XEROSTOMIA XEROSTOMIA XEROSTOMIA XEROSTOMIA XEROSTOMIA
Questions: Questions: never sometimes always
1 Do you drink some liquid to help swallow the food?
2 Do you feel your mouth is dry during meals?
3 Do you get up at night to take liquids?
4 Do you feel dry mouth?
5 Do you have difficulty eating dry foods?
6 Do you eat candy or treats to relieve dry mouth?
7 Do you have difficulty swallowing certain foods?
8 Does your face feel dry?
9 Do your eyes feel dry?
10 Do your lips feel dry?
11 Does the inside of your nose feel dry?
SCORE: SCORE: SCORE: SCORE: SCORE:
ANSWER OPTIONS: NEVER = 1; SOMETIMES = 2; ALWAYS = 3. ANSWER OPTIONS: NEVER = 1; SOMETIMES = 2; ALWAYS = 3. ANSWER OPTIONS: NEVER = 1; SOMETIMES = 2; ALWAYS = 3. ANSWER OPTIONS: NEVER = 1; SOMETIMES = 2; ALWAYS = 3. ANSWER OPTIONS: NEVER = 1; SOMETIMES = 2; ALWAYS = 3.