Your Smile

Chances are you picked up this brochure because you want to improve your smile. At one time there were limited means to enhance the appearance of your teeth. Today, however, there are a number of cosmetic treatments that can be performed in the dental office in just a few appointments.


To help you determine how you feel about your smile, take a moment to answer the following questions. Take your time, and answer each question as clearly and accurately as you can. This will help us make a definitive diagnosis and determine the type of treatment most suited to your needs.

1. Are you pleased with the general appearance of your teeth and smile?
Yes No
If not, explain
2. Are your teeth straight?
Yes No
If not, explain
3. Are there spaces between your front teeth that you dislike?
Yes No
If not, explain
4. Are you satisfied with the color of your teeth?
Yes No
If not, explain


5. Are you satisfied with the shape of your teeth?
Yes No
If not, explain


6. Are any of your teeth
Chipped?
Protruding?
Hidden?
If so, describe
7. Are you satisfied with the way your teeth come together?
Yes No
If not, explain
8. Do you have old fillings or dental work that makes you less confident about your smile and/or appearance?
Yes No
If not, explain

9. What would you most like to change about the appearance of your teeth?

10. How would you like your teeth to look to maximize your smile?

Now that you have completed this questionnaire, we would like to review your responses with you. Please return this evaluation to us. There are probably several alternatives we can suggest to help you achieve a more pleasing smile. (Some of the choices are listed below).

Also, please feel free to ask questions or express other concerns you may have about your oral health. Your smile is our reward.



Cosmetic Dental Treatment Choices:

Cosmetic bonding - a painless process that adheres tooth-colored material to your natural teeth
Tooth bleaching - a series of appointments to lighten your natural teeth
Porcelain veneers - tooth-colored laminates custom fit to cover the front surfaces of your natural teeth
Crowns - porcelain caps that completely cover your natural teeth
Orthodontics - straightening or aligning your smile