TMD Scale Evaluation Request

Find out if you potentially suffer from TMJ. Once you submit your answers, it will display the likelihood. If you would like to get diagnosed and explore treatment options, make sure to check the box to have our dental office contact you for an appointment.

Please check any boxes that apply to you.

Head and Face Pain
- Forehead headaches
- Temporal headaches
- Tension headaches
- Migraine headaches
- Sinus headaches
- Headaches in the back of the head
- Scalp tender to touch
Nasal
- Sinus Pain
- Sinus Problems
- Post Nasal Drainage
- Allergies
Eyes
- Pain in or around the eyes
- Bloodshot eyes
- Light sensitivity
- Excess tears
- Blurred vision
- Pressure behind the eye
Ears
- Ear pain without infection
- Diminished hearing
- Feelings that your ears are clogged or stuffy
- Ringing or buzzing in the ears
- Dizziness, vertigo or balance problems
Neck
- Reduced mobility
- Neck stiffness
- Neck pain
- Tense, tired, or sore neck muscles
- Shoulder pain
- Back pain
- Arm or finger pain and numbness
Throat
- Swallowing difficulties
- Feeling of foreign object in throat
- Sore throat without infection
- Voice Changes
- Laryngitis
- Frequent coughing or clearing
Jaw
- Pain in jaw muscles
- Pain in jaw joint
- Pain in jawbone
- Jaw sounds (popping, clicking, or grinding)
- Uncontrollable jaw movements
- Jaw locks open or closed
- Jaw deviates to one side when opening
- Limited jaw opening
Mouth
- Bad Bite or inability to find bite
- Missing or worn teeth
- Mouth breathing
- Mouth discomfort
- Teeth clenching or grinding
- Irregular or painful tooth contacts
Your Score
Your score will display here when all the questions above are answered.
If your score was 30 or higher, you should refer to a TMJ dentist. Scores between 15 to 29 are still considered to be at risk. Scores of 14 or below have a low probability of TMJ. A score below 30 does not necessarily mean that you do not have a problem. If you suspect that you may have problem, you should see a TMJ dentist.
Contact The Center for TMJ and Sleep Apnea right away to discuss your problems with TMJ.
Have The Center for TMJ and Sleep Apnea follow up with me about my results
- Have The Center for TMJ and Sleep Apnea follow up with me about my results
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Name*
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Our office will reach out to you within 1 to 2 business days regarding your submission.
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Mon – Wed	8:00am – 5:00pm
Thurs	9:30am – 5:00pm
Fri – Sun	Closed

Contact The Center for TMJ and Sleep Apnea right away to discuss your problems with TMJ.