ID

10505

Description

Tooth Sensitivity Questionnaire (PO1) NCT00867997 Noncarious Cervical Lesion Treatment Outcomes Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=23E09830-4E68-45B0-E044-0003BA3F9857

Link

https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=23E09830-4E68-45B0-E044-0003BA3F9857

Keywords

Versions (3)
  1. 9/19/12 9/19/12 -
  2. 6/2/15 6/2/15 -
  3. 6/3/15 6/3/15 -
Uploaded on

June 3, 2015

DOI

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License

Creative Commons BY-NC 3.0 Legacy
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Tooth Sensitivity Questionnaire (PO1) NCT00867997

English

No Instruction available.

1 forms  
  1. StudyEvent: Tooth Sensitivity Questionnaire (PO1)
    1. No Instruction available.
Tooth Sensitivity Assessment
Description

Tooth Sensitivity Assessment

When I eat cold food or drink cold liquids, I feel
Description

ToothSensitivityColdAssessmentScale

Data type

text

Alias
NCI Thesaurus ObjectClass
C12506
UMLS 2011AA ObjectClass
C0040426
NCI Thesaurus ObjectClass-2
C25201
UMLS 2011AA ObjectClass-2
C1522640
NCI Thesaurus Property
C25367
NCI Thesaurus Property-2
C62180
UMLS 2011AA Property
C0009264
NCI Thesaurus ValueDomain
C25664
UMLS 2011AA ValueDomain
C0349674
When I eat hot food or drink hot liquids, I feel
Description

ToothSensitivityHotAssessmentScale

Data type

text

Alias
NCI Thesaurus ObjectClass
C12506
UMLS 2011AA ObjectClass
C0040426
NCI Thesaurus ObjectClass-2
C25201
UMLS 2011AA ObjectClass-2
C1522640
NCI Thesaurus Property
C25367
NCI Thesaurus Property-2
C62181
UMLS 2011AA Property
C2350229
NCI Thesaurus ValueDomain
C25664
UMLS 2011AA ValueDomain
C0349674
When I eat sweet food or drink sweet liquids, I feel
Description

ToothSensitivitySweetAssessmentScale

Data type

text

Alias
NCI Thesaurus ObjectClass
C12506
UMLS 2011AA ObjectClass
C0040426
NCI Thesaurus ObjectClass-2
C25201
UMLS 2011AA ObjectClass-2
C1522640
NCI Thesaurus Property
C25367
NCI Thesaurus Property-2
C62182
UMLS 2011AA Property
C1537081
NCI Thesaurus ValueDomain
C25664
UMLS 2011AA ValueDomain
C0349674
When I chew food in general, I feel
Description

ToothSensitivityMasticationAssessmentScale

Data type

text

Alias
NCI Thesaurus ObjectClass
C12506
UMLS 2011AA ObjectClass
C0040426
NCI Thesaurus ObjectClass-2
C25201
UMLS 2011AA ObjectClass-2
C1522640
NCI Thesaurus Property
C25367
NCI Thesaurus Property-2
C62062
UMLS 2011AA Property
C0024888
NCI Thesaurus ValueDomain
C25664
UMLS 2011AA ValueDomain
C0349674
When I clench my teeth together, I feel
Description

ToothSensitivityPressureAssessmentScale

Data type

text

Alias
NCI Thesaurus ObjectClass
C12506
UMLS 2011AA ObjectClass
C0040426
NCI Thesaurus ObjectClass-2
C25201
UMLS 2011AA ObjectClass-2
C1522640
NCI Thesaurus Property
C25367
NCI Thesaurus Property-2
C25195
UMLS 2011AA Property
C0033095
NCI Thesaurus ValueDomain
C25664
UMLS 2011AA ValueDomain
C0349674
I experience sensitivity not related to any of the above in this tooth
Description

PatientToothQuadrantSensitivityAssessmentScale

Data type

text

Alias
NCI Thesaurus ObjectClass
C16960
UMLS 2011AA ObjectClass
C0030705
NCI Thesaurus Property
C20989
UMLS 2011AA Property
C0031809
NCI Thesaurus Property-2
C61106
UMLS 2011AA Property-2
C1631280
NCI Thesaurus Property-3
C12506
UMLS 2011AA Property-3
C0040426
NCI Thesaurus Property-4
C25201
UMLS 2011AA Property-4
C1522640
NCI Thesaurus ValueDomain
C25664
UMLS 2011AA ValueDomain
C0349674
Date Form Completed
Description

Date Form Completed

Date Form Completed
Description

FormCompleteDate

Data type

date

Alias
NCI Thesaurus ValueDomain
C25164
UMLS 2011AA ValueDomain
C0011008
NCI Thesaurus ObjectClass
C40988
UMLS 2011AA ObjectClass
C1516308
NCI Thesaurus Property
C25250
UMLS 2011AA Property
C0205197
NCI Thesaurus ValueDomain-2
C25367
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Similar models

No Instruction available.

