ask our doctors

Have You Ever Tried to Fix Your Own Dental Problems?

Have you ever had a dental problem such as a broken or loose tooth that you tried to fix yourself?

Have you ever tried to clean your teeth on your own instead of visiting the dentist for your yearly exam?

Or have you ever tried to fix your kids dental issues instead of going to the dentist?

If you have ever tried to fix your own dental problems, share your story with us! Please be specific and give lots of detail.

first name:	*
last name:	*
birthday:	*
E-mail address:	*
street address:	*
additional address:
city:	*
state:	*
province/Region (if not in U.S.):
zip/Postal code:	*
country:	*
day phone:	*
evening phone:
cell phone:
are you willing to appear on the show:	Yes No *
children's ages?:

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