Adult Patient Form

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Patient Information

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Insurance Information

Dental History

Gum and Bone health

Gum disease has been linked with an increased risk for many chronic diseases. Eliminating gum disease is especially important to the oral and overall health of the following patients:

Tobacco User

Tobacco users are more likely to develop gum disease which is more severe and more difficult to eradicate. Gum disease has recently been linked with an increased risk for heart disease

Diabetes

Diabetes is well-known risk factor for gum disease. Research is confirming that when left untreated, gum disease makes it harder to control blood sugar. Elimination of gum disease can improve the blood sugar control, reducing the risk for the serious complications.

Family history of gum disease

Some people are genetically prone to developing gum disease even if they take decent care of their mouths.

Stress

Stress is a well-known risk factor for gum disease.life altering events (loss of job, death in family,moving,etc) can be particularly strong factors for gum disease.

Rheumatoid Arthritis

If you have arthritis you are at an increased risk for gum disease. Emerging research suggest that eliminating gum disease and then keeping it at bay can lessen the crippling effects of arthritis.

Cosmetic concerns

Medical History

(Women)

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