apelgrendental.com-Dental and Health History

Apelgren Dental
3938 Cedar Grove Pkwy.
Eagan, MN 55122
651-452-9660

DENTAL AND HEALTH HISTORY
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DENTAL HISTORY
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Bad breathBleeding gumsClicking or popping jawFood collection between teethSores/growths in your mouthGrinding teethLoose teethPeriodontal treatmentBroken fillingsPrevious orthodontics (braces)Sensitivity to hotSensitivity to sweetsSensitivity to bitingSensitivity to cold
MEDICAL HISTORY
AnemiaArthritisArtificial heart valveArtificial jointsAsthmaBleeding disorderCancerChemical dependencyChemotherapyCortisone treatmentsCoughDiabetesEpilepsyHeadachesHeart murmurHeart problemsHemophiliaHepatitisHigh blood pressureHIV/AIDSJaw painKidney diseaseMitral valve prolapsePacemakerPregnantRadiationRheumatic feverShortness of breathSinus problemsSkin conditionStomach problemsStrokeThyroid problemTobacco useUlcerOther
ALLERGIES
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AspirinCodeineDental AnestheticPenicillinSulfaLatexOther
MEDICATIONS
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