Self Assessment form for TMJ disorders (TMD)

Kigo dental - Self Assessment form for TMJ Disorders (TMD)

The following is a self-assessment to help you identify factors that may put you at risk of developing or having Temporomandibular Joint Disorders (TMD). 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. Hereafter "you" can be related to you, your child, or any person in need of taking this test.

1. Do you experience pain or discomfort in your jaw joint or feel tightness or tension in your jaw muscles, especially when chewing, speaking, or opening your mouth wide?
Never Sometimes Always

2. Do you have difficulty opening your mouth wide, such as when yawning or eating a sandwich, or do you experience a sensation of locking or catching in your jaw joint when opening or closing your mouth?
Never Sometimes Always

3. Do you experience clicking, popping or grinding sounds in your jaw while chewing, speaking or opening & closing your mouth?
Never Sometimes Always

4. Do you clench or grind your teeth, especially during stressful situations or while you sleep? ( waking up irritated, uncomfortable feeling in your face or body after waking up is a symptom )?
Never Sometimes Always

5. Do you experience any neck or shoulder pain or stiffness? Do you experience tingling or numbness in your fingers or arms?
Never Sometimes Always

6. Do you experience pain or discomfort in your teeth or gums unrelated to dental problems?
Never Sometimes Always

7. Do you experience any pain or pressure in the ear or eye or around the ear or eye unrelated to any other medical condition?
Never Sometimes Always

8. Do you experience headaches or neck aches associated with any of the other symptoms mentioned here?
Never Sometimes Always

9. Do you experience any pelvic bone problems or problems in the spine or posture?
Never Sometimes Always

10. Do you experience dizziness or vertigo along with any of the other symptoms mentioned here?
Never Sometimes Always

11. Have you experienced any recent trauma or injury to your face or jaw? Have you been diagnosed with any medical conditions, such as arthritis or fibromyalgia?
Yes No

12. Have you been asked to consult a psychiatrist by any specialist to treat the above symptoms? (Note: This is for questionnaire purpose; TMJ Disorders (TMD) Treatment doesn't necessarily include Psychiatric therapy)
Yes No

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Note: Please note that this self-assessment form does not intend to provide a definitive diagnosis if you have concerns about TMJ disorders (TMD) or other health conditions. In that case, consulting with a qualified healthcare professional is mandatory.

Self Assessment form for TMJ disorders (TMD)

Kigo dental - Self Assessment form for TMJ Disorders (TMD)

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