TMJ Questionnaire

Fill out our below form and click the "Score Quiz" button to view our recommendations.

Do you feel you have any problems with your joints?

Yes

Pain Symptoms

Do you get "tension headaches"?	Yes	No
Do you get "migraine headaches"?	Yes	No
Do you frequently have neck aches or stiff neck muscles?	Yes	No
Do you have trouble sleeping soundly?	Yes	No
Have your teeth been sore upon awakening?	Yes	No
Does your jaw ache when you chew?	Yes	No
Do you have ear pain?	Yes	No
Do your jaws ache when you open wide?	Yes	No
Have you ever had chronic shoulder or back pain?	Yes	No
Do you get headaches in right or left temple areas?	Yes	No
Do you get headaches in the back of your head?	Yes	No

Trauma or Accidents

Have you had a severe blow to the head or jaw?		Yes			No
Any whiplash neck injuries?		Yes			No

Jaw Joint Symptoms

Does your jaw feel tired after a big meal?	Yes	No
Do you ever get dizzy?	Yes	No
Do you ever feel faint?	Yes	No
Do you ever feel nauseated (sick)?	Yes	No
Is there a family history of jaw joint (TMJ) problems?	Yes	No

Ear and Eye Symptoms

Do you have itchiness or stuffiness in either ear?	Yes	No
Do you suffer from any loss of hearing?	Yes	No
Do you get pain in, around or behind either eye?	Yes	No
Are there times when your eyesight blurs?	Yes	No
Have you ever worn ear tubes?	Yes	No

Have you received any treatment for your jaw joint?

Yes

Do you grind your teeth when asleep?

Yes

Are your jaws tired when you awaken from sleep?

Yes

Are your symptoms worse

How often do you take medicine for relief of pain?

Have you ever been involved in any serious accidents, such as a car accident?

Yes

Do you feel or hear a "clicking" or "popping" noise from either jaw joint?	Yes	No
Has your jaw ever locked where you were unable to open or close?	Yes	No
Have you ever had pain in either jaw joint?	Yes	No

Do you have any pain in your ears?	Yes	No
Do you hear ringing, buzzing, or hissing sounds in either ear?	Yes	No
Do you hear grating noises in ears? (like sand particles rubbing)	Yes	No

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