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, This questionnaire is about the effects of oral conditions on children's well-being and everyday life, and the effects on their families. We are in-terested in any condition that involves teeth, lips, mouth or jaws, INSTRUCTIONS TO PARENTS, vol.1
, To answer the question please put an ' in the box by the response
, Please give the response that best describes your child's experience. If The question does not apply to your child
How often has your child had a hard time paying attention in school ? If your child has had a hard time paying attention in school because of problems with his/her teeth, lips, mouth or jaws, choose the appropriate response. If it has happened for other reasons ,
Never Once or twice Sometimes Often Everyday or Don't know almost everyday ,
, Please do not discuss the questions with your child, as we are interested only in the parents' perspective in this questionnaire. SECTION 1 : Child's oral health and wellbeing 1. How would you rate the health of your child's teeth, lips, jaws and mouth ? Excellent Very good Good Fair Poor
, How much is your child's overall wellbeing affected by the condition of his/her teeth, lips, jaws or mouth ? Not at all Very little Some A lot Very much SECTION 2 : The following questions ask about symptoms and dis-comfort that children may experience due to the condition of their teeth, lips, mouth and jaws During the last 3 months
, jaws or mouth ? Never Once or twice Sometimes Often Everyday or Don't know almost everyday 4. Bleeding gums ? Never Once or twice Sometimes Often Everyday or Don't know almost everyday
, Sores in the mouth ?
, Never Once or twice Sometimes Often Everyday or Don't know almost everyday During the last 3 months, because of his/her teeth, lips, mouth, or jaws, how often has your child : 10. Breathed through the mouth ? Never Once or twice Sometimes Often Everyday or Don't know almost everyday 11. Had trouble sleeping ? Never Once or twice Sometimes Often Everyday or Don't know almost everyday 12, Difficulty biting or chewing foods such as fresh apple
, During the last 3 months, because of his/her teeth, lips, mouth, or jaws, how often has your child : 16. Had diet restricted to certain types of food
, Worried that he/she is not as good-looking as other people ? Never Once or twice Sometimes Often Everyday or Don't know almost everyday 28. Acted shy or embarrassed ? Never Once or twice Sometimes Often Everyday or Don't know almost everyday 29. Been teased or called names by other children ? Never Once or twice Sometimes Often Everyday or Don't know almost everyday 30. Been left out by other children ? Never Once or twice Sometimes Often Everyday or Don't know almost everyday 31. Not wanted or been unable to spend time with other children ? Never Once or twice Sometimes Often Everyday or Don't know almost everyday 32. Not wanted or been unable to participate in activities such as sport, clubs, drama, music, school trips ? Never Once or twice Sometimes Often Everyday or Don't know almost everyday 33. Worried that he/she has fewer friends ? Never Once or twice Sometimes Often Everyday or Don't know almost everyday During the last 3 months, how often has your child been : 34.Concerned what other people think about his/her teeth, lips, mouth or jaws ? Never Once or twice Sometimes Often Everyday or Don't know almost everyday 35.Asked questions by other children about his/her teeth, lips, mouth or jaws ? Never Once or twice Sometimes Often Everyday or Don't know almost everyday SECTION 4 : The following questions ask about effects that a child's oral condition may have on PARENTS AND OTHER FAMILY MEMBERS During the last 3 months, because of your child's teeth, lips, mouth or jaws, how often have you or another family member : 36. Been upset ? Never Once or twice Sometimes Often Everyday or Don't know almost everyday 37, p.25
, Never Once or twice Sometimes Often Everyday or Don't know almost everyday 40. Had less time for yourself or the family ? Never Once or twice Sometimes Often Everyday or Don't know almost everyday 41. Worried that your child will have fewer life opportunities (e.g. for dating, getting married, having children
, stores, restaurants) with your child ? Never Once or twice Sometimes Often Everyday or Don't know almost everyday During the last 3 months, because of his/her teeth, lips, mouth, or jaws, how often has your child : the family ? Never Once or twice Sometimes Often Everyday or Don't know almost everyday During the last 3 months, how often has the condition of your child's teeth, lips, mouth or jaws : 47.Interfered with family activities at home or elsewhere ? Never Once or twice Sometimes Often Everyday or Don't know almost everyday 48. Caused disagreement or conflict in your family ? Never Once or twice Sometimes Often Everyday or Don't know almost everyday 49. Caused financial difficulties for your family ? Never Once or twice Sometimes Often Everyday or Don't know almost everyday ___________________________________________________________________________ SITBON Olivier, Never Once or twice Sometimes Often Everyday or Don't know almost everyday 42. Felt uncomfortable in public places, pp.46-49
, Sous la direction de : Mme le Docteur RAJABO Noëline et sous la co-direction