Questiona
Functional limitation Have you had trouble pronouncing any words because of problems with your teeth, mouth or dentures?
Have you felt that your sense of taste has worsened because of problems with your teeth, mouth or dentures?
Physical pain Have you had painful aching in your mouth?
Have you found it uncomfortable to eat any foods because of problems with your teeth, mouth or dentures?
Psychological discomfort Have you been self-conscious because of your teeth, mouth or dentures?
Have you felt tense because of problems with your teeth, mouth or dentures?
Physical disability Has your diet been unsatisfactory because of problems with your teeth, mouth or dentures?
Have you had to interrupt meals because of problems with your teeth, mouth or dentures?
Psychological disability Have you found it difficult to relax because of problems with your teeth, mouth or dentures?
Have you been a bit embarrassed because of problems with your teeth, mouth or dentures?
Social disability Have you been a bit irritable with other people because of problems with your teeth, mouth or dentures?
Have you had difficulty doing your usual jobs because of problems with your teeth, mouth or dentures?
Handicap Have you felt that life in general was less satisfying because of problems with your teeth, mouth or dentures?
Have you been totally unable to function because of problems with your teeth, mouth or dentures?

aAnswers: 0 = never; 1 = hardly ever or nearly never; 2 = occasionally; 3 = fairly often or many times; 4 = very often.