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Cosmetic Analysis

Your smile affects your self-image, and can greatly influence the quality of your interactions with others. Many people hold back from laughing or smiling because they are uncomfortable about their appearance when they do. The following questions are designed to honestly appraise your smile. Go to a mirror, smile as wide as you can, and ask yourself the following questions:

Do You?

Grind or clench your teeth:
Yes
No
Use a Night Guard:
Yes
No
Have cracks in your teeth:
Yes
No
Have silver fillings that show when you smile:
Yes
No
Think you need braces:
Yes
No
Have white spots or discolored teeth:
Yes
No
Have overlapping teeth:
Yes
No
Have gum recession or sensitive teeth:
Yes
No
Don't like the size or shape of your teeth:
Yes
No
Want your teeth to be whiter:
Yes
No
Have pointed eye teeth:
Yes
No
Have spaces between your teeth:
Yes
No
Have prominent eye teeth
and can't see your back teeth:
Yes
No
Have teeth that are uneven or rotated:
Yes
No
Want a more confident smile:
Yes
No
Please describe how, if possible,
you would like your smile to look:
Dazzling
Friendly
Natural
Radiant
Sexy
Sporty
Youthful
Movie Star
Name:
Phone:
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Hour & Location

Office Hours:

Monday through Friday: 7:30am to 4:30 pm

Saturdays by appointment only