TMJ Quiz

1

Have you heard popping or clicking when you move your jaw?* This field is required.

Yes

No

2

Do you have jaw pain?* This field is required.

Yes

No

3

Has your bite (position of your teeth) noticeably shifted?* This field is required.

Yes

No

4

Do you ever feel like you can’t open or close your jaw?* This field is required.

Yes

No

5

Do you have ear pain, ear fullness, or ear ringing (tinnitus)?* This field is required.

Yes

No

6

Do you grind your teeth at night (bruxism) or clench during the day?* This field is required.

Yes

No

7

Does anyone in your family have sleep apnea, tmj disorder (TMD), or bruxism?* This field is required.

Yes

No

8

Do you have face, neck, shoulder, or ear soreness for seemingly no reason?* This field is required.

Yes

No

9

Do you wake up with headaches?* This field is required.

Yes

No

10

Are your cheeks swollen?* This field is required.

Yes

No

11

Are you experiencing a loss of balance or vertigo?* This field is required.

Yes

No

12

Have you ever had TMJ issues in the past?* This field is required.

Yes

No

13

Have you seen a dentist or doctor for any of these problems without resolution?* This field is required.

Yes

No

14

In addition to your symptoms, are you particularly stressed, anxious, or depressed?* This field is required.

Yes

No

15

Do you have an autoimmune disease such as rheumatoid arthritis, or another condition such as osteoarthritis or scoliosis?* This field is required.

Yes

No

16

Do we have your permission to receive an email of your results and follow up with you for a consultation?* This field is required.

Yes

No

17

What is your first and last name?* This field is required.

18

What is the best phone number to reach you for the consultation?* This field is required.

19

What is the best email address to reach you for the consultation?* This field is required.

20

Total point is