Questions to be answered by the examiner:

Answers (checkbox):

1. Level of evidence

To what extent the esthetic alteration is visible?

(Consider as parameters the exposure of incisors, the perception of the dental arch, and the exposure of the gingiva while smiling).

[ ] not detectable

[ ] detectable

[ ] clearly detectable

2. Tendency of looking straight to the alteration

Is the esthetic alteration causing fixation of the examiner that prevents him/her to look away?

(Consider looking as a natural behavior without inhibition. The examiner must get rid of any conditioning (e.g. education and compassion) that prevents him to report answer for this question).

[ ] alterations is not looked with fixation

[ ] fixed looking to the alterations

3. Level of memory regarding the alteration

When the patient is remembered, how can you describe the alteration?

[ ] do not remember

[ ] remember

[ ] causes important memory and the memory can be used to describe the patient

4. Level of emotion

Does the alteration trigger any emotion? (e.g. sadness)

[ ] does not trigger emotions

[ ] triggers emotions

→ Classification as permanent esthetic impairment* (deformity):

Do you consider it as a serious esthetic alteration capable of reducing considerably the victim’s general esthetics and triggering humiliation and sadness?

[ ] no

[ ] yes

5. Type of emotion

If you are close (relative or not) to the victim, do you think the esthetic impairment could affect your personal relation with her?

[ ] does not affect relationship

[ ] could affect the relationship superficially

[ ] could affect the relationship deeply