Name: Age: Date: Male/Female Types of Malocclusion: Types of work: Removable appliance/Separator placement/Initial arch wire placement/ Canine

retraction/ Arch contraction. Questions: 1. Did you feel pain? Yes/No 2. Pain during Day/Night/Day and Night 3. Pain site: Gums/Lips/Tongue/Cheek/Anterior teeth/Posterior teeth/ Temporomandibular joint 4. How much does is hurt? No pain 5. Pain during chewing? Very comfortable 6. Pain during Speech? Very comfortable 7. Pain during biting? Very comfortable 8. Headache? No Headache 9. How much the pain influence my daily life? Very Uncomfortable Very Uncomfortable Very Uncomfortable Unbearable headache Unbearable pain

Appendix- 1 DATA COLLECTION SHEET After 4 hrs/24 hrs/2days/3days/4days/5days/6days/7days Reg no:

No effect completely change 10. How much i change my diet because of pain(eg. Avoid hard foods, only soft foods as soup etc) No effect completely change 11. How strongly the pain influence my social life( eg. stay at home more, not see my friends as often etc) No effect completely change

Signature of the Pt. Date:

Signature of the attending doctor Date:

Signature of the Supervisor Date:

Appendix- 1 DATA COLLECTION SHEET After 4 hrs/24 hrs/2days/3days/4days/5days/6days/7days Name: Reg no: Age: Date: Male/Female: Types of Malocclusion: Types of work: Removable appliance/Separator placement/Initial arch wire placement/ canine retraction/ Arch contraction. ck: 1.Avcbvi wK e_v KiQ? nv/ bv 2. KLb e_v KiQ? w`b/ivZ/w`b I ivZ 3. Kv_vq e_v jMQ? gvwoZ/ VvU/ wRnvZ/ Mvj/ mvgbi `uvZ/ wcQbi `uvZ/ Pvqvji RqU 4. KZUzKy e_v jMQ? Kvbv e_v bvB Amnbxq e_v 5. wPevbvi mgq e_v? Kvbv mgmv bvB Amn e_v 6. K_v ejvi mgq e_v? Kvbv mgmv bvB Amn e_v 7. Kvgovbvi mgq e_v? Kvbv mgmv bvB Amn e_v 8. gv_v e_v? bB AbK 9. GB e_v Avcbvi `bw`b KvRKgK KZUzKz wewNZ KiQ? Kvbv cfve bvB cyivcywi cfve djQ 10. GB e_vi Rb Avcbvi Lvevii gbyi wK Kvb cwieZb nqQ? ( hgb, k Lvevi cwinvi KiQb, aygv big Lvevi LqQb, BZvw`) Kvb cwieZb nq wb cwiewZZ nqQ cyivcywi

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Signature of the Pt. Date:

Signature of the attending doctor Date:

Signature of the Supervisor Date: