Jaw Functional Limitation Scale

Question Title

* 1. Please type your name. Surname, First Name

Question Title

* 2. Who is your Physiotherapist?

Question Title

* 3. For each of the items below, please score your level of limitation from 0 (no limitation) to 10 (severe limitation), during the last month.

If the activity has been completely avoided because it is too difficult, then circle ‘10'.

If you avoid an activity for reasons other than pain or difficulty, then leave it blank and explain why below.

  No limitation 0 1 2 3 4 5 6 7 8 9 Severe Limitation 10
Chew tough food
Chew hard bread
Chew chicken (for example, prepared in oven)
Chew crackers
Chew soft food (for example, macaroni, canned or soft fruits, cooked vegetables, fish)
Eat soft food requiring no chewing (for example, mashed potatoes, apple sauce,
pudding, pureed food)
Open wide enough to bite from a whole
Open wide enough to bite into a sandwich
Open wide enough to talk
Open wide enough to drink from a cup
Putting on a happy face
Putting on an angry face

Question Title

* 4. Interpretation of scores (for office use only)

Total score: add up the total scores = _______                  MDC - not published                  SCORE RANGE = 0 (max disability) to 200 (no disability)

This questionnaire is taken from: Ohrbach R, Larsson P, List T (2008). The Jaw Functional Limitation Scale: Development, reliability, and validity of 8-item and 20-item versions. Journal of Orofacial Pain 22: 219-230.