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. |
Child Impacts |
How often has your child had pain in the teeth, mouth or jaws? |
How often has your child ....because of dental problems or dental treatments? |
   had difficulty drinking hot or cold beverages |
   had difficulty eating some foods |
   had difficulty pronouncing any words |
   missed preschool, daycare or school |
   had trouble sleeping |
   been irritable or frustrated |
   avoided smiling or laughing |
   avoided talking |
Family Impacts |
How often have you or another family member member......because of your child's dental problems or treatments? |
   been upset |
   felt guilty |
   taken time off from work |
How often has your child had dental problems or dental treatments that had a finacial impact on your family? |