[p.190]
Section R -- Orofacial Pain
Check Item 1
Status of sample person.
1[] Available (Intro)
2[] Callback required (Hhld page of HIS-1)
3[] Noninterview (Section T)
Intro
These next questions concern conditions of the teeth, mouth, or face. Tell me if you experienced any of these conditions more than once in the past 6 months.
Check Item 2
Refer to 4b and 5f, "Dental" page 26, for sample person.
8[] Other (1)
1a. During the past 6 months, did you have a toothache more than once, when biting or chewing?
2[] No (2)
b. Did you first have this pain more than 6 months ago?
2[] No
2a. (During the past 6 months) Did you have painful sores or irritations around the lips or on the tongue, cheeks, or gums more than once?
2[] No (3)
b. Did you first have the sores or irritations more than 6 months ago?
2[] No
3a. (During the past 6 months) Did you have a prolonged, unexplained burning sensation in your tongue or any other part of your mouth more than once?
2[] No (4)
9[] DK (4)
b. When you have this sensation, does it come and go or is it continuous and uninterrupted?
2[] Continuous/uninterrupted
8[] Other
9[] DK
c. During how many different months in the past 6 months did you have this sensation?
d. How many total days in the past 6 months did you have this sensation?
2[] 4-10 days
3[] 11-15 days
4[] 16-30 days
5[] 31-45 days
6[] 46+ days
7[] "Everyday"
9[] DK
e. Did you first have this sensation more than 6 months ago?
2[] No
4a. (During the past 6 months) Did you have pain in the jaw joint or in front of the ear more than once?
2[] No (5)
b. When you have this pain, does it come and go or is it continuous and uninterrupted?
2[] Continuous/uninterrupted
8[] Other
9[] DK
c. During how many different months in the past 6 months did you have this pain?
d. How many total days in the past 6 months did you have this pain?
2[] 4-10 days
3[] 11-15 days
4[] 16-30 days
5[] 31-45 days
6[] 46+ days
7[] "Everyday"
9[] DK
e. Did you first have this pain more than 6 months ago?
2[] No
f. On a scale of 1-10, where 1 is mild and 10 is severe, how would you rate this pain at its worst?
Circle only one.
2[]
3[]
4[]
5[]
6[]
7[]
8[]
9[]
10[]
[p. 191]
Section R -- Orofacial Pain -- Continued
Check Item 3
Refer to 3c, 5c, and 5c.
8[] Other (Section S)
6a. In the past 6 months, did you see or talk to a dentist for the pain we just discussed?
2[] No (6c)
b. How many times during the last 6 months did you see or talk to a dentist about the pain?
999[] DK
c. (In the past 6 months) Did you see or talk to a medical doctor about the pain?
2[] No (6e)
999[] DK
e. (In the past 6 months) Did you see or talk to any other type of health professional about the pain?
2[] No (6h)
f. What kind of health professional?
g. How many times during the past 6 months did you see or talk to the (person in 6f)?
999[] DK
h. (In the past 6 months) Did you worry about the health of your teeth and gums because of the pain?
2[] No
i. (In the past 6 months) Did you worry about the health of your body because of the pain?
2[] No
Hand Card R1. Read list if telephone interview.
Card R1
2. Take a prescription drug
3. Take an over-the-counter drug
4. Drink some liquor or wine because of the pain
5. Take time off work
6. Stay home more than usual
7. Avoid family and friends
8. Something else
7. Here is a list of things people do when they have teeth, mouth, or face pain. Please tell me the things you did for the pain during the past 6 months.
Circle all that apply.
2[] Take a prescription drug
3[] Take an over-the-counter drug
4[] Drink some liquor or wine because of the pain
5[] Take time off work
6[] Stay home more than usual
7[] Avoid family and friends
8[] Anything else? (Specify) ____
0[] None of the above
9[] Don't know