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Medicaid Nursing Facility Dentures Beneficiary Survey

If you received new, replacement or repaired dentures (full or partial), please complete this survey.

You may complete this survey on your own or you may ask someone for help. If you are not feeling well or can’t remember how you felt before getting your dentures or repairs, you can ask the staff or a family member for help or to complete the survey for you.

Section 1. General Information

Please tell us who is completing the survey and about the type of dentures you received:

Type of Full or Partial Dentures Received

Section 2. Nutrition and Communication

For each question below, please choose the box that indicates how strongly you agree with the statement. If you have no opinion, please choose “Neither Agree nor Disagree.”

A. My dentures make it easier for me to eat a wider variety of foods. For example, foods that are crunchy, hard, soft, and chewy.
B. My dentures make it easier for me to eat.
C. Since getting my dentures my weight has improved.
D. My dentures make it easier for people to understand what I am saying.
E. Since I received my dentures, I visit with staff and friends more often.
F. Since I received my dentures, I participate in more activities and/or events.
G. My dentures make it easier for me to tell staff what I need.
H. Since I received my dentures, I have less pain in my mouth.

Section 3. Overall Satisfaction with Dentures

Overall, how have your new dentures improved the quality of your life?
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PREVENTISTRY PULSE

The newsletter designed for anyone who wants to improve oral health for themselves, their families, customers or communities.