Smile Analysis | Woodbridge, VA | Estafanous Dental Center

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 with their smile. 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:

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! To schedule a FREE, no obligation office consultation, contact us today to schedule an appointment.

Note: Messages sent using this form are not considered private. Please contact our office by telephone if sending highly confidential or private information.

	Are any of your teeth yellow, stained or somewhat discolored?		Yes No
	Would you like your teeth to be whiter?		Yes No
	Do you have any gaps or spaces between your teeth?		Yes No
	Are any of your teeth turned, crooked, or uneven?		Yes No
	Are you missing any teeth?		Yes No
	Do you see any pitting or defects on the surfaces of your teeth?		Yes No
	Are the edges of any teeth worn down, chipped or uneven?		Yes No
	Do any of your teeth appear too small, short, large or long?		Yes No
	Do you have any prior dental work that appears unnatural?		Yes No
	Do you have any crowns or bridges that appear dark at the edge of your gums?		Yes No
	Do you have any gray, black or silver (mercury) fillings in your teeth?		Yes No
	Do you have a "gummy" smile (too much of your gums show when smiling)?		Yes No
	Are your gums red, sore, puffy, bleeding or receded?		Yes No
	Does the appearance of your smile inhibit you from laughing or smiling?		Yes No
	When being photographed, do you smile with your lips closed instead of flashing a full smile?		Yes No
	Are you self-conscious about your teeth or smile?		Yes No
	Would you like to change anything about the appearance of your teeth or smile?		Yes No
	Are any of your teeth yellow, stained or somewhat discolored?		Yes No
	Would you like your teeth to be whiter?		Yes No
	Do you have any gaps or spaces between your teeth?		Yes No
	Are any of your teeth turned, crooked, or uneven?		Yes No
	Are you missing any teeth?		Yes No
	Do you see any pitting or defects on the surfaces of your teeth?		Yes No
	Are the edges of any teeth worn down, chipped or uneven?		Yes No
	Do any of your teeth appear too small, short, large or long?		Yes No
	Do you have any prior dental work that appears unnatural?		Yes No
	Do you have any crowns or bridges that appear dark at the edge of your gums?		Yes No
	Do you have any gray, black or silver (mercury) fillings in your teeth?		Yes No
	Do you have a "gummy" smile (too much of your gums show when smiling)?		Yes No
	Are your gums red, sore, puffy, bleeding or receded?		Yes No
	Does the appearance of your smile inhibit you from laughing or smiling?		Yes No
	When being photographed, do you smile with your lips closed instead of flashing a full smile?		Yes No
	Are you self-conscious about your teeth or smile?		Yes No
	Would you like to change anything about the appearance of your teeth or smile?		Yes No

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