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