Healthy Smile Quiz

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Healthy Smile Quiz

Many people think correcting crooked teeth is for cosmetic purposes only. Surprisingly, that may be one of the last reasons for thinking about straightening your teeth!

Straight teeth are EASIER TO CLEAN and to keep clean. Therefore, it may lower your risk for cavities and gum disease which can help your breath stay fresh.

Straight teeth may HELP YOUR BITE feel more comfortable and reduce the risk of damage or trauma to your teeth, gums and jaw joint.

Straight teeth promote BETTER DIGESTION due to ease of thorough chewing. This can lead to better overall health.

Straight teeth may help promote a degree of ENHANCED AIRWAY VOLUME which can benefit sleep quality and reduce the symptoms of daytime fatigue, stress and academic struggles, just to name a few.

Straight teeth can IMPROVE YOUR QUALITY OF LIFE by improving your smile. Studies show that people who straighten their teeth boost their confidence and report an overall increased quality of life emotionally, socially and more!

A bonus benefit to straightening your teeth with clear aligners is... you can whiten your teeth while you straighten them since the aligners can double as professional whitening trays!

Find out if you would be a candidate for straightening your teeth with clear aligners by completing this quiz.

Check all that apply to you, or the person you are completing this form for.
AFTER YOU HAVE SUBMITTED THE FORM, click the "View Accuracy" button for interesting information about many of your specific symptoms.

Please complete ONE questionnaire per person (Adult or Child) that you would like a complimentary evaluation for.

Email *

Patient's Name (First & Last) *

Person's Name completing this form (if not the patient)

Patient's Age *

Best Phone Number to reach you for our complimentary evaluation: *

From the choices below, which best describes your current smile?

Underbite: Lower teeth protrude past upper front teeth.

Overbite: Upper front teeth close in front of the lower teeth.

Openbite: Top and bottom teeth don’t meet.

Gap Tooth: Extra spaces between teeth.

Crossbite: Upper and lower jaws don’t line up.

Crooked Teeth: There isn’t enough room in the jaw for teeth to fit normally.

Generally Straight: When you just want a more beautiful smile.

Mixed Baby Teeth: Phase 1 orthodontic treatment for growing children with a mix of baby and permanent teeth.

Required

Do you have or experience any of the following: *

History of cracked or broken teeth

History of periodontal gum disease

Jaw Joint Pain

Teeth Grinding/Clenching

Mouth Breathing Day or Night

Diagnosed with Sleep Apnea

Daytime Fatigue/Drowsiness

Deviated Septum

Difficulty breathing through nose

Been observed stop breathing while sleeping

Swollen (or Removed) Tonsils or Adenoids

Wear a partial or full denture(s)

None of the above

Required

What benefits would you like to experience from straighter teeth? *

Better bite

Healthier smile

Fresher breath

Enhanced airway

Closed spaces between teeth

Help with periodontal disease

Prevent wear, damage and trauma to teeth

Cosmetic purposes (straighter, whiter teeth)

Something else not listed above

Required

What’s the #1 question you have about straightening your teeth with Invisalign orthodontic treatment?

Can I afford it?

How long does it take?

Will it really work?

Do I have to visit the doctor in person?

Another question not listed here.

Where you are in your smile journey?

I've just started my research

I'd like to set up an appointment for a consultation

I've made an appointment for a consultation

Please offer any other pertinent information you feel would be helpful for us to know.

Click the Submit Button below to see what a healthy smile would look like on you!

By clicking the submit button, you consent for Darryl Azouz Dental Practices to contact you via phone, text and or email for a complimentary smile design consultation.

A copy of your responses will be emailed to the address you provided.

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