Oral Health Needs Assessment of Cancer Patient by Health Professionals

1. Oral Health Needs Assessment of Cancer Patient by Health Professionals

 
The purpose of the following survey is to assess the oral health needs of people living with cancer and to provide feedback about the OHCCP website.

This survey is voluntary and you may elect not to participate. Your completion of the survey, in whole or in part, indicates your willingness to participate and will serve as consent. There is no compensation for participating and there are no risks or benefits associated with completing the survey. Your answers are kept confidential and your responses will not be name linked to any summary information.

All collective information will exclusively be used for purposes of web development only.
1. Age of patient
2. Sex of patient
3. Location of patient
4. Please choose your highest level of education completed, job title, and average number of cancer patients seen per month from the drop down menus below.
ow many years of school did you complete?What is your job title?On average, how many cancer patients do you see per month that are actively receiving cancer therapy?
ducation and Professional Information
5. Due to chemotherapy and/or radiation therapy, my cancer patients generally present with the following conditions (please specify how many times per month you see a cancer patient with the following conditions):
1 patient/month2-5 patients/month6-10 patients/month11-15 patients/month16-20 patients/month20+ patients/month
mucositis
painful mouth and gums
oral and systemic infections
xerostomia
rampant tooth decay
burning, peeling or swelling tongue
stiffness in the jaw
impaired ability to eat, speak or swallow
change in ability to taste
poor diet because of problems eating
osteonecrosis of the jaw
hyposalivary function
candidaisis
gingivitis
periodontitis
sialadentitis
fissured tongue
6. Due to chemotherapy and/or radiation therapy, my cancer patients generally need/have needed the following treatments (please specify how many times per month you see a cancer patient that needs/has needed the following treatments):
1 patient/month2-5 patients/month6-10 patients/month11-15 patients/month16-20 patients/month20+ patients/month
Cleaning
Fluoride treatments
Filling(s)
Crown(s)
Extraction(s)
Endodontic therapy
Scaling/root planing
Periodontal maintenance
Debridement
Bridge
Implant
Complete denture - maxillary
Complete denture - mandibular
Complete denture - full
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