No.	Question	No	Yes
1	Do you have periodontal disease or gum disease?	□	□
2	Have you ever been told by a dentist that you have periodontal/gum disease with bone loss?	□	□
3	Have you ever been told that you need periodontal or gum treatment?	□	□
4	Have you ever had any form of periodontal or gum treatment?	□	□
5	Do your gums usually bleed?	□	□
6	Has any dentist or dental hygienist told you that you have deep pockets?	□	□
7	Do you find any area more red than it should be?	□	□
8	Do you have mobility in your teeth?	□	□
9	Do you notice changes in your teeth?	□	□
10	Do you feel pain in your gum?	□	□
11	Do you have food impaction between your teeth?	□	□
12	Do you notice that your teeth getting longer?	□	□
13	Do you feel any sensitivity in your teeth?	□	□
14	Do you notice bad odor from your mouth?	□	□
15	Do you have any abscesses in your mouth?	□	□
16	Do you have calculus/tartar on your teeth?	□	□
17	Do you feel your mouth dry?	□	□
18	Have you ever had periodontal surgery?	□	□

The final self-reported periodontal disease measure (questionnaire) consists of six questions: Q1, Q2, Q7, Q8, Q11 and Q12.