Dream Smile Dental
2184 Washington Street
Canton, MA 02021
appointments@dreamsmiledental.com (781) 330-0900
* Required

Captcha Image

Patient Resources

Bring A Friend Promotion - Click here to View Details!


Now that you have completed your treatment, please share a few words with us about how your enhanced smile has improved your life.

Captcha Image
* Required
Captcha Image

Dream Smile Dental New Patient Online Form

* are required fields


First Name*

Last Name*

Middle Initial*

Preferred Name

Home Address*



Zip Code*

Social Security #


Home Phone Number*

Cell Phone Number*

Other Contact Phone



Date of Birth*

Marital Status*

Employed By


Business Address

Business Phone

How do you prefer to be confirmed?

Do we have permission to leave a message on your home phone regarding your appointment?

In case of emergency, who should be notified?


Whom may we thank for referring you?


Full Name

Date of Birth

Social Security #

Employed by

Business Address

Business Phone


Who will be responsible?

Relationship to Patient

Dental Benefits Company

Group #

Secondary Benefits Company (if applicable)

Group #

Insured Employee

Employee's Social Security #


Have you ever had any of the following? (check the boxes that apply):

Heart Problems
High Blood Pressure
Low Blood Pressure
Circulatory Problems
Nervous Problems
Heart Murmur
Artificial Heart Valves
Artificial Joints
Recent Weight Loss
Back Problems
AIDS/other immune disorders

Jaundice/Liver Disease
Psychiatric Care
Chronic Diarrhea
Allergies to Anesthetics
Blood Disease
General Allergies
Allergies to Medicine/Drug

Radiation Treatment
Swollen Neck Glands
Rheumatic Fever
Sinus Problems
Respiratory Disease
Latex Allergy
Special Diet
Venereal Disease
Chemical Dependency

Have you ever had an adverse reaction to any medication?

Have you ever had an adverse reaction to any medication?

Are you currently taking any medications?

Do you use tobacco products?

Are you under the care of a physician?

Is there anything else we should know about your medical history?

If you answered "Yes" to any of the above questions please explain:

Name of Physician*

Office Phone



Do you suspect that you are pregnant?

Are you nursing?


Why did you leave your last dentist?

Are your teeth sensitive to:

Heat Cold Sweets Biting Pressure

Have you ever had an adverse reaction to any dental treatment?

Does food constantly get stuck between certain teeth in your mouth?

Do you get frustrated because you always have something to be treated or repaired when you visit a dentist?

Are you dissatisfied with your teeth in any way?

Has bad breath ever been a concern to you?

Do you snore?

Have you ever been diagnosed with Sleep Apnea?

Are you dissatisfied with the way your teeth look?

For Example

Color Shape

Other Issues:

Do you have any fillings that show in your front teeth?

Do any of your fillings show when you smile?

If any of your mercury amalgam fillings need replacement, would you prefer to have a more natural, tooth-colored restoration instead?

Have you ever had any teeth removed?

How long have these teeth been missing?

Do your gums bleed when brushing?

Do you avoid any part of the mouth while brushing?

Have you been instructed regarding proper home care?

Have you ever considered whitening your teeth?

Would you like more information on whitening techniques?

Rate your smile on a scale of 1-10

If there were anything you could change about your smile, what would it be?

Is there anything else you would like to share about your dental history?


    Fill out our New Patient Form Click Here

    Download PDF file Click Here


    Fill out our Success Story Form Click Here


    Check my appoinments, view my balance, review my Invisalign Treatment and more! - Click Here


    E-mail a friend to invite them to Dream Smile Dental! Click Here

    Bring A Friend Promotion - Click here to View Details!


    If your tooth has been knocked out, you should get to your dentist immediately, as he or she may be able to reimplant the tooth. To transport the tooth, use any of these options (and do it quickly, as the longer you wait, the less chances of a successful reimplantation):

    • Put the tooth back in the socket. Bite down on gauze or a wet tea bag to help keep it in place.
    • Store the tooth in a small container covered with a small amount of whole milk or saliva.
    • If you cannot get it into the socket, the tooth can be carried between the lower lip and lower gum or under the gum. (Be careful not to swallow the tooth.)
    • Special devices called Save-a-Tooth and EMT Tooth Saver, which contain a case and a special fluid to use if a tooth is knocked out, may be available from your dentist to keep in your first-aid kit.

    When handling the tooth, only touch the chewing end, not the root. You can also apply a cold compress to the mouth area to ease pain and apply pressure, using gauze, to control bleeding.

    If a tooth is fractured, you should seek medical help immediately, as exposed nerve tissue could become infected. Small chips are less of an emergency, but should be looked at by your dentist.

