Replacement of Dental Crown / Bridge Assessment Form

Kigo Dental - Self Assessment form for the need for correction/replacement of dental crown or bridge.

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

Crown & Bridge Dental 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. Have you noticed any pain, discomfort, swelling or redness around the area where the crown or bridge is located?
Yes No

2. Have you noticed any changes in the appearance of your crown or bridge, such as discolouration, chipping, or cracking?
Yes No

3. Have you experienced any difficulty eating or speaking due to your crown or bridge?
Yes No

4. Have you noticed any sensitivity to hot or cold temperatures around the area where the crown or bridge is located?
Yes No

5. Have you experienced any loosening of the crown or bridge? Are you concerned about the fit or appearance of your crown or bridge?
Yes No

6. Have you noticed any bad taste or odour coming from around the crown or bridge?
Yes No

7. Have you had any recent trauma or injury to the area where the crown or bridge is located?
Yes No

8. Have you experienced difficulty flossing or cleaning around the area where the crown or bridge is located?
Yes No

9. Have you experienced difficulty biting down or chewing on the side where the crown or bridge is located?
Yes No

10. Have you noticed any changes in your bite or how your teeth fit together since getting the crown or bridge?
Yes No

11. Have you experienced difficulty speaking clearly or pronouncing words since getting the crown or bridge?
Yes No

12. Have you had any issues with food getting stuck around the crown or bridge?
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 dental crowns or bridges or other health conditions; it is developed to give you approximate knowledge about the need for correction or replacement of dental crowns or bridges so that you can get appropriate consultation. Consulting with a qualified healthcare professional is mandatory to get a definitive diagnosis.

Replacement of Dental Crown / Bridge Assessment Form

Kigo Dental - Self Assessment form for the need for correction/replacement of dental crown or bridge.

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