Reason for Visit

Soft Tissue and Gums (Periodontal)

  • Do your gums bleed and/or are they painful when brushing of flossing?
  • Is there a history of gum disease in your family?
  • Have you frequently noticed an unpleasant taste in your mouth or bad breath?
  • Do you have spaces developing between your teeth and/or consistently get food caught between your teeth?
  • Have you ever had teeth become loose and/or do you have difficulty chewing or biting?

Hard Tissue and Teeth (Biomechanical)

  • Are your teeth sore on hot/cold/sweet, or when biting, or on touch?
  • Do you frequently eat or drink acidic or sweet foods?
  • Do you regularly chip/break teeth or fillings?
  • Do you have a dry mouth or any persistent swelling or ulcers in the mouth?

Jaw Joint & Bite (Functional)

  • Do you have clicking or pain in the jaw joint?
  • Do you get a tired jaw or sore teeth in the morning?
  • Do you clench or grind your teeth?
  • Do you have any gaps in your mouth that bother you?


  • Is there anything about the appearance of your teeth that you would like to change?
  • Have your teeth changed in the last 5 years? Become shorter/thinner or worn?
  • Have you ever had an upsetting dental experience?
  • Do you watch ‘Make-over’ TV programmes and wish that you could have the same result?
  • Do you like to smile in public?

Feel free to contact us now on (04) 472 5377 or (04) 472 7826.