Smile Evaluation

Cosmetic dentistry strives to merge function and beauty with the values and individual needs of every patient. Hold a full face mirror about 12 inches from your face in a bright light. Smile to show your teeth. Take time to observe your teeth and gums carefully and bring this completed form to your next appointment. You deserve the smile of your dreams!

1. Do you like the appearance of your teeth and your overall smile?
2. Do you like the color of your teeth?
3. Do you have any spaces between your teeth that bother you?
4. If your teeth are crooked or crowded, does that bother you?
5. Do you feel that your teeth are protruding or receding?
6. Do you have any broken or chipped teeth that bother you?
7. Do you like the size and shape of your teeth?
8. Do you have any unsightly old fillings or dental work?
9. Do you show too much gum when you smile?
10. Are your gums pink and "knife-edged," or are they red and swollen?
11. In a slight smile, with your teeth parted, do the tips of your teeth show?
12. Are your two upper front teeth slightly longer than the adjacent teeth?
13. Are your two upper front teeth too long or too wide?
14. Are your upper six front teeth even in length?
15. Do your teeth have white or brown stains?
16. Are your lower six front teeth straight and even in appearance?
17. In a full smile, the back teeth normally show. Are your back teeth free of stains and discolorations from unsightly restorations?
18. Do the necks of your teeth indicate erosion, a ditched-in "V," that either can be seen or felt with your fingernail?
19. Do your restorations - fillings, laminates and crowns - look natural?
20. If you could alter your smile, what would you like to change?
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