╨╧рб▒с>■  24■   1                                                                                                                                                                                                                                                                                                                                                                                                                                                ье┴3 Ё┐∙jbjb^^ 0h<h<∙      l╘╘╘╘╘╘╘@@@@@ L4@╟"ФФФФФФФФДЖЖЖЖЖЖ,щ  ┬▓╘ФФФФФ▓╘╘ФФФФB╘Ф╘ФДш,,╘╘╘╘ФДhД╘╘ДАfp┤╢@@╓FДД╟╟Д╦╦Д├х Checklist On TemporoMandibular Joints (TMJ) Disorder This is one of three survey instruments on this website. Please plan to fill out all three and send it to us at: JJAMD, The Forsyth Institute, 140 Fenway, Boston MA 02115. TemporoMandibular Joints (TMJ) Disorder can spread pain and dysfunction throughout the entire body and lead to loss of productivity at home, work, and play. TMJ Disorder has also been referred to as "The Great Imposter" because of the wide diversity of symptoms and disorders it mimics. This checklist is intended to help you think or re-think all the symptoms you are experiencing throughout your entire neuromusculo-skeletal system, including dysfunction and pain. It also can serve as a history for your care and add data for future research. Please add any other information clearly and briefly in chronological order at the end of this leaflet. Include information on the causes; symptoms; all diagnoses; all treatments, including all drugs, dosage, and frequency of use, and good and bad results. Please state what has helped you, what has not helped you, and what you believe has hurt you and in what way. Please send a copy of this survey to: The Jaw Joints & Allied Musculo-Skeletal Disorders Foundation, Inc. (JJAMD), Forsyth Research Institute, 140 Fenway, Boston, MA. 02115-3799. (Note: DO NOT sent this information to Healthtouchо.) а Please include your name, address, age, and sex. (Your confidentiality will be absolutely respected.) Which Of These Symptoms Do You Have? Before each pertinent item, check symptoms that apply, then mark as appropriate: 1= Mild 2= Severe S= Sometimes A= Always P= Pain D= Dysfunction L= Left side only R= Right side only B= Both sides Symptoms Head & Face: _______Forehead _______Migraine Type _______Sinus Type _______Temples _______Back of Head _______Shooting Pain _______Throbbing Pain _______Other Eyes: _______Asymmetrical _______Glasses Don't Help _______Itch & Burn _______Light Sensitive _______Pain Behind _______Other Ears: _______Clogging _______Dizziness _______Ear Ache _______Hissing _______Pain, No Infection _______Reduced Hearing _______Ringing (Tinnitus) _______Other Mouth: _______Can't Find Bite _______Discomfort _______Jerky Opening _______Limited Opening _______Locks Open _______Locks Shut _______Other Teeth: _______Chewing Problems _______Clenching _______Dentures _______Grinding _______Ground Down by Dentist _______Orthodonture _______Pain (Chronic) _______Other Throat: _______Feeling of Foreign Object _______Frequent Coughing _______Laryngitis _______Sore _______Swallowing Difficulties _______Voice Irregularities _______Other Jaw Joints: _______Clicking _______Grating _______Muscle Pain _______Popping _______Uncontrolled Movement _______Other Neck: _______Dull Pain _______Lack of Mobility _______Sore Muscles _______Stiffness _______Throbbing Pain _______Tired Muscles _______Other Back & Appendages: _______Arm or Finger Numbness _______Back Ache _______Cramps in Legs _______Muscles _______Numbness & Tingling _______Shoulder Ache _______Tired or Achy _______Other Seemingly Diverse Disorders: _______Depression _______Fatigue _______Insomnia _______Nausea _______Nervousness _______Sleep Disturbed _______Stomach Upset _______Fibromyalgia _______Chronic Fatique Syndrome _______Myofascial Pain Disorder _______Tinnitus _______Ehlers-Danlos _______Lupus _______Scleroderma _______Sjogren's Syndrome _______Ectodermal Dysplagias _______Anorexia Bulimia _______Carpal Tunnel Syndrome _______Ulcers _______Heart Problems _______Osteoarthritis in other joints _______Rheumatoid arthritis in other joints _______Other________________________________________________ MSI-JJAMD003 ------------------------------------------------------------------------ The Jaw Joints & Allied Musculo-Skeletal Disorders Foundation (JJAMD), an independent 501(c)(3), nonprofit, educational, advocacy organization, was founded in 1982 in response to the void in dealing with The TMJ Dilemma. "TMJ," the acronym for TemporoMandibular Joints and the disorders affecting these Jaw Joints, is one of the most pervasive, least understood, and controversial health disorders in existence today. A patient friendly "Plain Talk Guide to TMJ: With Self Help Tips How To Keep Your Jaw Joints Health," is available for a $5 donation. Patient membership in JJAMD for Healthtouch users is available for $10 for new members only. Please send a large self-addressed stamped envelope to JJAMD, Forsyth Dental Research Center, 140 Fenway, Boston, MA 02115-3799.а JJAMD's fax number is 617-267-9020. Please note: While JJAMD disseminates helpful, important, and useful patient and professional educational materials, the foundation cannot provide doctor referrals or specific medical/dental advice, in the absence of any universally accepted scientifically-proven treatments, which was concluded by the 1996 NIH TMD (TMJ) Technology Assessment Conference Panel. Copyright 1993-2000, Jaw Joints & Allied Musculo-Skeletal Disorders Foundation, Inc. Licensed to Medical Strategies, Inc. 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