Dentures Replacement Assessment Form

Kigo Dental - Self Assessment form for the need for correction/replacement of dentures.

The following is a self-assessment to help you identify factors that may determine your need for correction/replacement of dentures. The assessment is meant to be informative but does not substitute for a comprehensive dental evaluation by your dentist to determine your actual needs and condition.

Aligners Assessment

Be sure to answer all the questions honestly to obtain an accurate score. Hereafter "you" can be related to you, or any person in need of taking this test.

1. Have you noticed any of the following symptoms?

A. Difficulty chewing or biting
B. Sore or irritated gums
Yes No

2. Have you experienced any of the following complications while wearing dentures?

A. Gum infection or inflammation
B. Bone loss in the jaw
Yes No

3. Are you experiencing pain or discomfort in the jaw or surrounding areas while wearing dentures?
Yes No

4. Have you been diagnosed with any dental or medical conditions that may affect the fit or wear of your dentures?
Yes No

5. How often do you wear your dentures?

All the time Mostly during the day Mostly at night Rarely or never

6. How long have you been using your current dentures?

Less than one year 1 to 5 years 5 to 10 years More then 10 years

7. Are your dentures cracked, broken, or chipped? Have you noticed any changes in the appearance of your dentures?
Yes No

8. Do your dentures feel loose or ill-fitting? Are you experiencing difficulty keeping dentures in place?
Yes No

9. Have you noticed any changes in the shape of your face or mouth?
Yes No

10. Are you experiencing difficulty speaking or pronouncing certain sounds or words while wearing dentures?
Yes No

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Note: Please note that this self-assessment form does not intend to provide a definitive diagnosis if you need correction or replacement of dentures or other health conditions; it is developed to give you approximate knowledge about the need for correction or replacement of dentures so that you can get appropriate consultation. Consulting with a qualified healthcare professional is mandatory to get a definitive diagnosis.

Dentures Replacement Assessment Form

Kigo Dental - Self Assessment form for the need for correction/replacement of dentures.

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