Table 1 Questionnaire including the various components of oral health

Questions

Do you have:

☐ natural teeth

☐ natural teeth in combination with a removable partial denture

☐ removable complete dentures

☐ no natural teeth, no removable dentures

What is the time period since your last visit to an oral health care provider?

☐ Less than one year

☐ 1–5 year(s)

☐ 5–10 years

☐ 10–20 years

Do you experience pain or discomfort in your mouth?

☐ Yes

☐ No

☐ Sometimes

Are you able to chew adequately?

☐ Yes

☐ Rather good

☐ Poor

☐ No

Which option does apply to your situation?*

☐ My mouth feels dry when eating

☐ My mouth feels dry

☐ I have difficulty eating dry foods

☐ I have difficulties swallowing certain foods

☐ My lips feel dry