Orthodontic Re-treatment Self assessment form

Kigo Dental - Self Assessment form for Orthodontic Re-treatment.

The following is a self-assessment to help you identify factors that may determine your need for orthodontic re-treatment. The assessment is meant to be informative but does not substitute for a comprehensive orthodontic evaluation by your dentist or orthodontist to determine your actual needs and condition.

Orthodontic Treatment

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

1. Does your teeth or smile look like this after treatment, or was it like this before treatment, got corrected after treatment, and has started looking like this again?

Yes No

2. Has your face started looking like this after treatment, or was it like this before treatment, got corrected after treatment, and has started looking like this again?

Yes No

3. Does your face look imbalanced, or does it not look symmetrical on both sides after treatment, or was it imbalanced before treatment, got corrected after treatment, and has started looking imbalanced again?
Yes No

4. Are you experiencing difficulty cleaning your teeth due to irregularity in your teeth? Or Does food get stuck in between your teeth?
Yes No

5. Do you have speech problems like lisping, unclear speech, or difficulty speaking or pronouncing certain sounds or words?
Yes No

6. Do you have problems with biting, chewing or swallowing?
Yes No

7. Do you have the habit of biting your cheeks? Does your cheek gets accidentally bitten at times?
Yes No

8. Do you have the habit of breathing through your mouth or other breathing or sleeping disorders like sleep apnea?
Yes No

9. Do you have the habit of thumb sucking, tongue thrusting, or lip biting?
Yes No

10. Do you forcefully close your lips or mouth to avoid showing your teeth or smile? Do you consciously smile or talk less on occasions due to your smile consciousness?
Yes No

11. Has anyone ever told you that your mouth stays open or you snore while sleeping?
Yes No

12. Are you dissatisfied with the previous orthodontic treatment, or have the teeth started returning to their previous position?
Yes No

13. Have you started experiencing any pain or discomfort in your jaw, neck or face, such as headaches or clicking/popping sounds when opening or closing your mouth?
Yes No

14. Have you had a dental injury or trauma that affected the alignment or position of your teeth?
Yes No

15. Do you position your head and neck forward or backwards to camouflage your jaw discrepancies?
Yes No

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Note: Please note that this self-assessment form does not intend to provide a definitive diagnosis if you have malocclusion or jaw growth discrepancies, or other health conditions; it is designed to give you approximate knowledge about malocclusion and jaw growth discrepancies so that you can get appropriate consultation. Consulting with a qualified healthcare professional is mandatory to get a definitive diagnosis.

Orthodontic Re-treatment Self assessment form

Kigo Dental - Self Assessment form for Orthodontic Re-treatment.

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