Impaired Mouth Syndrome Quiz

Let's see if you or your patient would be a good candidate.

Answer "0" or "1" for each of the following questions and submit the form.

Snoring, morning dry mouth

Gasping or choking in sleep

Teeth grinding, jaw

Neck, shoulder, or back pain, headaches

Mouth breathing, chapped lips

Erectile dysfunction or PMS

Persistent/wandering dental sensitivity

High blood pressure, heart disease

Gum recession and/or redness

Diabete type 2 , bloating after meals

Clicking/locking jaw joints, zig zag jaw opening

Weight gain, pot belly, acid reflux

Morning headache and/or sore jaws

Daytime sleepiness, fatigue

Deep overbite or underbite (weak chin)

Senile memory, ADD/ADHD

Frequent cavities or broken/chipped teeth

Frequent colds, flu, and skin disorders

Teeth prints on the sides of the tongue

Obstructive sleep apnea from a sleep test

Bony outgrowth on palate or inside lower jaw

Stuffy/runny nose, scratchy/itchy throat

Sunken lips and reverse smile curve (sad)

Forward head: ears ahead of shoulders

History of teeth extractions for braces

Waking up to urinate more than once

Bulge under lower jaw, double chin

Large neck size (M>17, W>15)

History of lots of dental work + medical symptoms

Poor digestion and elimination

Malocclusion (crowded teeth)

Depression, anxiety, grouchiness

Total Mouth Score

Total Body Score

Name

Phone

DOWNLOAD THE QUIZ FOR FREE

Have all your current and new patients do this self-survey, and you will soon see how many Impaired Mouth Syndrome cases are waiting for you to show up as an AMD or Integrative Mouth Consultant.