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| Lifestyle | |
| (1) Do you live a regular life rhythm? (Yes, No) | |
| (2) Do you have a regular sleep? (Yes, No) | |
| (3) Do you perform regular physical activity? (Yes, No) | |
| (4) Do you have current tobacco habit? (No, Yes) | |
| (5) Do you drink alcohol? (No, Yes) | |
| Stress | |
| (6) Do you feel stressed? (No, Yes) | |
| Oral hygiene habit | |
| (7) Do you observe your teeth and/or gum using a mirror? (Yes, No) | |
| (8) Do you use an interdental brush and/or dental floss? (Yes, No) | |
| (9) Do you spend enough time for tooth brushing? (Yes, No) | |
| Subjective oral health symptom | |
| (10) Have you choked? (No, Yes) | |
| (11) Do you feel mouth dry? (No, Yes) | |
| Eating behavior | |
| (12) Do you have a deviated food habit? (No, Yes) | |
| (13) How many times do you chew before swallowing? (more than 30 times, fewer than 30 times | |
| Subjective masticatory ability | |
| (14) Can you chew all foods well? (Yes, No) | |
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