Do you have pain on the right side of your face, the left side or both sides?
Could you point to the areas where you feel pain?
Rigth
Left
Opening Pattern
Vertical range motion
Unassisted opening without painmm
Maximum unassisted openingmm
Maximum assisted openingmm
Vertical incisal overlapmm
Joint sounds
Rigth
Measurement of Opening Clickmm
Left
Measurement of Opening Clickmm
Excursions
Right Lateral Excursionmm
Left Lateral Excursionmm
Protrusionmm
Midline Deviation
Deviationmm
Joint sounds excursions
Rigth sounds
Excursion right
Excursion left
Protrusion
Left sounds
Excursion right
Excursion left
Protrusion
Directions for next items
The examiner will be palpating (touching) different areas of your face, head and neck. We would like you to indicate if you do not feel pain or just feel pressure (0), or pain (1-3). Please rate how much pain you feel for each of the palpations according to the scale below. Circle the number that corresponds to the amount of pain you feel. We would like you to make a separate rating for both the right and left palpations.
0 = No Pain/Pressure Only
1 = Mild Pain
2 = Moderate Pain
3 = Severe Pain