TMJ Self-Assessment Questionnaire

Patient Information:

How often do you experience the following? (1 = Rarely, 10 = Constantly)

Frequent headaches or migraines

Jaw pain, discomfort, or stiffness

Clicking, popping, or grinding sounds when opening/closing your mouth

Difficulty chewing or biting food

Pain in your neck, shoulders, or upper back

Earaches or ringing in your ears (tinnitus)

Difficulty fully opening or closing your mouth

Teeth grinding or clenching (especially at night)

Dizziness or balance issues

Fatigue or trouble sleeping

Have you ever been diagnosed with a TMJ disorder?

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