Please provide any specific comments about the lower teeth including staining, wear, fixed crowns or bridges, and broken teeth, condition of the supporting bone, retained roots, and evidence of gum disease or anatomical variations. ........................................................................................................................................................... ........................................................................................................................................................... ........................................................................................................................................................... Describe the injuries to the hard tissues (if present): ........................................................................................................................................................... ........................................................................................................................................................... ........................................................................................................................................................... Describe the injuries to the soft tissues (if present): ........................................................................................................................................................... ........................................................................................................................................................... ........................................................................................................................................................... Name of Examiner / Doctor: .................................................................... Signature of Examiner / Doctor: .................................................................... 87