male (0)
female (1)


smoke
tea/coffee
drink red wine


1
2
3
4
5


1
2
3
4
5


1
2
3
4
5


1
2
3
4
5


No (0)
Yes (1)


No (0)
Yes (1)


implants
dentures
crowns
bridges


sensitivity
bad breath
tooth decay
bleeding gums
gingivitis


once a day (1)
twice a day (2)
more than once a day (3)
less than once a day (4)


floss
mouth wash
whitening