temp 5275

15. Date ot last dental visit Phone Moderately YES a a a a a a Hard Extremel¥— NO a a a a 16. Have you ever been treated for periodontal disease (gum disease, pyorrhea. trench mouth)? If so, when? 17. Do you have or have you ever had any of the following? MOUTH Loose teeth Sensitive to hot Sensitive to cold .. Sensitive to sweets . Sensitive ... ................
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