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Smile Analysis

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
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.
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Question or Comment

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

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Call us today at
(951) 372-9094
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Norco Family Dental Group

2031 River Road
Norco, CA 92860

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