| OHIP questions | Very often | Fairly often | Occasionally | Rarely | Never |
| 1) Have you had difficult chewing any food because of problem with your teeth? |
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| 2) Have you had trouble pronouncing any words because of problems with your teeth? |
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| 3) Has your sense of taste been affected by problems with your teeth? |
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| 4) Have you had painful aching anywhere in your teeth? |
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| 5) Have you been self-conscious because of your teeth? |
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| 6) Have you felt tense because of problems with your teeth? |
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| 7) Has your diet been unsatisfactory because of problems with your teeth? |
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| 8) Have you had to interrupt meals because of problems with your teeth? |
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| 9) Have you found it difficult to relax because of problems with your teeth? |
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| 10) Have you been embarrassed because of your teeth? |
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| 11) Have you been a bit irritable with other people because of your teeth? |
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| 12) Have you had difficulty doing your usual jobs (or attending school) because of problems with your teeth? |
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| 13) Have you found life less satisfying because of problems with your teeth? |
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| 14) Have you been unable to perform the usual functions because of problems with your teeth? |
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