Home | Help | Contact Us

 MALE QUESTIONNAIRE - PAGE 3(d) 

  < You are on page 3(d) of 9


This section deals with specific mouth problems.
330.  Do you have any kind of bad or abnormal taste in your mouth?
No / rarely / don't know
Yes, some
Yes, significant
331.  Do you have a bitter taste in your mouth, particularly after meals?
No / rarely / don't know
Yes, some
Yes, significant
332.  Do you have a metallic taste in your mouth?
No / rarely / don't know
Yes, some
Yes, significant
333.  Other than ulcers, do you have any tenderness or soreness inside your mouth?
No / don't know
Yes, some
Yes, significant
334.  Have you had any ulcers, sores, or red or white patches in your mouth lasting for more than three weeks? (Aphthous ulcers / canker sores generally heal within a couple of weeks.)
No / don't know
Yes, but not now
Yes, barely noticeable AND lasting under 2 months
Yes, significant OR lasting over 2 months
Yes, significant AND lasting over 2 months
335.  Do you have a rough, raw or sore sensation in the back of your mouth or throat?
No / don't know
No
Not currently, but happens frequently
Yes, somewhat sore
Yes, very sore
336.  Is your tongue sore?
No / don't know
Occasionally / a little
Often / very
337.  Is your tongue swollen or inflamed?
No / don't know
Somewhat / occasionally
Very / often

Add any additional information here for the questions above:

Please mention the question number(s) if possible.

 


 


GLOSSARY

Canker Sores (Aphthous Ulcers, Apthous Stomatitis)
Small, painful ulcers that occur on the inside of the cheek, lip or underside of the tongue. Caused by an assortment of viruses, doctors call this condition aphthous stomatitis. Canker sores usually clear up by themselves within a week or so, but they often recur, sometimes in the form of multiple sores.

Ulcer (Ulceration, Ulcers)
Lesion on the skin or mucous membrane.





























 

Home | Help | Contact Us
Design by: RoyalWebHosting.com