Dental Pain Assessment Checklist
Patient Name:
Date:
Location of Pain:
Pain Severity (0-10):
Onset:
Sudden
Gradual
Pain Duration:
Character of Pain:
Sharp
Dull
Throbbing
Intermittent
Constant
Aggravating Factors:
Relieving Factors:
Associated Symptoms:
Swelling
Bleeding
Fever
Difficulty Opening Mouth
Other
Comments / Notes: