• Clenching and Grinding Questionnaire

  • Date
     / /
    2 digit month, 2 digit day, 4 digit year
  • Do you clench or grind your teeth during the day?*
  • Have you been made aware of clenching or grinding your teeth during the night?*
  • Do you often wake up during the night?*
  • Are your jaws or teeth tired when you wake in the morning?*
  • Do you feel refreshed when you wake in the morning?*
  • Do you suffer from chronic headaches, or neck and shoulder pain?*
  • Do you now, or have you ever had pain in your jaw joint or the sides of your face particularly around the ear?*
  • Have your jaws ever clicked or locked opened or closed?*
  • Do you tend to chew on only one side of your mouth?*
  • Have you ever had any dental work (crowns, bridges, fillings, etc) that stopped your teeth biting normally together or felt "in the way"?*
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  • Should be Empty: