General Questionnaire


Do you like the color of your teeth?

Do you feel that your teeth are too small/short/large/long/crooked/discolored/overlapped/fractured?

Do you feel there are spaces between your teeth?

Do you show a lot of gum tissue when you smile?

Are your gums irregularly shaped (higher or lower on some teeth)?

Are the biting edges of your teeth uneven, worn down, or chipped?

Does your front teeth keep falling over your lips?

Are your gums red, sore, puffy, bleeding or receeded ?

Do you suffer from bad breath?

Is the midline of your upper two front teeth centered with your nose?

Are any of your teeth missing?

Are there any dental filling or crowns that don’t match your teeth or look ugly / have irritating gum margins / or cause food lodgment?

Do you grind or clench your jaw at night?

Is there anything else about your smile or teeth that you don’t like, would like to change?


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! contact us today to schedule an appointment.