CLÍNICA DENTAL INTERNACIONAL Pedro Amor Koole
Questionnaires
  • Smile analysis

    • If you have determined that you are candidate for cosmetic dentistry, it’s now time to get down to specifics. Perform this smile analysis in front a close-up mirror and in good light.

  • 1. In a slight smile, with teeth parted; do the tips of your teeth show?
    YES NO

  • 2. Are your two upper front teeth slightly longer tan the adjacent teeth?
    YES NO

  • 3. Are your two upper front teeth too long?
    YES NO

  • 4. Are your two upper front teeth too wide?
    YES NO

  • 5. Are your upper six front teeth even in length?
    YES NO

  • 6. Do you have a space in between your front teeth?
    YES NO

  • 7. Do your front teeth protrude or stick out?
    YES NO

  • 8. Are your front teeth crowded or overlapping?
    YES NO

  • 9. When you smile broadly, are your teeth all the same color?
    YES NO

  • 10. Do your teeth have white or brown stains?
    YES NO

  • 11. If your front teeth contain tooth-colored filling, do they match the shade of your teeth?
    YES NO

  • 12. Is one of your front teeth darker than the others?
    YES NO

  • 13. Are your lower six front teeth straight?
    YES NO

  • 14. Are your lower six front teeth even in appearance?
    YES NO

  • 15. In a full smile, the back teeth normally show. Are your back teeth free o stains and discolorations from unsightly restorations?
    YES NO

  • 16. Do the necks of your teeth indicate erosion, a ditched in V, that either can be seen or felt with your fingernail?
    YES NO

  • 17. Do your restorations-fillings, laminates and crowns look natural?
    YES NO

    GUMS

  • 18. Are your gums pink and “knife-edged”, or are they red and swollen?
    YES NO

  • 19. Have your gums receded from the necks of the teeth?
    YES NO

  • 20. Does the curvature of your gum arround each tooth create a half-moon shape?
    YES NO

    BREATH

  • 21. Is your mouth free of decay or gum disease that can cause bad breath?
    YES NO

  • If you could alter your smile, what would you most like to change?

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    Please, provide your name and e-mail address if you want to get response (not necessary).
    Name:    E-mail:


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