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Home
Orthodontics
Dra. Dinarda Vargas
Endodontics
Surgery and implants
Same Day Teeth
Periodontics
Veneers and Crowns
All On 4 Treatment
General Dentistry
Robotic Dentistry
Our Clinic
Reach Us
Patient Resources
Post Treatment
Smile Analysis
Accommodations
Testimonials
Treatments
Latest Cases
Smile Analysis
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Name
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Where are you from?
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What is your age?
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Would you like your teeth to be whiter?
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Are you missing any teeth?
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Are your teeth yellow, stained, or discolored?
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Do you have any crowns or bridges that appear dark at the edge of your gums?
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Do you have any crowns or bridges that appear dark at the edge of your gums?
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Yes
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Do you have a "gummy" smile (too much of your gums show when smiling)?
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Yes
No
Does the appearance of your smile inhibit you from laughing or smiling?
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Yes
No
When being photographed, do you smile with your lips closed instead of flashing a full smile?
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No
Would you like to change anything about the appearance of your teeth or smile?
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Do you have any gaps or spaces between your teeth?
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No
Are any of your teeth turned, crooked, or uneven?
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Yes
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Do you see any pitting or defects on the surfaces of your teeth?
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Yes
No
Do any of your teeth appear too small, short, large or long?
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Yes
No
Do you have any gray, black or silver (mercury) fillings in your teeth?
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Yes
No
Are the edges of any teeth worn down, chipped or uneven?
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Yes
No
Do you have any prior dental work that appears unnatural?
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Yes
No
Are your gums red, sore, puffy, bleeding or receded?
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Yes
No
Are you self-conscious about your teeth or smile?
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Yes
No
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