1. Do our gums bleed when you brush your teeth? | Yes | No |
2. Are your gums red, swollen or tender? | Yes | No |
3. Have your gums pulled away (receded) from your teeth? | Yes | No |
4. Is there pus between your teeth and gums when gums are pressed? | Yes | No |
5. Are your permanent teeth loose or separating? | Yes | No |
6. Is there a change in the way your teeth fit when biting? | Yes | No |
7. Is there a change in the way your partial dentures fit? | Yes | No |
8. Do you have persistent bad breath? | Yes | No |