Smile Analysis

1) Are any of your teeth yellow, stained or somewhat discolored?
YesNo
2) Would you like your teeth to be whiter?
YesNo
3) Do you have any gaps or spaces between your teeth?
YesNo
4) Are any of your teeth turned, crooked, or uneven?
YesNo
5) Are you missing any teeth?
YesNo
6) Do you see any pitting or defects on the surfaces of your teeth?
YesNo
7) Are the edges of any teeth worn down, chipped or uneven?
YesNo
8) Do any of your teeth appear too small, short, large or long?
YesNo
9) Do you have any prior dental work that appears unnatural?
YesNo
10) Do you have any crowns or bridges that appear dark at the edge of your gums?
YesNo
11) Do you have any gray, black or silver (mercury) fillings in your teeth?
YesNo
12) Do you have a "gummy" smile (too much of your gums show when smiling)?
YesNo
13) Are your gums red, sore, puffy, bleeding or receded?
YesNo
14) Does the appearance of your smile inhibit you from laughing or smiling?
YesNo
15) When being photographed, do you smile with your lips closed instead of flashing a full smile?
YesNo
16) Are you self-conscious about your teeth or smile?
YesNo
17) Would you like to change anything about the appearance of your teeth or smile?
YesNo

Anything else you would like to let us know?