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DENTAL CARE AT MEMORIAL SOUTHWEST
           Steve Fortenberry, D.D.S.
              J.C. Martinez, D.D.S.
                 7737 Southwest Freeway, Suite 960
                        Houston, TX 77074
                          713-774-9774


             Temporomandibular Disorder Questionnaire:

   Do you experience pain in your face, ears, below/ in front of your ears or
   headaches for which your medical doctor has not found a cause?
   Where is your pain located? If your having trouble locating the exact origin,
   imagine gently placing your finger into your ear canal. Is your finger pointing
   at the pain or is the pain in front of your finger, toward your face?
   Do your jaw joints (TMJ), located in front of your ears, hurt when you chew
   and do they make clicking, popping or crackling noises?
   Do your facial muscles feel tired or stiff when you awaken, during the day,
   after a lot of speaking or when yawning?
   Do you clench your teeth together while sleeping or awake? A spouse can
   often tell you about your jaw muscle activity during sleeping.
   Do you have headaches in the sides of your temples?
   Are you able to open your mouth freely, smoothly and as wide as you are
   accustomed to doing?
   Can you move your jaw from side to side with your mouth open?
   Do you experience episodes when your jaw feels that it locks open or shut?
   Do you feel that your upper and lower teeth don't fit together as they usually
   do?
   Is your bite comfortable? Is chewing tough foods uncomfortable or painful?
   Do you experience dental pain in lots of teeth for which your dentist has
   found no cause?
   Are your teeth chipping and are the front teeth worn flat on their edges?
   Do your upper front teeth completely cover the lower teeth when you bite
   together?
   Have your teeth been shifting, creating spaces or crowding for no apparent
   dental reason?

If you answered “YES” to any of these questions, you may have a TMJ disorder.

Call our office at 713-774-9774 to schedule an appointment for treatment to
avoid or relieve any painful/ dysfunctional symptoms as well as dental
destruction resulting from TMD.
Painful symptoms include: headaches, facial & dental pain, pain in the jaw joints,
pain associated with jaw movement, ear pain/ pressure, tinnitus, neck pain, back
pain, shoulder pain and chest pain.

Dysfunctional symptoms include:

   Jaw joint: locked/ dislocated, facial asymmetry

   Jaw movement: limited, deviated, slow/ irregular

   Head movement: limited range of motion

   Ears: muffling, dizziness/ clicking

   Throat: difficulty swallowing, prolonged speech

Dental Destruction include: traumatic occlusion, clenching, bruxism (grinding),
abrasion (wearing down), chipping of natural, restored/ denture teeth,
looseness of teeth, bone loss without gum inflammation and movement of teeth
(spreading, crowding, loss of teeth & bite changes).

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TMJ Disorder Questionnaire

  • 1. DENTAL CARE AT MEMORIAL SOUTHWEST Steve Fortenberry, D.D.S. J.C. Martinez, D.D.S. 7737 Southwest Freeway, Suite 960 Houston, TX 77074 713-774-9774 Temporomandibular Disorder Questionnaire: Do you experience pain in your face, ears, below/ in front of your ears or headaches for which your medical doctor has not found a cause? Where is your pain located? If your having trouble locating the exact origin, imagine gently placing your finger into your ear canal. Is your finger pointing at the pain or is the pain in front of your finger, toward your face? Do your jaw joints (TMJ), located in front of your ears, hurt when you chew and do they make clicking, popping or crackling noises? Do your facial muscles feel tired or stiff when you awaken, during the day, after a lot of speaking or when yawning? Do you clench your teeth together while sleeping or awake? A spouse can often tell you about your jaw muscle activity during sleeping. Do you have headaches in the sides of your temples? Are you able to open your mouth freely, smoothly and as wide as you are accustomed to doing? Can you move your jaw from side to side with your mouth open? Do you experience episodes when your jaw feels that it locks open or shut? Do you feel that your upper and lower teeth don't fit together as they usually do? Is your bite comfortable? Is chewing tough foods uncomfortable or painful? Do you experience dental pain in lots of teeth for which your dentist has found no cause? Are your teeth chipping and are the front teeth worn flat on their edges? Do your upper front teeth completely cover the lower teeth when you bite together? Have your teeth been shifting, creating spaces or crowding for no apparent dental reason? If you answered “YES” to any of these questions, you may have a TMJ disorder. Call our office at 713-774-9774 to schedule an appointment for treatment to avoid or relieve any painful/ dysfunctional symptoms as well as dental destruction resulting from TMD.
  • 2. Painful symptoms include: headaches, facial & dental pain, pain in the jaw joints, pain associated with jaw movement, ear pain/ pressure, tinnitus, neck pain, back pain, shoulder pain and chest pain. Dysfunctional symptoms include: Jaw joint: locked/ dislocated, facial asymmetry Jaw movement: limited, deviated, slow/ irregular Head movement: limited range of motion Ears: muffling, dizziness/ clicking Throat: difficulty swallowing, prolonged speech Dental Destruction include: traumatic occlusion, clenching, bruxism (grinding), abrasion (wearing down), chipping of natural, restored/ denture teeth, looseness of teeth, bone loss without gum inflammation and movement of teeth (spreading, crowding, loss of teeth & bite changes).