Striving for Beauty, Precision and Excellence in Esthetic Dentistry
191 The West Mall Suite 100
Etobicoke, ON M9C 5K8
TeL: 416-620-7903
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Your Smile Analysis
Your Name:
Your Age:
Your Email:
Your City and Province:
Please look into the mirror and evaluate your smile
1.
How many teeth do you show with your best smile?
2.
My teeth seem too dark.
Yes
No
3.
How would you describe their colour and shade?
very white
moderate-yellow
dark-brown
moderate-white
dark-yellow
moderate grey
light-yellow
light-brown
dark grey
4.
How are colour and shade distributed?
Even
Uneven
5.
Do you have white or discoloured spots on your teeth?
Yes
No
6.
Do you see any pitting or defects on the surface of
your teeth?
Yes
No
7.
Do your front teeth have any visible fillings and/or crowns?
Yes
No
8.
Are your teeth crowded?
Yes
No
9.
Do you have spaces between your teeth?
Yes
No
10.
I show my gums when I smile?
Yes
No
11.
I like the amount of gums that I show?
Yes
No
12.
How would you describe your lips?
Very Full
Full
Normal
Narrow
Is there anything you would like to mention about your smile? How did you find us?
Please use the text area below for your comments: