Do I have it?

TMD Questionnaire

1. Do you have a grating, clicking or popping sound in either or both jaws when you chew? Yes or No

2. Do you have sensations of stuffiness, pressure or blockage, ringing, hissing, or buzzing in your ears? Yes or No

3. Do you ever feel dizzy or faint?  Yes or No

4. Is your jaw painful or locked when you wake up in the morning?  Yes or No

5. Do you consider yourself chronically fatigued?   Yes or No

6. Are you ever nauseated for no apparent reason? Yes or No

7. Do your fingers sometimes go numb?   Yes or No

8. Check any area where you have pain or soreness:

___ Jaw joints ___ Upper jaw or teeth ___ Back of head

___ Forehead ___ Lower jaw or teeth ___ Chewing muscles

___ Temples    ___ Side of neck           ___ Behind the eyes

___ Tongue

9. Is it hard to move your jaw side-to-side, forward or backward? Yes or No

10. Do you have difficulty chewing?   Yes or No

11. Do you have back teeth missing? Yes or No

12. Have you had extensive dental crowns and bridgework?    Yes or No

13. Do you clench your teeth during the day?   Yes or No

14. Do you grind your teeth at night? (Ask someone)  Yes or No

15. Do you ever have a headache when you wake up?  Yes or No

16. Have you ever had a whiplash injury?  Yes or No

17. Have you worn a cervical collar or had neck traction? Yes or No

18. Have you ever had a blow to the chin, face or head?  Yes or No

19. Have you reached the point at which drugs no longer relieve your symptoms?  Yes or No

20. Does chewing gum start up your symptoms?  Yes or No

21. Does your jaw deviate to the left or right when you open wide?  Yes or No

22. When your mouth is wide open, can you insert three fingers into your mouth vertically?  Yes or No


  1. Do you have pain in the Temporal Mandibular Joint (TMJ)?
  2. Do you have pain in your jaw muscles?
  3. Do you have toothaches?
  4. Do your ears frequently hurt, frequently feel stuffy, clogged, or ring?
  5. Does your jaw feel tired and ache after eating?
  6. Do you wake up with jaw pain, or headaches?
  7. Do you have pain in the neck or shoulder muscles?
  8. Do you have frequent headaches? 


  1. Do you grind or clench your teeth?
  2. Do you do it at night? During the day? All the time?
  3. Is there damage to your teeth?
  4. Does your bite feel wrong, or awkward?
  5. Do you bite stronger on some teeth then the others?
  6. Do you have to force your jaw to open?
  7. Do you know when the problem started?
  8. Did you have your wisdom teeth, or any other teeth taken out?
  9. Did you have your fillings changed?
  10. Did you have Did you have a new denture installed?
  11. Did you have orthodontic treatment (e.g. braces or invisiline)?
  12. Are you wearing a retainer?
  13. Have you been hit in the in a fight or accident?
  14. Do you know when the problem started?
  15. Are you under a lot of stress?
  16. What do you think causes it?
  17. What stress did you have at the time when this problem began?
  18. Are you under the care of psychologist, or psychiatrist?
  19. What are your expectations from our treatment?