"Problems with the teeth, mouth or jaws and their treatment can affect the well-being and everyday lives of children and their families. For each of the following questions please circle the number next to the response that best describes your child's experiences or your own. Consider the child's entire life from birth until now when answering each question. If a question does not apply, check 'Never"' Response options: 1. Never, 2. Hardly ever, 3. Occasionally, 4. Often, 5. Very often and 6. Don't know. |
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1. How often has your child had pain in the teeth, mouth or jaws? (Child symptoms domain) |
How often has your child......because of dental problems or dental treatments? (Child function domain) |
2. had difficulty drinking hot or cold beverages |
3. had difficulty eating some foods |
4. had difficulty pronouncing any words |
5. missed preschool, daycare or school |
How often has your child......because of dental problems or dental treatments? (Child psychological domain) |
6. had trouble sleeping |
7. been irritable or frustrated |
How often as your child......because of dental problems or dental treatments? (Child self-image/social interaction domain) |
8. avoided smiling or laughing when around other children |
9. avoided talking with other children |
How often have you or another family member......because of your child's dental problems or dental treatments? (Parent distress domain) |
10. been upset |
11. felt guilty |
How often.... (Family function domain) |
12. have you or another family member taken time off from work .....because of your child's dental problems or dental treatments |
13. has your child had dental problems or dental treatments that had a financial impact on your family? |