Dental Health History Form

Dental health is also called as oral hygiene and it is as important as any other organ of the body. Our digestive tract begins from the oral cavity and the 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 the food. Since the oral cavity keeps food for quite a time, it really requires proper hygiene routine for better function and to avoid the problems related to the oral cavity.

Components of oral cavity

Oral cavity does not only include the teeth but it also consists of gums, gingiva, 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 the oral hygiene and what can be done to avoid it.

How to take dental health history

  1. Like any other history sheet, dental health history begins with the personal information of the patient. This includes name, age, and 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. Level of activity of the patient coming into a dental clinic is also inquired 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, and aching, clicking and tired jaws.
  9. We also ask them if they are suffering from the 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 head, face and neck are asked and if he underwent any sort of surgeries of head and neck.
Dental health history form
Dental health history form
Sample form provided by

Simi Karton

Simi Karton is a regular contributor to National Science Quarterly and an enthusiastic Lakers fan. She recently collaborated on a manuscript with friends and colleagues. Dr. Simi Karton, entitled Parkinsons and the Genetic Response to Eastern Medicine, in which she and Dr. Inshal presented research compiled during a summer spent in United States. She 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 stuff at an easy approach. The information has been collected from different sources at one place.

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