Table 2.

Short Forms for Parents and Children to Measure RFTN and COHSI.

	Child Short Form			Parent Short Form
Domains	Outcome	Item Questions	Response Dategories	Outcome	Item Questions	Response Categories
PHY/ Symptoms	COHSI	It hurts my teeth to chew.	Always (1); Almost Always (2); Often (3);Sometimes (4); Almost Never (5); Never (6).
PHY/ Symptoms	COHSI	My teeth are straight. C_TEETHA	No (0); Yes (1).
PHY/ Symptoms				COHSI	My child’s mouth hurts. P_CHOPA	Always (1); Almost Always (2); Often (3); Sometimes (4); Almost Never (5); Never (6).
PHY/ Symptoms	RFTN	It was hard for me to eat because of the pain in my mouth. C_CHOPF	Always (1); Almost Always (2); Often (3);Sometimes (4); Almost Never (5); Never (6).	Both	It was hard for my child to eat because of pain in his or her mouth. P_CHOPF	Always (1); Almost Always (2); Often (3); Sometimes (4); Almost Never (5); Never (6).
PHY/ Symptoms				RFTN	During the last school year, how many days of school did your child miss because of pain in his/her mouth, tongue, teeth, or gums? P_SCHMISS	4 or more days (1); 2 to 3 days (2); 1 day (3); None (4).
PHY/ Functions	Both	In general, would you say your overall oral health is: C_HEALT	Poor (1); Fair (2); Good (3); Very Good (4); Excellent (5).	Both	In general, would you say your child’s oral health is: P_CLDHEALT	Poor (1); Fair (2); Good (3); Very Good (4); Excellent (5).
PHY/ Functions	Both	In the last 4 wk, how much of the time did you limit the kinds or amounts of foods because of problems with your mouth, tongue, teeth, jaws or gums? C_PHYFUNC	Always (1); Almost Always (2); Often (3); Sometimes (4); Almost Never (5); Never (6).
MEN/ Affect	COHSI	How much are you afraid to go to a dentist? C_AFRAID	A great deal (1); Somewhat (2); A little bit (3); Not at all (4).
MEN/ Affect	Both	In the last 4 wk, how much of the time were you pleased or happy with the look of your mouth, teeth, jaws, or gums? C_HAPPY	Never (1); Almost Never (2); Sometimes (3); Often (4); Almost Always (5); Always (6).	Both	In the last 4 wk, how much of the time were you pleased or happy with the look of your child’s mouth, teeth, jaws, or gums? P_SH1	Never (1); Almost Never (2); Sometimes (3); Often (4); Almost Always (5); Always (6).
MEN/ Affect				Both	In the last 4 wk, how much of the time was your child worried or concerned about problems with his/her mouth, tongue, teeth, jaws, or gums? P_WORRY	Always (1); Almost Always (2); Often (3); Sometimes (4); Almost Never (5); Never (6).
MEN/ Behavior	COHSI	How often do you brush your teeth? C_BRUSH	Never (1); A few (2–3) times a month (2); Once a week (3); A few (2–3) times a week (4); Once a day (5); Two or more times a day (6).
MEN/ Cognition	RFTN	It was hard for me to pay attention because of the pain in my mouth. C_CHOPJ	Always (1); Almost Always (2); Often (3); Sometimes (4); Almost Never (5); Never (6).	Both	It was hard for my child to pay attention because of pain in his or her mouth. P_CHOPJ	Always (1); Almost Always (2); Often (3); Sometimes (4); Almost Never (5); Never (6).
MEN/ Cognition	RFTN	How often do you use dental floss on your teeth? C_FLOSS	Never or Don’t know what that is (1); A few (2–3) times a month (2); Once a week (3); A few (2–3) times a week (4); Once a day (5); Two or more times a day (6).
SOC/ Functions	COHSI	Have you ever avoided laughing or smiling because of the way your teeth look? C_TEELOOK1	Yes (0); No (1).
SOC/ Functions				Both	In the last 4 wk, how much of the time did your child’s oral health interfere with his/her social activities? P_OHEFFECT	Always (1); Almost Always (2); Often (3); Sometimes (4); Almost Never (5); Never (6).
SOC/Relation-ships	RFTN	Do other students make jokes about the way your teeth look? C_TEELOOK2	Yes (0); No (1).

COHSI, children’s oral health status index; PHY, physical; MEN, mental; RFTN, referral for treatment needs; SOC, social.