Speech problems/therapy?
Clench or Grind Teeth?
Oral habits (thumb/finger sucking, lip/nail biting)?
Injury to face, jaw, teeth or mouth?
Discomfort from teeth or gums?
Pain, tenderness or noise in either jaw?
Frequent headaches?
Neck/shoulder pain?
Frequent sore throats?
Chipped or injured permanent teeth?
Teeth sensitive to hot or cold?
Previous root canal therapy?
Bad taste/mouth odor?
Previous periodontal (gum) treatment?
Abnormal swallowing (tongue thrust)?
Teeth that irritate tongue, cheek, lip, etc?
Numerous fillings?
Brush teeth daily?
Floss teeth daily?
Fluoride treatments?
Mouth breathing?
Snores during sleep?
Apprehensive about dental care?
Frequently Chew Gum?
Thumb or finger habit as a child?
Jaw Fractures, cysts, mouth infections?
Bleeding gums?
Other periodontal (gum) problems?
Frequent canker sores or cold sores?
Have wisdom teeth been removed?
Problems with food trapped between teeth?
Is there any dental work yet to be completed?
If any of the above dental questions were answered 'Yes', please explain:
Has the patient had a TMJ screening?
Does the patient experience soreness in the muscles of his/her face or around his/her ears?
Does the patient have a history of jaw joint problems?
Has the patient been treated for "TMJ"?
Does the patient notice clicking or popping in his/her jaw joint?
Does the patient clench his/her teeth?
Has the patient's jaw ever locked?
Does the patient have difficulty chewing or opening his/her mouth?
Does the patient's bite feel uncomfortable or unusual?
If any of the above TMJ questions were answered 'Yes', please explain: