Select the option that best describes the problem.
Broken or cracked
The denture is broken, cracked, or has visible damage
Missing tooth or teeth from the denture
One or more teeth are missing or loose from the denture
Denture falls out or will not stay in
The denture is loose, falls out, or will not stay in place (acrylic dentures only)
Pain, ulcers, or pinching
The patient is experiencing pain, sore spots, ulcers, or pinching
Difficulty chewing / worn denture
The patient has trouble chewing or the denture teeth appear worn
Denture looks very old or poorly maintained
The denture appears aged, stained, or poorly maintained
