• Holistic Dental Advisors

    Toxicity Survey

  • Fluoride

  • Is it in your water?
  • Is it in your toothpaste?
  • Is it in your mouthwash?
  • Is it in your treatment at the dentist?

  • Mercury

  • Do you have silver / mercury fillings?
  • Have you ever had silver / mercury fillings in the past?

  • Root Canals

  • Do you have teeth that have a root canal?
  • Have you ever had a root canal?

  • Metals

  • Do you have metals of any kind in your mouth?
  • Do you have any crowns with metal?
  • Do you have any partial dentures with metal?

  • Missing Teeth

  • Do you have missing teeth?

  • Implants

  • Do you have implants?*
  • If yes, are the implants titanium or metal?
  • If yes, are the implants zirconium or ceramic?

  • General

  • Do your gums bleed easily?
  • Do you have stained teeth?
  • Do you have bad breath?
  • Are your teeth sensitive to hot or cold?

  • Your info

  • Format: (000) 000-0000.
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