Jaw Function Questionnaire Jaw Disability Checklist What activities does your present jaw problem prevent or limit you from doing? No Yes Chewing 0 1 Drinking 0 1 Exercising 0 1 Eating hard foods 0 1 Eating soft foods 0 1 Smiling/laughing 0 1 Sexual activity 0 1 Cleaning teeth or face 0 1 Yawning 0 1 Swallowing 0 1 Talking 0 1

headache, face or jaw pain to markedly interfere with my enjoyment, willingness and satisfaction. 3 I must limit my customary sexual expression and activities because of headache, face or jaw pain or limited mouth opening. 4 I abstain from almost all sexual activities and expression because of the head, face or jaw pain it causes. 7.

Date _____ TMD Disability Index Questionnaire Date _____ Section 6 - Sexual function (Including Kissing, Hugging and Any and All Sexual Activities to Which You Are Accustomed) I am able to engage in all my customary sexual activities and expressions without limitation and/or causing headache, face or jaw …

5-part questionnaire. Can you now or could you ever place your hands on the floor by bending forward with your knees straight? ... Problems with my jaw have always been on the right side where I had a dental crown and they would come and go. When the crown decayed I had the tooth removed and a dental bridge fitted which did not fit correctly ...

The Jaw Functional Limitation Scale: Development, reliability, and validity of 8-item and 20-item versions

Take Our TMJ Questionnaire It's Easy: You fill out our questionnaire We will process your information We will contact you within 48 hours (weekdays only) ... He has been wearing a physiological fixed mouth appliance to help with his jaw and he also recieved reconstruction on his upper teeth with the placement of implants and cosmetic ...

Please download and fill out our TMJ Questionnaire Form. After you have completed the form, please make sure to bring it on your first visit to our office.

Jaw pain Assessment Questionnaire Questions Your Doctor May Ask - and Why! During a consultation, your doctor will use various techniques to assess the symptom: Jaw pain. These will include a physical examination and possibly diagnostic tests. (Note: A physical exam is always done, diagnostic tests may or may not be performed depending on the ...

Clinician Name Address This questionnaire is designed to help your doctor evaluate your problem. Please answer all questions as honestly as possible.

QUESTIONNAIRE FOR TMJ PROBLEMS 1. Do you have: Headaches?____ Stuffiness?____ Neck pain?____ Pain in: Jaw?____ Ear?____ Face?____ Eye?____

Mandibular Function Impairment Questionnaire (M.F.I.Q) This questionnaire addresses functional jaw activities. With this questionnaire we want to learn to what extent your symptoms affect your ability to use your jaw. To this end it is important that you answer all questions honestly.

Answer these 9 questions of the TMD Screening Questionnaire and find out if you should have a comprehensive TMD Screening Examination. 1. Do you have difficulty or pain when opening your mouth? 2. Does your jaw get 'stuck', 'locked', or 'go out'? 3. Do you have difficulty/pain, when chewing, talking, using jaw…

Temporomandibular Joint (TMJ) Pain Questionnaire designed by Dr. Larry M. Wolford will assist us in diagnosing the cause of your TMJ joint pain. Larry M. Wolford, DMD Oral and Maxillofacial Jaw Surgeon

Jaw swelling Assessment Questionnaire Questions Your Doctor May Ask - and Why! During a consultation, your doctor will use various techniques to assess the symptom: Jaw swelling .

Use this helpful TMJ Pain questionnaire as a screening tool if you suspect that you're suffering from TMJ disorder. Symptoms include migraines, tension headaches, ear and jaw pain, and upper body muscle tension . We will contact you back with recommendations and whether it's necessary to come in for a consultation.

This questionnaire is taken from: Ohrbach R, Larsson P, List T (2008). The Jaw Functional Limitation Scale: Development, reliability, and validity of 8-item and …

TEMPOROMANDIBULAR JOINT (TMJ) CONDITIONS DISABILITY BENEFITS QUESTIONNAIRE. NAME OF PATIENT/VETERAN. PATIENT/VETERAN'S SOCIAL SECURITY NUMBER 4A. ROM FOR LATERAL EXCURSION: SECTION III - FLARE-UPS. Following the initial assessment of ROM, perform repetitive use testing. For VA purposes, repetitive use testing must be included in all joint exams.

Click the button below to download and print your new patient health questionnaire that you can fill out and bring to your appointment. Search. Search: Recent Posts ... tooth extraction, wisdom tooth removal, pathology and biopsy, soft tissue grafting, jaw surgery, reconstructive surgery, sinus lift, and periodontal services. We are oral ...

HEAD, NECK, FACIAL PAIN & TMJ QUESTIONNAIRE This questionnaire is designed to provide important facts regarding the history of your pain or condition. The information you provide will assist in reaching a diagnosis to aid in determining the ... TMJ – Jaw Clicking noise R L Grinding noise R L Jaw/cheek pain R L Jaw joint pain R L ...

JAW RELATED QUESTIONS 1. Does it hurt to chew? !Yes !No 2. Does it hurt to open wide? !Yes !No 3. Do you have headaches? !Yes !No 4. Is it difficult to swallow? !Yes !No! 5. Are you teeth sensitive or sore? !Yes !No 6. Do you have implants or splints? !Yes !No 7. Do you have neck pain? !Yes !No 8.

Sep 07, 2016· This study aimed to investigate medical doctors' awareness of bisphosphonate-related osteonecrosis of the jaw (BRONJ) and the status of dental referrals. Self-administered questionnaires were distributed to medical doctors practicing internal medicine, family medicine, and …

TMJ/Bite Stability Questionnaire. Take a few minutes to run through the bite stabilization checklist. If you answer yes to any of the questions below call our office today today to schedule your comprehensive bite and jaw exam.

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 . TMJ Dysfunction Questionnaire

Severe emotional upset ( ) A blow on the jaw ( ) Excessively large bite or yawn ( ) Traction for cervical whiplash ( ) Traction for cervical arthritis ( ) 7.

The JFLS is a patient self-report questionnaire designed to assess a patient's functional level that is both joint-specific and separate from pain-related disability (Form 6-1). 6,7 It has a total of 20 items that address three levels of functional limitation includ-ing mastication (6 items), jaw mobility (4 items),

This questionnaire was designed to provide important facts regarding the history of your pain or condition. The information you ... Jaw Joint Noises Jaw Locking Jaw Pain Limited Mouth Opening Migraine Headaches Muscle Twitching Neck Pain Pain when Chewing Ringing in the Ears

TMJ PROBLEM QUESTIONNAIRE PAGE 2 PATIENT NAME: DO NOT WRITE IN THIS SPACE What medication do you take or have you taken previously for your

Jaw pain Popping or clicking of the jaw Neck Pain Difficulty chewing ...