Self Assesment form for Jaw growth corrections in children

Kigo Dental - Self Assessment form for Need for myofunctional treatment or to identify jaw growth problems in children

The following is a self-assessment to help you identify factors that may put your child at risk of developing or having jaw growth discrepancies. The assessment is meant to be informative but does not substitute for a comprehensive orthodontic evaluation by your dentist or orthodontist to determine your actual risk and condition.

Dental Health Risk Assessment

Be sure to answer all the questions honestly to obtain an accurate score.

1. Does your child's face look like this?

Yes No

2. Does your child's teeth look like this?

Yes No

3. Does your child's face look imbalanced, or does it not look symmetrical on both sides?

Yes No

4. Does the child have speech problems like lisping or unclear speech, any difficulty speaking or pronouncing certain sounds or words?
Yes No

5. Does the child have problems with biting, chewing or swallowing?
Yes No

6. Does the child have the habit of biting cheeks?
Yes No

7. Does the child have a habit of breathing through the mouth & get frequent sinus infections or other breathing or sleeping disorders?
Yes No

8. Does the child have a habit of thumb sucking, tongue thrusting or lip biting?
Yes No

9. Does the child forcefully close their lips & mouth, or does their lips & mouth stay open?
Yes No

10. Does any of the siblings, parents, grandparents or siblings of parents have these problems?
Yes No

11. Does the child sleep with their mouth open, snore, grind teeth, or clench their jaw during sleep?
Yes No

12. Does the child experience any pain or discomfort in the jaw, neck or face, such as headaches or clicking/popping sounds when opening or closing the mouth?
Yes No

13. Has the child ever had a dental injury or trauma that affected the alignment or position of teeth?
Yes No

14. Does the Child experience any emotional and social problems like low self-esteem, anxiety, and social isolation (bullying in school)?
Yes No

15. Does the child position their head and neck forward or backwards to camouflage their jaw discrepancies?
Yes No

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Please note that this self-assessment form does not intend to provide a definitive diagnosis if your child has jaw growth discrepancies or other health conditions; it is developed to give you approximate knowledge about your child’s jaw growth discrepancies so that your child can get appropriate consultation. Consulting with a qualified healthcare professional is mandatory to get a definitive diagnosis.

Self Assesment form for Jaw growth corrections in children

Kigo Dental - Self Assessment form for Need for myofunctional treatment or to identify jaw growth problems in children

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