TMJ/Malocclusion Self-Evaluation |

TMJ/MALOCCLUSION SELF-EVALUATION STEP 1

Check each box that describes a symptom you currently have, or have had in the past:

Jaw joint(s) click or pop (occasionally to frequently)

Worn teeth: edges of front top and/or bottom teeth look flat, like they have been “ground off”

Tension headaches (occasional to frequent)

Night grinding or clenching of teeth (Bruxism)

A history of trauma to the jaw or chin in childhood or adulthood (falling off a bike, sports injury, etc.)

Waking in the morning with the jaws tight or clenched

Clenching teeth together during the day

You have to wiggle your jaw to find the “right bite”

Tension in the temples, cheeks or jaws (moderate finger pressure to these areas causes slight discomfort)

Migraines centered in your temples

Chipping or breaking teeth

Jaw joint(s) locking open or closed

Jaw joint pain

Pain when opening wide

Sensitive teeth (usually to cold and/or pressure)

Loose or wiggly teeth

Gaps opening between teeth (you may see spaces or have food often getting stuck between teeth)

Ringing in your ears

Notches in your teeth where they meet your gums (you can feel them with your fingernail)

Total Number of Boxes You Checked

Less than five

Six to ten

More than ten

If you have checked more than five boxes, there is a strong possibility that you have Malocclusion (unbalanced or mismatched bite). You should perform the more advanced Malocclusion Self-Evaluation Step #2 found below.

TMJ/MALOCCLUSION SELF-EVALUATION STEP #2

1. Tip your head back so you are looking at the ceiling.

2. Relax your jaw muscles and open your mouth about two fingers wide. Pretend you're saying “ahhhhhhh” for your doctor during a physical exam.

3. With your index finger, make a “hook” shape.

4. Hang your hooked index finger on the bump on your chin and gently pull in a downward direction, keeping your jaw relaxed.

5. Keeping your jaw relaxed, slowly bring your teeth together until they just barely touch. Don’t bite hard or clench, but rather tap-tap-tap your teeth together as lightly as possible. Take note of which teeth touch first.

This is called the “First Point of Contact.”

6. With your finger still hooked on your chin, tap lightly a few times, then clench your teeth together hard. You may feel your bite “slide” or feel like different teeth start to touch.

This is called a “Slide.”

7. Now keep relaxed with the same chin pressure, open wide and close a few times. Do you hear anything?

8. Now, put your two eye teeth on one side of your mouth tip to tip. Are any other teeth touching each other? Now do the other side.

This is called “Canine Guidance.”

"POINT OF CONTACT"

Where was your first point of contact?

Only the teeth on my right side touched first.

Only the teeth on my left side touched first.

A back tooth touched first.

All of my teeth touched at the same time.

If you checked one of the first three boxes, there is an 80% chance that you have Malocclusion. You should see a dentist who treats Malocclusion to prevent your teeth from becoming more damaged.

"SLIDE"

Did your teeth slide?

Yes, my teeth slid to one side when I went beyond First Point of Contact to clenching my teeth.

No, my teeth did not move when I clenched down.

If you checked the first box, there is a 90% chance that you have Malocclusion. You need to see a dentist who treats Malocclusion soon to prevent permanent damage to your teeth.

"CANINE GUIDANCE"

When you put your top and bottom eye teeth together on one side and then the other...

One or more front teeth were still touching.

One or more back teeth were still touching.

None of my other teeth were touching.

If you checked either of the first two boxes, there is a 100% chance that you have Malocclusion. You should immediately see a dentist who treats Malocclusion to prevent permanent and disfiguring damage. You should also look at functional esthetic restoration of your teeth.

Your Full Name

Enter your Email address if you would like to receive a pdf file with more information about malocclusion. Your email address and your Malocclusion Self-Evaluation results are kept confidential.

TMJ/Malocclusion Self-Evaluation

Print this form now if you want to complete the form manually and bring it to your appointment.

You may also type in your answers and then print the form for your records at the bottom.

TMJ/MALOCCLUSION SELF-EVALUATION STEP 1

If you have checked more than five boxes, there is a strong possibility that you have Malocclusion (unbalanced or mismatched bite). You should perform the more advanced Malocclusion Self-Evaluation Step #2 found below.

TMJ/MALOCCLUSION SELF-EVALUATION STEP #2

"POINT OF CONTACT"

If you checked one of the first three boxes, there is an 80% chance that you have Malocclusion. You should see a dentist who treats Malocclusion to prevent your teeth from becoming more damaged.

"SLIDE"

If you checked the first box, there is a 90% chance that you have Malocclusion. You need to see a dentist who treats Malocclusion soon to prevent permanent damage to your teeth.

"CANINE GUIDANCE"

If you checked either of the first two boxes, there is a 100% chance that you have Malocclusion. You should immediately see a dentist who treats Malocclusion to prevent permanent and disfiguring damage. You should also look at functional esthetic restoration of your teeth.

To print this self-evaluation for your own records, YOU MUST PRINT IT BEFORE YOU CLICK "SEND".

Copyright 2015, Curtis Marketing Group, Inc. Do not use without written permission from Curtis Marketing Group, Inc.

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