| I have missing teeth or embarrassing gaps |
Yes
|
No |
| My teeth are badly stained or discoloured |
Yes |
No |
| My teeth are too big or too small |
Yes |
No |
| My teeth are worn down |
Yes |
No |
| I have prominent eye teeth |
Yes |
No |
| I have pointy teeth |
Yes |
No |
| My teeth are chipped and uneven |
Yes |
No |
| My fillings are unsightly |
Yes |
No |
| My gums are red, swollen, receding and/or bleeding |
Yes |
No |
| I have old unsightly caps with black lines |
Yes |
No |
| My teeth are crowded and crooked |
Yes |
No |
| I have an overbite or an underbite |
Yes |
No |