    Tips on How to Avoid Bad Breath

    Tongue scraping- Bacteria collects on the tissue of your tongue and causes a bad odor. To avoid this, brush your tongue while brushing your teeth with your tooth brush or a tongue scraper.

    Regular flossing- Bacteria can colonize in the gums between the teeth and if not removed at least once per day, an unpleasant odor can result. The solution: Floss at least once per day!

    Regular hygiene visits- The hygienist uses special instruments to remove plaque and calculus leaving your teeth biologically sound. A toothbrush and floss alone, no matter how frequently used, cannot reach areas that the dental hygienist can. It’s important to attend regular hygiene visits to avoid the developing of periodontal disease.

    Regular Dental Exams- Tooth decay is also a form of disease. Bacteria cause the tooth to erode which releases a foul odor. To detect any untreated decay it’s important to come in for a dental exam at least twice per year.

    Regular use of alcohol-free mouthwash- Mouthwash helps lower the level of bacteria that causes bad breath. We recommend using alcohol-free mouthwash to prevent from dry-mouth.

    Chewing sugar-free gum with xylitol- Chewing gum helps loosen soft depositing that may accumulate on your teeth after eating and in between brushing.

    The right toothbrush- An electric toothbrush is far superior in removing the bacterial layer than a manual toothbrush. Use an electric toothbrush and make sure to replace the head every 3 months.


    Congratulations on starting your Invisalign Treatment! Here are a few helpful reminders...

    1. Be sure to wear your Invisalign aligners for at least 22 hours a day. This is important so that you stay on track with your treatment. If you do not wear your aligners for the appropriate amount of time, the teeth will not achieve the full movement from each aligner. This will cause you to become further and further off track as you progress through treatment.
    2. If your Invisalign retainer is not in your mouth, keep it in the case! When you take your aligners out to eat, do not place them in a napkin. It is very easy to throw them away accidentally. Dogs and cats love Invisalign aligners! Be sure to keep the aligners IN THE CASE and out of reach from pets and small children.
    3. Keep them clean. Whenever you brush your teeth, brush your aligners. Use a soft bristle tooth brush with liquid hand soap and cold water. Toothpaste is abrasive and will cause tiny scratches in the aligners that will collect stain. We strongly recommend an ultra-sonic bath to keep them as clean as possible. Cleaning kits are sold here, be sure to ask at your next visit!
    4. Step up your oral hygiene habits! Be sure to brush and floss after eating and before putting in your aligners. If there is plaque build-up or food in between your teeth after eating, and you put your aligners in with out brushing, the aligners are holding that debris tight to the teeth. This can create cavities or gum problems.
    5. Now that you’ve started Invisalign, you can not be with out it! Accidents happen. If your aligners break or you lose them, be sure to put your PREVIOUS aligner back in your mouth. It is important that your teeth are held in place to ensure that the replacement aligners will fit. Let us know which aligner(s) is broken or lost, and we will order replacement(s).
    6. Be sure to save all of your aligners! Once you have completed the two weeks in an aligner, put it back in its numbered bag. If down the road, relapse occurs and the teeth shift, there is a possibility we can use the aligners to straighten the teeth again.
    7. We are just a phone call away! If you have any questions at all, please call the office. Several staff members have had Invisalign treatment themselves, and can answer any questions you might have.

    One of my brackets came off...

    If a bracket has come off, or if it is loose, please contact the office and be seen as soon as possible to have it replaced. The bracket should stay attached to the wire with the elastic that’s around it, but if it comes out completely, please save it and bring it with you.

    My wire has come out of a bracket...

    It is not uncommon for some of the lighter wires to come out from the brackets in the back. If it has come out, and it is not bothersome, it is ok to leave it the way it is until your next appointment. If it is bothersome, you can call to make an appointment to have the wire cut. If the wire has come out of any bracket other than the last one, please call and set up an appointment to have it checked.

    My non-removable appliance has fallen out...

    If a non-removable appliance has fallen out, please contact the office and be seen as soon as possible to have it replaced. The most important thing to do from the time it has fallen out, to the time you are seen is keep the appliance in the mouth. If an appliance has come out and it is left out of the mouth, the results that have been achieved thus far can relapse and the appliance may not fit properly back in the mouth.

    I lost or broke my removable appliance...

    If a removable appliance is lost or broken, please contact the office and be seen immediately for impressions for a temporary retainer.


    Does dental insurance or medical insurance cover the sleep apnea appliance?

    The sleep apnea appliance is considered medical treatment and dental insurance will not cover treatment however most medical policies will consider paying for the appliance at a dental office.

    Do you participate with my medical insurance?

    As a dental provider we are contracted with dental policies only. Medical insurances create barriers for dental providers and usually only have medical physicians as participating providers. However, since most medical professionals are not trained in the fabrication and treatment of sleep apnea appliances, medical insurances will usually cover the appliance even though we are not in their network of providers.

