Check all that apply
- Have you ever had braces?
- Do you have grating, clicking, or popping sounds in either or both jaw joints when you open your mouth or chew?
- Do you have sensation of stuffiness, pressure or blockage in your ears?
- Do your ears produce excessive wax?
- Do you ever have a ringing, roaring, hissing or buzzing sound in your ears?
- Do you ever feel dizzy or faint?
- Is your jaw painful or locked when you get up in the morning?
- Are you ever nauseated for no apparent reason?
- Do you fatigue easily or consider yourself chronically fatigued?
- Are there imprints of your teeth on the side of your tongue?
- Does your tongue go between your front teeth when you swallow?
- Do your fingers sometimes for numb for no reason?
- Do you have pain or soreness in any of the following areas (please circle); jaw joints, upper jaw or teeth, lower jaw or teeth, side of neck, back of head, forehead, behind eyes, temples, tongue or chewing muscles?
- Is it hard to move your jaw from side to side, or forward and back?
- Do you have difficulty in chewing your food?
- Do you have any missing back teeth?
- Have you had any extensive dental crowns and bridgework?
- Do you clench your teeth during the day or night?
- Do you grind your teeth at night?
- Do you ever awaken with ah headache?
- Have you ever had a whiplash injury?
- Have you ever worn a cervical collar or had neck traction?
- Have you ever experienced a blow to the chin, face or head?
- Have you reached the point where prescription drugs no longer relieve your symptoms?
- Does chewing gum start your symptoms?
- Is it painful, or is there soreness, when you press on your jaw joints or on the cheek just below them?
- Is it painful to stick you little finger in to your ears with your mouth open wide an then close your mouth while pressing forward with those fingers? (It sounds strange, but try it.)
- Does your jaw deviate to the left or right when you open wide?
- Are you unable to comfortably insert you first three fingers vertically into your mouth when it is opened wide?
On a pain scale of 0-10, 10 being the worse pain you have ever experienced with this problem, where are you now?
Complete Comfort = 0, 1, 2, 3, 4, 5, 6, 7, 8, 9, 10 = Severe Pain
If you checked four or more of the above and are experiencing a pain level of five or higher, you may be suffering from TMJ dysfunction. Call 604-541-1800 consult with Dr. Willoughby about this disorder.