(416) 538-8883
415 Bloor Street West Suite 300
Toronto, Ontario M5S 1X6

TMJ Self-Assessment Questionnaire

Here are a few questions you may want to ask yourself, to help determine if you have any symptoms:

Do you get an unusual amount of headaches? YES NO
Do you have a grating, clicking or popping sound in either or both jaw joints, when you chew or open and close your mouth? YES NO
Do you have pain or soreness in any of the following areas: jaw joints, upper jaw, lower jaw, side of neck, back of head, forehead, behind the eyes or temples? YES NO
Do you have sensations of stuffiness, pressure or blockage in your ears? Is there excessive wax buildup? YES NO
Do you ever have ringing, roaring, hissing or buzzing sounds in your ears? YES NO
Do you ever feel dizzy or faint? YES NO
Do your fingers, hands or arms sometimes tingle or go numb? YES NO
Are you tired all the time, fatigue easily or consider yourself chronically fatigued? YES NO
Are there imprints of your teeth on the sides of your tongue? YES NO
Does your tongue go between your teeth when you swallow? YES NO
Do you have difficulty in chewing your food? YES NO
Do you have any missing back teeth? YES NO
Do you clench your teeth during the day or at night? YES NO
Do you grind your teeth at night? (Ask your family.) YES NO
Do you ever awaken with a headache? YES NO
Have you ever had a whiplash injury? YES NO
Have you ever experienced a blow to the chin, face or head? YES NO
Have you reached the point where drugs no longer relieve your symptoms? YES NO
Does chewing gum worsen your symptoms? YES NO
Is it painful to stick your "pinky" fingers into your ears with your mouth open wide and then close your mouth while pressing forward with your "pinky" fingers? YES NO
Does your jaw slide to the left or right when you open wide? (Look in a mirror.) YES NO
Are you unable to insert your first three fingers vertically into your mouth when it is open wide? YES NO
Is your face crooked and not symmetrical? YES NO

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