1 forms
  1. StudyEvent: Tooth Sensitivity Questionnaire (PO1)
    1. No Instruction available.
Name
Type
Description | Question | Decode (Coded Value)
Data type
Alias
Item Group
Tooth Sensitivity Assessment
Item
When I eat cold food or drink cold liquids, I feel
text
C12506 (NCI Thesaurus ObjectClass)
C0040426 (UMLS 2011AA ObjectClass)
C25201 (NCI Thesaurus ObjectClass-2)
C1522640 (UMLS 2011AA ObjectClass-2)
C25367 (NCI Thesaurus Property)
C62180 (NCI Thesaurus Property-2)
C0009264 (UMLS 2011AA Property)
C25664 (NCI Thesaurus ValueDomain)
C0349674 (UMLS 2011AA ValueDomain)
CL.7
Code List
When I eat cold food or drink cold liquids, I feel
CL Item
1 (1)
CL Item
2 (2)
C66833 (NCI Thesaurus)
C0205448 (UMLS 2011AA)
CL Item
3 (3)
CL Item
4 (4)
CL Item
5 (5)
CL Item
6 (6)
CL Item
7 (7)
CL Item
8 (8)
CL Item
9 (9)
CL Item
10 (10)
Item
When I eat hot food or drink hot liquids, I feel
text
C12506 (NCI Thesaurus ObjectClass)
C0040426 (UMLS 2011AA ObjectClass)
C25201 (NCI Thesaurus ObjectClass-2)
C1522640 (UMLS 2011AA ObjectClass-2)
C25367 (NCI Thesaurus Property)
C62181 (NCI Thesaurus Property-2)
C2350229 (UMLS 2011AA Property)
C25664 (NCI Thesaurus ValueDomain)
C0349674 (UMLS 2011AA ValueDomain)
CL.8
Code List
When I eat hot food or drink hot liquids, I feel
CL Item
1 (1)
CL Item
2 (2)
C66833 (NCI Thesaurus)
C0205448 (UMLS 2011AA)
CL Item
3 (3)
CL Item
4 (4)
CL Item
5 (5)
CL Item
6 (6)
CL Item
7 (7)
CL Item
8 (8)
CL Item
9 (9)
CL Item
10 (10)
Item
When I eat sweet food or drink sweet liquids, I feel
text
C12506 (NCI Thesaurus ObjectClass)
C0040426 (UMLS 2011AA ObjectClass)
C25201 (NCI Thesaurus ObjectClass-2)
C1522640 (UMLS 2011AA ObjectClass-2)
C25367 (NCI Thesaurus Property)
C62182 (NCI Thesaurus Property-2)
C1537081 (UMLS 2011AA Property)
C25664 (NCI Thesaurus ValueDomain)
C0349674 (UMLS 2011AA ValueDomain)
CL.9
Code List
When I eat sweet food or drink sweet liquids, I feel
CL Item
1 (1)
CL Item
2 (2)
C66833 (NCI Thesaurus)
C0205448 (UMLS 2011AA)
CL Item
3 (3)
CL Item
4 (4)
CL Item
5 (5)
CL Item
6 (6)
CL Item
7 (7)
CL Item
8 (8)
CL Item
9 (9)
CL Item
10 (10)
Item
When I chew food in general, I feel
text
C12506 (NCI Thesaurus ObjectClass)
C0040426 (UMLS 2011AA ObjectClass)
C25201 (NCI Thesaurus ObjectClass-2)
C1522640 (UMLS 2011AA ObjectClass-2)
C25367 (NCI Thesaurus Property)
C62062 (NCI Thesaurus Property-2)
C0024888 (UMLS 2011AA Property)
C25664 (NCI Thesaurus ValueDomain)
C0349674 (UMLS 2011AA ValueDomain)
CL.10
Code List
When I chew food in general, I feel
CL Item
1 (1)
CL Item
2 (2)
C66833 (NCI Thesaurus)
C0205448 (UMLS 2011AA)
CL Item
3 (3)
CL Item
4 (4)
CL Item
5 (5)
CL Item
6 (6)
CL Item
7 (7)
CL Item
8 (8)
CL Item
9 (9)
CL Item
10 (10)
Item
When I clench my teeth together, I feel
text
C12506 (NCI Thesaurus ObjectClass)
C0040426 (UMLS 2011AA ObjectClass)
C25201 (NCI Thesaurus ObjectClass-2)
C1522640 (UMLS 2011AA ObjectClass-2)
C25367 (NCI Thesaurus Property)
C25195 (NCI Thesaurus Property-2)
C0033095 (UMLS 2011AA Property)
C25664 (NCI Thesaurus ValueDomain)
C0349674 (UMLS 2011AA ValueDomain)
CL.11
Code List
When I clench my teeth together, I feel
CL Item
1 (1)
CL Item
2 (2)
C66833 (NCI Thesaurus)
C0205448 (UMLS 2011AA)
CL Item
3 (3)
CL Item
4 (4)
CL Item
5 (5)
CL Item
6 (6)
CL Item
7 (7)
CL Item
8 (8)
CL Item
9 (9)
CL Item
10 (10)
Item
I experience sensitivity not related to any of the above in this tooth
text
C16960 (NCI Thesaurus ObjectClass)
C0030705 (UMLS 2011AA ObjectClass)
C20989 (NCI Thesaurus Property)
C0031809 (UMLS 2011AA Property)
C61106 (NCI Thesaurus Property-2)
C1631280 (UMLS 2011AA Property-2)
C12506 (NCI Thesaurus Property-3)
C0040426 (UMLS 2011AA Property-3)
C25201 (NCI Thesaurus Property-4)
C1522640 (UMLS 2011AA Property-4)
C25664 (NCI Thesaurus ValueDomain)
C0349674 (UMLS 2011AA ValueDomain)
CL.12
Code List
I experience sensitivity not related to any of the above in this tooth
CL Item
Not At All (Not at all)
C91213 (NCI Thesaurus)
CL Item
Hardly Ever (Hardly ever)
CL Item
Occasionally (Occasionally)
CL Item
Fairly Often (Fairly often)
CL Item
Very Often (Very often)
Item Group
Date Form Completed
FormCompleteDate
Item
Date Form Completed
date
C25164 (NCI Thesaurus ValueDomain)
C0011008 (UMLS 2011AA ValueDomain)
C40988 (NCI Thesaurus ObjectClass)
C1516308 (UMLS 2011AA ObjectClass)
C25250 (NCI Thesaurus Property)
C0205197 (UMLS 2011AA Property)
C25367 (NCI Thesaurus ValueDomain-2)
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