Patients often say they aren’t please with their smile, but don’t really know what they would like to change.  One way many dentists help determine a patient’s needs is to have them do a “Self Analysis” of their smile.  It’s a wonderful way to communicate your desires to the dentist.  This is a portion of the form we utilize in our office.

Walk up to a mirror and smile at yourself. You may like what you see, but then again you may not. Now look again and think of a funny moment in your life. Is your smile different? Usually it is. This is the smile you show when you hear or see something that makes you laugh. It’s a much larger smile than when you pose, especially if you aren’t happy with your teeth. However, when your smile is improved, your big “funny smile” returns and you feel confident and look great. Our Smile Analysis is a way to help us figure out what’s holding your smile back… what bothers you about your teeth and what can be done to help you have the smile you’ve always wanted.

Your Teeth

Yes No        In a full (laughing) smile, is there anything you would like to change about your smile?

Yes No        In a full smile, do the edges of the upper front teeth follow the curve of the lower lip?

Yes No        In a full smile, does the upper lip rise above the necks of the teeth so the gums show?

Yes No        In a relaxed position, with your lips slightly parted, do the tips of your upper front teeth show?

Yes No        Looking at the two upper front teeth, are they slightly longer, equal in length or shorter than the others? (circle one)

Yes No        Do any of the teeth look too long or too short? too pointed or too flat?

Yes No        Do any of the teeth have a shape you do not like?

Yes No        Are there spaces between your teeth?

Yes No        Do your teeth slant one way or another?

Yes No        Is the midline of your two front teeth centered with your face and nose?

Yes No        Are you missing any teeth?

Yes No        Are the upper front teeth in your smile straight (versus being crooked, overlapped or protruding?

Yes No        Are the lower front six teeth straight and even in appearance?

Yes No        Do you like the color of your teeth? Are all of the teeth the same color?

Yes No        Are there any unsightly, stained fillings or discolorations (white or brown) on your teeth?

Yes No        Do any teeth that have crowns not match your natural teeth?

Yes No        In a full smile, sometimes the back teeth show. If so, are there any teeth that have been stained blue or gray by silver fillings?

Yes No        Do the necks of the teeth have any eroded or notched areas (a ditched in “V” appearance that can be felt with your fingernail)?

Your Gums

Yes No        Are the gums pink and healthy looking everywhere (versus red and swollen)?

Yes No        Are your gums irregularly shaped, higher on some teeth and lower on others?

Yes No        Are the curvatures of the gum tissue on the necks of the teeth a good shape (half-moon shaped)?

Yes No        In a full smile, does too much or too little gum tissue show?

Yes No        Have the gums receded from the necks of the teeth anywhere?