Your Smile Analysis

Your Name

Your Age

Your Email Address

Your City & State

01. How many teeth do you show with your best smile?

02. My teeth seem too dark

Yes    No

03. How would you describe their color and shade?

very white    moderate - white    light-yellow    moderate - yellow    dark - yellow       light - brown       dark - brown    moderate - grey    dark grey

04. How are color and shade distributed?

Even    Uneven

05. Do you have white or discolored spots on your teeth?

Yes    No

06. Do you see any pitting or defects on the surface of your teeth?

Yes    No

07. Do your front teeth have any visible fillings and/or crowns?

Yes    No

08. Are your teeth crowded?

Yes    No

09. Do you have spaces between your teeth? How many?

Yes    No   

10. What shape and sige your teeth have? Please choose one value per section.

11. I see significant differences between neighboring teeth.

Yes    No

12. I show my gums when I smile.

Yes    No

13. I like the amount of gums that I show.

Yes    No

14. How would you describe your lips?

Very Full    Full    Normal    Narrow

15. Is there any thing you would like to mention about smile? How did you find us? Use the text area for your comments.