Purpose: The aim of this study was to assess the relative weights of each factor related to tooth retention identified in our previous study with an objective of developing a risk assessment tool that could be incorporated into a selfadministered oral salutogenic checklist. Materials and Methods: Oral health status and lifestyle were investigated in 777 subjects aged >= 20 years. Eleven items that had a statistically significant odds ratio of being related to the number of retained teeth in our previous study were identified. Discriminant analysis was used to calculate the scores for each item. Results: Based on the discriminant analysis, the variables affecting tooth retention, from the most to the least important, were 'gum swelling' (1.241), followed by 'toothache' (0.766) and 'do you have any hobbies' (0.691). Based on the above analysis, a total of 20 points were allocated in proportion to the ranges. The final oral salutogenic score (OSS) was swollen gums (4), toothache (3), frequency of between-meal snacks (3), having some hobbies (3), having a family clinician (2), consulting a clinician when having dental symptoms (1), bleeding gums (1), frequency of tooth brushing (1), having one's own toothbrush (1) and smoking (1). Conclusions: A self-administered checklist for the OSS was designed. The first part contains a list of questions for the participants to fill out. The second part offers comments depending on the range of score values. The suggestions include advice to decrease or to stop the behaviours for which the subject obtained zero points. Keywords: behaviours, checklist, salutogenic, tooth loss