TMD Pain Quiz

Do you clench or grind your teeth?

No, not that I'm aware of

Occasionally (e.g. during periods of high stress)

I've been told I grind my teeth in my sleep.

Yes, I've noticed myself clenching or grinding often

Do you experience facial pain or tenderness?

No, not that is noticeable.

I have before, but it doesn’t bother me regularly.

Yes, and it bothers me occasionally (once or twice a year).

Yes, and it bothers me on a regular basis.

Yes, and it interferes with my daily life.

How often do you experience ear pain or earaches?

Not often or not at all.

Once or twice a year.

More than once or twice a year.

Very frequently (more than once a month).

How often do you experience headaches?

Never.

Occasionally (less than three times a year).

Once a month or so.

More than once a month.

More than once a week.

Have you ever experienced pain while chewing?

No.

Once or twice, but not frequently.

Yes, once or twice in the last year.

Yes, frequently in the last year.

When opening and closing your mouth, does your jaw make a sound (e.g. clicking or popping)?

No.

It makes a slight sound that I hadn’t noticed before.

Yes.

Do you often suffer from neck or back pain?

No.

Very infrequently.

Yes, but not often enough to bother me.

Yes, and it bothers me at least once every month or so.

Yes, and it bothers me almost every day.

Have you ever experienced pain or numbness in your lower jaw?

No.

Not in the last year.

Yes, within the last year.

Do you ever have trouble opening your mouth (your jaw locking up)?

No.

I’ve had trouble with this before, but not recently.

Yes, I’ve had this happen once or twice in the last year.

Yes, I’ve had this happen more than twice in the last year.

Have you been to multiple doctors to address your pain?

No, I haven’t been to any doctors yet.

No, I’ve only gone to one doctor.

Yes, I’ve seen multiple doctors about my issues.

First Name

Last Name

Phone

Email