OCCLUSAL FUNCTION QUESTIONNARE
Come for the Dentistry, Stay for the Friendship
OCCLUSAL FUNCTION QUESTIONNARE
Examination of TMJ
If yes, Circle #1 (Mild), #2 (Moderate), #3(Severe) or mark an (X) in the NO column.
NO YES
1 2 3 1. Do you ever have any problems when you chew?
1 2 3 2. Do you ever have any sensitive or tender teeth or do you
grind and/or clench your teeth?
1 2 3 3. Does it ever hurt or bother you to close, swallow, yawn, open or
take a big bite?
1 2 3 4. Do you ever have problems keeping your balance or do you
occasionally bump into things?
1 2 3 5. Do your jaw joints ever make noise?
1 2 3 6. Do you have pain around or in your ears?
1 2 3 7. Do you ever have headaches for any reasons?
1 2 3 8. Do you ever have cramps, “spasms”, tightness, or pulling, in the
head, neck or throat area?
1 2 3 9. Do you ever have a feeling your mouth or throat is dry, hot, or
burning?
1 2 3 10.Do you ever feel your teeth do not fit or do you search for a place
to fit your teeth?
_________Occlusal Index total
If any YES answers above. please complete the following, items 11 to 15 -Circle YES or NO.
NO YES 11. Do you ever do or take anything for any of the above conditions?
NO YES 12. Do you feel you have a problem that began after an accident, surgery, or
other head injury?
NO YES 13. Have you ever had teeth capped (crowns) , ground on, straightened,
or had treatment for TMJ/jaw/joint problems?
NO YES 14. Do you feel you have a problem, which needs treatment?
NO YES 15. Do any of the above conditions stop you from doing things/living life?
Question #1: If teeth are not identified as the cause for chewing difficulties then the muscles, ligaments and TM joints are usually the problem.
Question #2: Teeth sensitive to hot and cold are often associated with a bruxing or clenching problem. A poor fit of teeth in the intercuspal position can cause the same sensitivity problem. Tender and/or sensitive teeth may be indicative of periodontal or pulpal disorders.
Question #3: Difficulty opening wide or taking a big bite may vary from no problems to severe muscle, joint and ligament disorders. Often this is related to trauma, recent general anesthesia or prolonged dental therapies.
Question #4: Balance problems often accompany TMJ disorders because of associated posture imbalances within the craniosacral system. This may be due to a simple posture imbalance or a severe musculoskeletal dysfunction.
Question #5: Noises in the TMJ area usually indicate a disharmony between the condyle, disc and eminentia. This can be caused by joint diseases, trauma, and muscle and ligament problems. A lower jaw intercuspal position not in harmony with a physiologic TMJ position can cause joint noises plus muscle disharmonies.
Question #6: Pre-auricular pain is often one of the first or early signals of a TMJ of craniomandibular problems. Dental history often indicates numerous visits to ENT specialists without resolution of the pain.
Question #7: Patients having headaches symptoms require a very careful differential diagnosis. Headaches have a myriad of causes. TMJ headaches, characteristically, respond to few except the most powerful of medications. Patients often just live with the headaches.
Question #8: Swallowing difficulties are common symptoms in TMJ disorders, especially in the absence of a cause. Asymmetry of head and neck muscles plus unilateral pain is often related to TMJ disorders.
Question #9: A dry mouth is often associated with a bruxing or clenching disorder. Nutritional disorders can also produce the same type of symptoms.
Question #10: Searching for a place to fit the teeth together is probably one of the most common symptoms of a TMJ patient.
DOCTOR INFORMATION
• Patients with an OCCLUSAL INDEX of less than 5 have few significant occlusion and/or TMJ problems and usually do not require treatment.
• Patients with an OCCLUSAL INDEX of 5 or more have significant symptoms and should receive a more extensive examination.
• Patients with an OCCLUSAL INDEX over 10 can be classified as TMJ disorder patients.
• Patients with an OCCLUSAL INDEX over 20 can be classified as complex TMJ disorder patients.
This questionnaire has been used with predictable results, for over 25 years by dental faculty and practicing dentists in the U.S. and Europe,
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doyle and baker, PSC
dentistry for the family
dr. chris baker
dr. kenny nusbacher
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