Durga Dental Care & Research Centre
+91-22-24110597
+91-9820031142
[email protected]
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Analyse Your Smile
Kindly, go through the series of questions down here, choose or write what you think explains your smile. You can submit this form by clicking on the button at bottom. This is help us to know, what is the prime concern of the people living in a particular area. Leaving your contact number or email address is optional.
If you want us to contact you with the treatment options available for your smile, please fill the personal details, contact mode and tick the boxes below
Select the options below
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I would like to get the treatment options available for my smile improvement.
I would like to get the special offers, emailed me as and when available.
*
marked fields are compulsory.
Name
*
Date of Birth
*
Gender
*
Male
Female
Contact no.
Email
Emotional Smile Evaluation
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:
This is a more subjective evaluation method focusing on the individual’s perception regarding his/her smile. The questions below are designed to gauge an individual’s idea of a smile and his/her personality.
• Do you love the appearance of your teeth and smile?
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Yes
No
• Do you ever turn your face when smiling or hold your hand up in front of your mouth when talking to others?
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Yes
No
• Have you ever found yourself looking at models or other people with beautiful smiles and wishing you had a similar smile?
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Yes
No
• Have you figured out a way to use your lips to cover any aspect of your smile?
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Yes
No
• Are you embarrassed to visit a cosmetic dentist due to the condition of your teeth or the length of time since your last visit to a dentist?
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Yes
No
• How does your smile make you feel? Confident?
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Yes
No
• Do you shy away from showing a full smile in front of other people, especially strangers?
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Yes
No
• When taking pictures, do you tend to smile with your lips closed instead of flashing a happy smile?
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Yes
No
• Have you ever held back a laugh because you felt uncomfortable about your smile?
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Yes
No
• Would a beautiful new smile make you feel confident?
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Yes
No
• What would you like to change about your smile?
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Objective Smile Evaluation:
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The objective method, is more of a checklist method, relying on questions that focus on observable facts regarding ones smile.
• What is the colour of your teeth?
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Brilliant white
Yellow
Dark
Stained
• Are there spaces between any of your teeth?
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No space
Front in the middle only
All front teeth
• Are you missing any of your teeth?
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No missing tooth
Tooth in your smile zone
Back tooth
• Do you have teeth that are in a line?
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Yes
Crooked
Uneven
Out of line?
• Do the biting edges of your upper teeth follow the curvature of your lower lip?
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Yes
Flat
Reverse
Not seen
• What is the size of your teeth?
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Perfect
Short
Fat
Small
Large
• How are the edges of your teeth?
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Even
Too long
Too short
• Do your teeth (as a group) slant one way or another?
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No
Right
Left
• Is the midline of your two front teeth centred with your face and nose?
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Yes
Right
Left
• Are the edges of your canine teeth?
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Flat
Too long
Sharp
Look out of line
• Do you grind your teeth or are any of the biting edges on your teeth chipped or worn down?
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Yes
No
• How much gingival do you show when smiles?
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None
Little
Too much gum tissue
• Are your gums even, in line and symmetrical?
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Yes
No, higher on some teeth and lower on other.
• Does your gums appear red or puffy?
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Yes
No
• Do you have any grey, black or silver dental fillings in your front teeth?
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Yes
No
• Do you have any old crowns that have dark edges at the top or that don't really look natural in your smile?
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Yes
No
You can upload your X-Rays or Smile Photos, to help us to get back with better options for your smile
Contact Details
Our Address
DURGA DENTAL CARE & RESEARCH CENTRE
Shop no.: 5, Sahakar Nagar market,
Near Talwalkar's Gym,
Wadala-West,
Mumbai, India.
Give us a call
+91 22 24110597,
+91 9820031142
You can email us at
[email protected]
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