Use this English–Japanese guide to complete dental forms, understand key terms, and feel confident at your Plano appointment.
Key Takeaways
- US dental forms ask detailed medical history questions that may differ from what you’re used to in Japan—accuracy is critical for your safety.
- This guide provides English–Japanese translations for common form fields, dental vocabulary, and appointment phrases to help you feel confident at Vitality Dental.
- You can download and print our bilingual cheat sheet to bring to your appointment, and our team is always ready to walk through any section with you.
Understanding consent forms and insurance terminology ensures you know exactly what treatment you’re receiving and what your coverage includes.
If you’ve recently moved to Plano or are visiting family in North Texas, the thought of navigating a US dental appointment in English might feel overwhelming. You’re not alone—and you have absolutely nothing to be ashamed of. Many of our patients at Vitality Dental speak Japanese as their first language, and we know that medical terminology can be challenging even when you’re fluent in everyday English.
This guide is designed to be your translator and confidence-builder. We’ll walk through the most common forms you’ll encounter at a US dental office, provide English–Japanese vocabulary for symptoms and procedures, and give you the phrases you need to communicate clearly with our team. Whether you’re scheduling your first cleaning or preparing for a more complex treatment, this resource will help you feel prepared, understood, and safe.
Why Understanding US Dental Forms Matters
Dental care in the United States follows different protocols than you may be accustomed to in Japan. American dental offices are required by law to collect detailed medical histories, obtain informed consent for procedures, and verify insurance coverage before treatment begins. When language barriers exist, three important things can get lost:
Your medical history might be incomplete. US dentists need to know about conditions like diabetes (糖尿病 / tounyoubyou), heart disease (心臓病 / shinzoubyou), and any medications you’re taking—especially blood thinners (抗凝固薬 / kougyouko-yaku). A missed detail can lead to complications during treatment or dangerous drug interactions.
Consent becomes unclear. Before any procedure beyond a basic cleaning, you’ll sign a consent form explaining the treatment, risks, and alternatives. If you don’t fully understand what you’re agreeing to, you may feel anxious or surprised by what happens during your appointment. We want you to feel confident and informed every step of the way.
Insurance confusion causes stress. The US dental insurance system is complex, and terminology like “deductible,” “copay,” and “maximum benefit” doesn’t always translate directly. Understanding these terms helps you know what you’ll pay out-of-pocket and avoid unexpected bills.
At Vitality Dental, we’re here to change that narrative. Our boutique, high-touch practice is designed to be the antidote to the cold, corporate dental clinic. We take the time to explain every form, answer every question, and make sure you feel comfortable before we begin any treatment. Your comfort is as important as your smile.
How to Fill Out Your Medical History Form
When you arrive for your first appointment at our Plano office on Coit Road, you’ll receive a medical history form (問診票 / monshin-hyou in Japanese medical settings). This is the most important document you’ll complete, because it tells us how to keep you safe during treatment.
Personal Information Section (個人情報 / kojin jouhou)
The top of the form asks for basic details:
- Full Name (氏名 / shimei): Write your name as it appears on your ID or insurance card. In the US, we typically write the given name first, then family name (e.g., “Yuki Tanaka”, not “Tanaka Yuki”).
- Date of Birth (生年月日 / seinengappi): Use the US format: Month/Day/Year (e.g., 03/15/1985).
- Address (住所 / juusho): Your current US address. If you’re staying temporarily, provide the location where you’re residing now.
- Phone Number (電話番号 / denwa bangou): Include your US mobile number so we can reach you for appointment reminders.
- Emergency Contact (緊急連絡先 / kinkyuu renrakusaki): Name and phone number of someone we can call if needed.
Medical Conditions Checklist (既往歴 / kiourekki)
You’ll see a list of health conditions with checkboxes. Common terms you’ll encounter:
| English | Japanese | Notes |
| Diabetes | 糖尿病 (tounyoubyou) | Check “Yes” if you have Type 1 or Type 2 |
| High Blood Pressure | 高血圧 (kouketsuatsu) | Also called hypertension |
| Heart Disease | 心臓病 (shinzoubyou) | Includes heart attack history, arrhythmia, and heart valve issues |
| Asthma | 喘息 (zensoku) | Important for sedation planning |
| Liver Disease | 肝臓病 (kanzoubyou) | Affects how your body processes medications |
| Kidney Disease | 腎臓病 (jinzoubyou) | May require adjusted medication dosing |
| Arthritis | 関節炎 (kansetsu-en) | Includes rheumatoid arthritis |
| Thyroid Problems | 甲状腺疾患 (koujoussen shikkan) | Hyper- or hypothyroidism |
| Cancer | がん (gan) | Past or current; include type if comfortable sharing |
If you have a condition not listed, write it in the “Other” (その他 / sonota) section. Our team will review it with you.
