Clinical Forms

This form includes both the screening questionnaire and the screening exam forms. I suggest copying this form on both sides. Then split the page down the center. That way you will have the questionnaire on one side and the exam form on the other. The exam form will not be needed until the responses on the questionnaire indicate the need for a screening exam. With the questionnaire, you can lay the previous form beside the most current form and compare the “Yes”, “No” responses. This will be the means by which you are able to see if there has been any progression since the previous questionnaire was completed. Be sure that you and the hygienist(s), who may see the questionnaire, are thoroughly familiar with how to interpret the responses on the questionnaire. Here is the download link:  Screen Hx & Ex. 

Also be sure to see the “Interpretation of Screening Questionnaire and Screening Exam Form”, below,  for this important information.

This form, which describes how to interpret both the screening questionnaire and the screening exam, is largely self-explanatory. The important thing is for you to be able to determine the need to do a screening TMD exam, based on the responses to the questionnaire. Here is the download link: Interpretation of Screen

I have had a classical training in doing an assessment of a patient’s dental occlusion and have been doing that for 45 years. However, in the context of a TMD practice, I discovered quite a long time ago that not infrequently the patient will be able to tell me important things about how their bite feels to them that I might not have discovered by my personal exam alone. Frequently, with this information from the patient, I have found that this is an important adjunct to the other information that a thorough exam requires. And not infrequently, from hearing their own description, I know the primary role that their occlusion is playing in their overall problem. Here is the donload link to this document: Pt. Self-Ass. Occlus. Condition