Headache History
yes no dk/ u Any pain in jaw or ringing in the ears? yes no dk/u Any pain or soreness in the muscles of the face or around the ears? yes no dk/u Difficulty encountered in chewing or jaw opening? yes no dk/u Aware of loose, broken or missing restorations (fillings)? yes no dk/u Any teeth irritating cheek, lip, tongue or palate? ................
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