• Are any of your teeth yellow, stained or somewhat discolored?*
  • Would you like your teeth to be whiter?*
  • Do you have any gaps or spaces between your teeth?*
  • Are any of your teeth turned, crooked, or uneven?*
  • Are you missing any teeth?*
  • Do you see any pitting or defects on the surfaces of your teeth?*
  • Are the edges of any teeth worn down, chipped or uneven?*
  • Do any of your teeth appear too small, short, large or long?*
  • Do you have any prior dental work that appears unnatural?*
  • Do you have any crowns or bridges that appear dark at the edge of your gums?*
  • Do you have any gray, black or silver (mercury) fillings in your teeth?*
  • Do you have a "gummy" smile (too much of your gums show when smiling)?*
  • Are your gums red, sore, puffy, bleeding or receded?*
  • Does the appearance of your smile inhibit you from laughing or smiling?*
  • When being photographed, do you smile with your lips closed instead of flashing a full smile?*
  • Are you self-conscious about your teeth or smile?*
  • Would you like to change anything about the appearance of your teeth or smile?*
  • Should be Empty: