Patient Information
Smile Analysis
Patient Information
Smile Analysis
Your smile affects your self-image, and can greatly influence the quality of your interactions with others. Many people hold back from laughing or smiling because they are uncomfortable about their appearance when they do. The following questions are designed to honestly appraise your smile. Go to a mirror, smile as wide as you can, and ask yourself the following questions:
Are any of your teeth yellow, stained or somewhat discolored?
Yes
No
Are any of your teeth yellow, stained or somewhat discolored?
Yes
No
Are any of your teeth yellow, stained or somewhat discolored?
Yes
No
Would you like your teeth to be whiter?
Yes
No
Would you like your teeth to be whiter?
Yes
No
Would you like your teeth to be whiter?
Yes
No
Do you have any gaps or spaces between your teeth?
Yes
No
Do you have any gaps or spaces between your teeth?
Yes
No
Do you have any gaps or spaces between your teeth?
Yes
No
Are any of your teeth turned, crooked, or uneven?
Yes
No
Are any of your teeth turned, crooked, or uneven?
Yes
No
Are any of your teeth turned, crooked, or uneven?
Yes
No
Are you missing any teeth?
Yes
No
Are you missing any teeth?
Yes
No
Are you missing any teeth?
Yes
No
Do you see any pitting or defects on the surfaces of your teeth?
Yes
No
Do you see any pitting or defects on the surfaces of your teeth?
Yes
No
Do you see any pitting or defects on the surfaces of your teeth?
Yes
No
Are the edges of any teeth worn down, chipped or uneven?
Yes
No
Are the edges of any teeth worn down, chipped or uneven?
Yes
No
Are the edges of any teeth worn down, chipped or uneven?
Yes
No
Do any of your teeth appear too small, short, large or long?
Yes
No
Do any of your teeth appear too small, short, large or long?
Yes
No
Do any of your teeth appear too small, short, large or long?
Yes
No
Do you have any prior dental work that appears unnatural?
Yes
No
Do you have any prior dental work that appears unnatural?
Yes
No
Do you have any prior dental work that appears unnatural?
Yes
No
Do you have any crowns or bridges that appear dark at the edge of your gums?
Yes
No
Do you have any crowns or bridges that appear dark at the edge of your gums?
Yes
No
Do you have any crowns or bridges that appear dark at the edge of your gums?
Yes
No
Do you have any gray, black or silver (mercury) fillings in your teeth?
Yes
No
Do you have any gray, black or silver (mercury) fillings in your teeth?
Yes
No
Do you have any gray, black or silver (mercury) fillings in your teeth?
Yes
No
Do you have a "gummy" smile (too much of your gums show when smiling)?
Yes
No
Do you have a "gummy" smile (too much of your gums show when smiling)?
Yes
No
Do you have a "gummy" smile (too much of your gums show when smiling)?
Yes
No
Are your gums red, sore, puffy, bleeding or receded?
Yes
No
Are your gums red, sore, puffy, bleeding or receded?
Yes
No
Are your gums red, sore, puffy, bleeding or receded?
Yes
No
Does the appearance of your smile inhibit you from laughing or smiling?
Yes
No
Does the appearance of your smile inhibit you from laughing or smiling?
Yes
No
Does the appearance of your smile inhibit you from laughing or smiling?
Yes
No
When being photographed, do you smile with your lips closed instead of flashing a full smile?
Yes
No
When being photographed, do you smile with your lips closed instead of flashing a full smile?
Yes
No
When being photographed, do you smile with your lips closed instead of flashing a full smile?
Yes
No
Are you self-conscious about your teeth or smile?
Yes
No
Are you self-conscious about your teeth or smile?
Yes
No
Are you self-conscious about your teeth or smile?
Yes
No
Would you like to change anything about the appearance of your teeth or smile?
Yes
No
Would you like to change anything about the appearance of your teeth or smile?
Yes
No
Would you like to change anything about the appearance of your teeth or smile?
Yes
No
If you answered YES to ANY of the questions above, there are often several alternatives to improve your teeth and smile. To receive a personalized response to your smile analysis, please complete the form below.
You can have the smile you’ve always wanted! To schedule an office consultation, contact us today.
Smile Start
Book Your Family Dental Visit Today
Begin with your basic details — from preventive check-ups to cosmetic care — and we’ll guide your next steps.
Smile Start
Book Your Family Dental Visit Today
Begin with your basic details — from preventive check-ups to cosmetic care — and we’ll guide your next steps.
Smile Start
Book Your Family Dental Visit Today
Begin with your basic details — from preventive check-ups to cosmetic care — and we’ll guide your next steps.