Current Medications (服用中の薬 / fukuyou-chuu no kusuri)
List all medications you’re currently taking, including:
- Prescription medications (処方薬 / shohou-yaku)
- Over-the-counter supplements (サプリメント / sapurimento)
- Herbal remedies (漢方薬 / kanpou-yaku)
Critical for dental safety: If you take blood thinners like warfarin (ワーファリン), aspirin (アスピリン), or newer medications like Eliquis or Xarelto, we need to know before performing extractions or gum surgery. Bring your prescription bottles or a photo of the labels—US brand names may differ from Japanese ones.
Other important medications to mention:
- Bisphosphonates (骨粗鬆症治療薬 / kotsusoshoushou chiryouyaku): Used for osteoporosis; can affect jaw healing
- Steroids (ステロイド): May require special precautions
- Immunosuppressants (免疫抑制剤 / men-eki yokusei-zai): Used after organ transplants or for autoimmune conditions
Allergies (アレルギー / arerugii)
You’ll be asked about allergies to:
| English | Japanese |
| Penicillin / Antibiotics | ペニシリン / 抗生物質 (penishirin / kouseibusshitsu) |
| Local Anesthesia | 局所麻酔 (kyokusho masui) |
| Latex | ラテックス (ratekkusu) |
| Metals | 金属 (kinzoku) |
| Iodine | ヨード (yoodo) |
Important distinction: The form may ask if you’ve had a side effect (副作用 / fukusayou) versus a true allergic reaction (アレルギー反応 / arerugii hannou). Nausea from antibiotics is a side effect; hives or difficulty breathing are an allergy. Be specific about what happened.
Women’s Health Questions
If applicable, you’ll see questions about:
- Are you pregnant? (妊娠していますか? / ninshin shite imasu ka?) — We’ll avoid certain X-rays and medications if yes
- Are you nursing? (授乳中ですか? / junyuu-chuu desu ka?) — Some medications pass through breast milk
- Could you be pregnant? (妊娠の可能性はありますか? / ninshin no kanousei wa arimasu ka?) — We’ll take precautions if unsure
Understanding Your Consent Form
Before we begin any treatment beyond a routine cleaning, you’ll sign a consent form (同意書 / douisho). This document explains what we’re going to do, why we recommend it, and what risks you should know about.
What the Consent Form Includes
Procedure Name and Description
The form will state exactly what treatment you’re receiving. Common procedures:
| English | Japanese | What It Means |
| Filling | 詰め物 (tsumemono) | Repairing a cavity with composite resin or amalgam |
| Crown | クラウン / 被せ物 (kuraun / kabusemono) | A cap that covers a damaged tooth |
| Root Canal Therapy | 根管治療 (konkan chiryou) | Removing infected nerve tissue from inside the tooth |
| Extraction | 抜歯 (basshi) | Removing a tooth |
| Dental Implant | インプラント (inpuranto) | An artificial tooth root is surgically placed in the jawbone |
| Scaling / Deep Cleaning | スケーリング / 歯石除去 (sukeeringu / shiseki jokyo) | Removing tartar buildup below the gumline |
Risks and Complications
Every procedure has potential risks, and US law requires us to inform you of them. For example:
- Extractions may cause temporary numbness (しびれ / shibire), dry socket (ドライソケット / dorai soketto), or rarely, nerve damage (神経損傷 / shinkei sonshou).
- Root canals can occasionally require retreatment if infection persists.
- Crowns may need adjustment if the bite feels uneven.
These risks are rare, and we take every precaution to prevent them. But informed consent means you understand what could happen, not just what we expect.
Alternative Treatments
The consent form should mention other options. For example:
- If we recommend an implant, alternatives might include a bridge (ブリッジ / burijji) or denture (入れ歯 / ireba).
- If we suggest a root canal, the alternative is often extraction.
Your Right to Ask Questions
Before you sign, we’ll ask: “Do you have any questions?” If anything is unclear, please ask us to explain in simpler terms or draw a diagram. You can even bring this guide to your first visit so our team can review it with you—we’re always ready to lend our patients a hand if they need it.
