Smile Analysis

Please fill out the form below or click here for the print version.

When I see a picture of myself, the first thing I notice about my smile is

Something I often notice about other smiles I consider attractive is

Please check the box next to any statement you agree with.

I wish the color of my teeth where whiter.

I wish I had a bigger smile.

I think some of my teeth are too small.

I think some of my teeth are too large.

I wish my teeth were straighter.

I think my gums show too much when I smile.

I think my smile shows too much space between some of my teeth.

Because I am not totally pleased with my smile, I sometimes hesitate to smile.

I have often wished I could change some of the features of my smile.

I feel as though I don’t really know all of the options available to enhance my smile.

Concerns over what the end result might look like, have been a factor in my not having aesthetic dentistry in my own mouth.

Concerns over fees have prevented me from taking advantage of some of the available options to enhance my smile.

I feel as though I could do a better job protecting the health of my teeth and gums, and therefore, the longevity of my own smile.

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