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TMJ/Malocclusion Self-Evaluation

Print this form now if you want to complete the form manually and bring it to your appointment.
You may also type in your answers and then print the form for your records at the bottom.

TMJ/MALOCCLUSION SELF-EVALUATION STEP 1

If you have checked more than five boxes, there is a strong possibility that you have Malocclusion (unbalanced or mismatched bite). You should perform the more advanced Malocclusion Self-Evaluation Step #2 found below.

TMJ/MALOCCLUSION SELF-EVALUATION STEP #2

1. Tip your head back so you are looking at the ceiling.

2. Relax your jaw muscles and open your mouth about two fingers wide. Pretend you're saying “ahhhhhhh” for your doctor during a physical exam.

3. With your index finger, make a “hook” shape.

4. Hang your hooked index finger on the bump on your chin and gently pull in a downward direction, keeping your jaw relaxed.

5. Keeping your jaw relaxed, slowly bring your teeth together until they just barely touch. Don’t bite hard or clench, but rather tap-tap-tap your teeth together as lightly as possible. Take note of which teeth touch first.

This is called the “First Point of Contact.”

6. With your finger still hooked on your chin, tap lightly a few times, then clench your teeth together hard. You may feel your bite “slide” or feel like different teeth start to touch.

This is called a “Slide.”

7. Now keep relaxed with the same chin pressure, open wide and close a few times. Do you hear anything?

8. Now, put your two eye teeth on one side of your mouth tip to tip. Are any other teeth touching each other? Now do the other side.

This is called “Canine Guidance.”

"POINT OF CONTACT"

If you checked one of the first three boxes, there is an 80% chance that you have Malocclusion. You should see a dentist who treats Malocclusion to prevent your teeth from becoming more damaged.

"SLIDE"

If you checked the first box, there is a 90% chance that you have Malocclusion. You need to see a dentist who treats Malocclusion soon to prevent permanent damage to your teeth.

"CANINE GUIDANCE"

If you checked either of the first two boxes, there is a 100% chance that you have Malocclusion. You should immediately see a dentist who treats Malocclusion to prevent permanent and disfiguring damage. You should also look at functional esthetic restoration of your teeth.

To print this self-evaluation for your own records, YOU MUST PRINT IT BEFORE YOU CLICK "SEND".

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