Navigating US Dental Insurance Information
The US dental insurance system can feel confusing, especially if you’re accustomed to Japan’s National Health Insurance (国民健康保険 / kokumin kenkou hoken). Here’s what you need to know.
Insurance Information Fields
When you fill out our new patient form, you’ll see a section asking for:
- Insurance Company Name (保険会社名 / hoken gaisha-mei): Examples include Delta Dental, Cigna, Aetna, MetLife
- Policy Number / ID Number (保険証番号 / hoken-shou bangou): Found on your insurance card
- Group Number (グループ番号 / guruupu bangou): Often provided by your employer
- Subscriber Name (被保険者名 / hi-hokensha-mei): The person whose name the policy is under (may be you or a family member)
Bring your insurance card to your first appointment. We’ll make a copy and verify your benefits before your visit. At Vitality Dental, we understand that dental insurance can be complicated to navigate, so we’ll be glad to offer complimentary insurance benefits advice. We want to take uncertainty out of the picture.
Key Insurance Terms (Explained in English and Japanese)
| English Term | Japanese Translation | What It Means |
| Premium | 保険料 (hokenryou) | The monthly amount you (or your employer) pay for coverage |
| Deductible | 控除額 (koujo-gaku) | The amount you must pay out-of-pocket before insurance starts covering costs |
| Copay / Copayment | 自己負担額 (jiko futan-gaku) | A fixed amount you pay at each visit (e.g., $25) |
| Coinsurance | 共同保険 (kyoudou hoken) | The percentage you pay after meeting your deductible (e.g., you pay 20%, insurance pays 80%) |
| Annual Maximum | 年間上限額 (nenkan jougen-gaku) | The maximum amount your insurance will pay in one year (often $1,000–$2,000) |
| In-Network | ネットワーク内 (nettowa-ku nai) | Dentists who have a contract with your insurance (lower cost to you) |
| Out-of-Network | ネットワーク外 (nettowa-ku gai) | Dentists without a contract (you may pay more) |
Vitality Dental accepts most major insurance plans, and we’re in-network with many providers. If you don’t have insurance, no problem—we offer in-house membership plans with clear pricing and benefits. Your dental treatment is affordable, and we’ll work with you to find a solution that fits your budget.
Essential Vocabulary for Your Appointment
When Dr. Kung or one of our team members asks about your symptoms, these phrases will help you communicate clearly.
Describing Your Symptoms (症状の説明 / shoujou no setsumei)
Types of Pain:
| English | Japanese | When to Use It |
| Throbbing pain | ズキズキする痛み (zuki-zuki suru itami) | Pulsing pain, often from infection |
| Sharp pain | 鋭い痛み (surudoi itami) | Sudden, stabbing sensation |
| Dull ache | 鈍い痛み (nibui itami) | Constant, low-grade discomfort |
| Sensitivity | 知覚過敏 (chikaku kabin) | Pain triggered by hot, cold, or sweet foods |
Common Symptoms:
- “My tooth hurts.” — 歯が痛いです (ha ga itai desu)
- “My gums are bleeding.” — 歯茎から血が出ます (haguki kara chi ga demasu)
- “I have a toothache.” — 歯痛があります (shitsuu ga arimasu)
- “My filling fell out.” — 詰め物が取れました (tsumemono ga toremashita)
- “I chipped my tooth.” — 歯が欠けました (ha ga kakemashita)
Pain Triggers:
- Cold drinks — 冷たい飲み物 (tsumetai nomimono)
- Hot foods — 熱い食べ物 (atsui tabemono)
- Sweets — 甘いもの (amai mono)
- When chewing — 噛む時 (kamu toki)
Common Dental Procedures
| English | Japanese |
| Cleaning / Prophylaxis | クリーニング / 予防処置 (kuriiningu / yobou shochi) |
| X-rays | レントゲン / エックス線 (rentogen / ekkusu-sen) |
| Fluoride Treatment | フッ素塗布 (fusso tofu) |
| Sealants | シーラント (shiiranto) |
| Tooth Whitening | ホワイトニング (howaitoningu) |
| Braces / Orthodontics | 歯列矯正 (shiretsu kyousei) |
| Invisalign | インビザライン (invizarain) |
| Dentures | 入れ歯 (ireba) |
| Veneers | ベニア (benia) |
Medications and Instructions
After your procedure, we may prescribe:
- Pain reliever — 鎮痛剤 (chintsuu-zai): Examples include ibuprofen (イブプロフェン) or acetaminophen (アセトアミノフェン)
- Antibiotic — 抗生物質 (kouseibusshitsu): Such as amoxicillin (アモキシシリン)
- “Take after meals” — 食後に服用 (shokugo ni fukuyou)
- “Three times a day” — 1日3回 (ichi-nichi san-kai)
Post-Treatment Instructions:
- Avoid hard foods — 硬い食べ物は避けてください (katai tabemono wa sakete kudasai)
- Don’t drink through a straw — ストローは使わないでください (sutoroo wa tsukawanai de kudasai) — important after extractions
- Apply ice — 氷で冷やしてください (koori de hiyashite kudasai)
- Rinse gently with salt water — 塩水で優しくうがいしてください (shio-mizu de yasashiku ugai shite kudasai)
