Dental History Have you ever had serious trouble during previous dental treatments? YesNo Have you ever had sores on your lips or mouth that are slow to heal? YesNo Are you allergic to latex? YesNo Are you a smoker/tobacco user? YesNo Are you dissatisfied with the appearance of your teeth? YesNo Do you have difficulty in chewing your food? YesNo Have you ever had injuries to your face or jaw? YesNo Do your jaws “pop” or “lock” when opening your mouth wide? YesNo Do you have pain or discomfort now? YesNo Do you wear dentures/partials? YesNo Do you sleep with your denture? YesNo Please leave this field empty.