hygiene and cleanliness are very important for the longevity of the teeth and a beautiful smile for long.

Dental health history

For all the reasons listed above, it is important for a dentist to know the status of oral hygiene. For this, he has to ask a couple of questions in the form of history to know what is affecting oral hygiene and what can be done to avoid it.

How to take a dental health history

  1. Like any other history sheet, dental health history begins with the personal information of the patient. This includes name, age, sex, date of birth, contact number, address, occupation, and email address.
  2. Then we have to ask if he is taking any medications for any medical disorder or any sort of vitamins or drugs in any form.
  3. History of allergies is also asked for future reference because definitely, the doctor does not want to prescribe any medicine patient is allergic to.
  4. If the patient is female, we have to know her marital status and if she is pregnant or a nursing mother. We are interested to know this because we do avoid many drugs in pregnancy and certain drugs in nursing mothers.
  5. Any history of drug abuse or alcoholism is also asked and its frequency is also asked. This is because oral hygiene is really badly affected by smoking and alcoholism.
  6. The level of activity of the patient coming into a dental clinic is also inquired about and mentioned in the history sheet with complete details.
  7. Now we start asking the questions related to dentistry.
  8. We are interested to know any pain in the teeth, bleeding gums, sensitivity to any stimulus, headaches, earaches, aching, clicking, and tired jaws.
  9. We also ask them if they are suffering from a clenched jaw, teeth grinding and what are their eating and brushing habits.
  10. The frequency of brushing is inquired along with flossing.
  11. If the person is a smoker, we ask him what kind of smoking he is into. Also, any habit of chewing is also asked.
  12. His past history of trauma t the head, face, and neck are asked if he underwent any sort of surgery on the head and neck.
Dental health history form
Dental health history form
Sample form provided by

Simi Karton

Dr. Simi Karton currently resides in Los Angeles with her husband. This website is a voluntary work of Dr. Karton to provide people with useful health-related information with a straightforward approach.

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