What to Bring to Make Your Visit Easier
To help your appointment go smoothly, bring:
- Your insurance card (保険証 / hoken-shou) — or information about your plan if you’re still enrolling
- A list of your medications — including dosages; a photo of the bottles works too
- Your previous dental records — if you have X-rays or treatment history from Japan, we can request them, or you can bring copies
- A form of ID — driver’s license, passport, or state ID
- This vocabulary guide — print it out or save it on your phone
Helpful phrases for the front desk:
- “This is my first visit.” — 初めての来院です (hajimete no raiin desu)
- “I have an appointment at 2 PM.” — 午後2時に予約があります (gogo ni-ji ni yoyaku ga arimasu)
- “I’d like to schedule a cleaning.” — クリーニングの予約を取りたいです (kuriiningu no yoyaku wo toritai desu)
- “Do you speak Japanese?” — 日本語を話せますか? (Nihongo wo hanasemasu ka?)
While our team primarily communicates in English, we’re patient, understanding, and experienced at working with patients from diverse backgrounds. We’ll speak clearly, use simple terms, and make sure you understand every step of your treatment. If you’re feeling anxious, let us know—we offer different levels of sedation to help make our patients feel comfortable and relaxed.
Your Comfort Is As Important As Your Smile
At Vitality Dental, we know that visiting a new dentist in a new country can feel overwhelming. But you don’t have to navigate this alone. Our boutique, high-touch practice is designed to make every patient feel welcome, understood, and cared for—regardless of language or background.
We’re located right here on Coit Road in Plano, just south of W 15th Street, with plenty of free surface parking right in front of Suite 106. We serve patients from all over West Plano, East Plano, Allen, Richardson, and the surrounding communities, and we’ve helped hundreds of families—including many from Japan—restore their smiles, confidence, and ultimately improve their lives.
Ready to schedule your first appointment? Call us at (972) 573-5951 or book online. We’re open Monday through Friday, 7 AM to 3 PM, and we’re always ready to answer your questions. You can even bring this guide to your first visit so our team can review it with you.
We can’t wait to meet you. Your journey to a healthy, beautiful smile starts here—and we’ll be with you every step of the way.
Common Questions from Our Japanese-Speaking Patients
What if I don’t understand something on the form?
Leave it blank and ask us when you arrive. Our team will sit down with you and walk through each section. You can even point to this guide and say, “I need help with this part.” We’re here to help, not to rush you.
Is dental care in the US more expensive than in Japan?
Costs vary depending on the procedure and your insurance coverage. In general, US dental care can be more expensive than Japan’s National Health Insurance system, but most employers offer dental insurance that significantly reduces your out-of-pocket costs. At Vitality Dental, we’ll provide a detailed treatment plan with costs before we begin, and we’ll work with you to maximize your insurance benefits.
Can I bring a family member to translate?
Absolutely. Many of our patients bring a spouse, friend, or adult child to help interpret. We’ll speak slowly and clearly so your translator can keep up.
What if I need emergency dental care?
Call us right away at (972) 573-5951. We offer same-day appointments for dental emergencies like severe pain (激しい痛み / hageshii itami), broken teeth (折れた歯 / oreta ha), or knocked-out teeth (抜けた歯 / nuketa ha). Toothaches don’t wait for business hours, and neither do we.
How often should I visit the dentist in the US?
Most dental insurance plans cover two cleanings per year (6-month intervals). Regular checkups help catch problems early, when they’re easier and less expensive to treat. In Japan, you may have visited more frequently—US recommendations are similar, typically every six months unless you have gum disease or other concerns.
Do I need to bring anything from my dentist in Japan?
If you have recent X-rays (within the past year) or a treatment summary, bringing them can be helpful. We can often request records directly from your previous dentist if you provide their contact information. This helps us understand your dental history and avoid repeating unnecessary X-rays.
