TMJ Society - Survey

TMJ patients are invited to share your TMJ experiences and knowledge with the TMJ and Orofacial Pain Society of America (TOPS America).


Do you have a TMJ Disorder?		Yes	No
Have you been diagnosed by a medical/dental professional as having TMJ?		Yes	No
If yes, how long have you had TMJ?
What are your TMJ symptoms?	P = Primary	S = Secondary	N = None
Jaw Pain	P	S	N
Facial Pain	P	S	N
Joint Noise	P	S	N
Limited Opening	P	S	N
Locking Joint	P	S	N
Dizziness	P	S	N
Ringing Ears	P	S	N
Clicking Joints	P	S	N
Neck Pain	P	S	N
Back Pain	P	S	N
Morning Headaches	P	S	N
Sore Teeth	P	S	N
Earaches	P	S	N
Fatigue	P	S	N
Teeth Clenching	P	S	N
Teeth Grinding	P	S	N
Other:
Please identify professional(s) that you have seen for TMJ care and rate the benefit received from their services:
Professional:		1 = None	5 = Symptom Relief
General Dentist	Yes	No	15
Oral Surgeon	Yes	No	15
Orthodontist	Yes	No	15
TMJ Specialist	Yes	No	15
Neurologist	Yes	No	15
Chiropractor	Yes	No	15
Physical Therapist	Yes	No	15
Psychologist	Yes	No	15
Psychiatrist	Yes	No	15
Other:
Please indicate which TMJ treatment(s) you have received and rate long-term benefit:
Treatment:		1 = None	5 = Symptom Relief
Hard Splint	Yes	No	15
Soft Splint	Yes	No	15
Occlusal Adjustment	Yes	No	15
Orthodontics - braces	Yes	No	15
Pain Medication	Yes	No	15
Surgery	Yes	No	15
Stress Counseling	Yes	No	15
Acupuncture	Yes	No	15
Other:
What do you think is the cause of your TMJ?	P = Primary	S = Secondary	N = None
Orthodontics	P	S	N
Injury / Trauma	P	S	N
Whiplash Accident	P	S	N
Stress	P	S	N
Occlusion	P	S	N
Clenching Teeth	P	S	N
Grinding Teeth	P	S	N
Do Not Know
Other:
Are you satisfied with your current condition?		Yes	No
Are you satisfied with the TMJ treatment you have received?		Yes	No
Are you looking for TMJ treatments?		Yes	No
Has insurance covered all or part of your TMJ treatment?		Yes	No

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