    How do I get my insurance to cover treatment if you do not participate?

    If you medical insurance policy is not an HMO plan, we are usually able to obtain benefits from your medical carrier if you meet their guidelines for treatment. We may also be able to request a "network insufficiency" which means if your medical policy does not have any contracted providers for the service, they will provide coverage at the same rate as they would for the in-network provider. If you have an HMO policy, which does not allow members to see a physician out of their network, we may request a "gap waiver". If approved, this would allow you to be seen out of the HMO network since there are no providers in the network that perform this service.

    How much does my medical insurance cover?

    Medical policies vary depending an insurance companies and plans. They also set forth guidelines as to what a patient's clinical indications should be for the appliance to be considered under the medical policy. This is called "medical necessity". At the initial consult we will evaluate your signs and symptoms to make sure you are a candidate for the treatment and that you meet your insurance policy's guidelines. At the time of the consultation we will discuss how your medical insurance policy covers the sleep apnea treatment.

    What do I have to do to get the waivers and reimbursement from my insurance?

    Our office will contract your insurance to obtain all your benefit information and request any waivers if necessary. We will also submit all claims proving medical necessity to your insurance carrier. Our goal is to get the maximum reimbursment from your plan.



All of my life, the financial needs of my children and my business took precedence over my own personal desires. One of these was to improve the appearance of my smile. Once my children were grown and my business had sold, I decided that it was time to do something special just for me.

read more

I was confident that my expectations would be met because of my positive experience with Dr. Ronkin. Honestly, when I first sat with Dr. Ronkin, my one and only fear was if it was going to be all worth it.

read more

After years of visiting different dentists and leaving with my questions unanswered, Dream Smile Dental provided the solution that I had been looking for.

read more

What our Patients are Saying

Front desk people were awesome as usual. Courtney the hygienist is always great too. Pushed me to go have something on my lip looked at which proved to be pre cancer that needs to be removed.

LZ 3-26-13

Dr. Barton was great with my son. He let him "play" with some of the instruments before actually using them so that made my son feel more comfortable. My son, at age three, loves going to the dentist and hopefully this will continue.

CC 11-7-12

Courtney Wager was excellent......she had a thorough understanding of my Son's needs. She also advised me to seek a total diagnosis with an ENT doctor. She was looking at the whole condition (tongue-thrust swallow) not just her speciality. Great experience over all!

RL 11-4-12

Ever since I have been coming to Dream Smile I have had nothing but great experiences. All the employees are very professional and cater to your every need, especially Nicole.

EDC 7-28-11

My visit, from start to the end, was great. When I do have the work done on my tooth, I would prefer the dentist that was on duty that day, as he took the time to explain things to me about the tooth. Also, special thanks to the girls behind the desk who were patient and extremely nice as my Delta Dental Plan was being determined.

MG 8-24-11

There was some confusion re: my appointment time. Courtney was kind enough to fit me in. The front desk team is excellent!

PC 9-20-11

I am always treated with respect and Service is always provided in a prompt timely and professional manner. Also Courtney does a great Job cleaning my teeth and providing needed information so that I don't have to make so many vists to the Dentist. Thank you.

PC 9-21-11

All the staff were wonderful!

JF 9-22-11

Sandy and Courtney are awesome. And the girls at the desk treated me great. Always look forward to going to Dreamsmile.

TR 9-30-11

All of the staff was wonderful and the office was the nicest dentist's office I have ever been to. Even my son had a good time and is looking forward to his visit in November.

MD 10-2-11

I just want you to know that Courtney and Sandy are the best!!!

DO 10-5-11

Your office is extemely professional and talented. Thank you so much. I will continue to be a patient here.

CC 10-8-11

The entire staff at DSD is outstanding, professional and makes you feel very comfortable...outstanding!!

MD 10-12-11

The girls were great and were very knowledgeable about what they do.

EC 10-19-11

It is always a pleasure to come in and see everyone again.

AL 10-19-11

Many offices to choose from, but nothing else compares, THE BEST.

RO 10-21-11

Ashlee is always so friendly! It was our first time meeting Dr. Barton but he is also great!

QG 10-25-11

I would like to thank Courtney and Dr Shwartzman for cathing my sinus infection. I saw Dr Dana and I am now on amocicillin for 2 weeks.

DC 10-25-11

It was a very pleasant experience! I'm hoping to dazzle family and friends with my pearly whites during the holidays.

NM 10-25-11

My appt. was for a whitening and the dental technician explained everything clearly and was very attentive to my comfort during the whole procedure. I'm sorry I don't recall her name but she was very friendly, professional did a very good job.

PS 10-27-11

Staff is always friendly, efficient and highly skilled. Although the idea of "going to the dentist" is not something I look forward to, DreamSmile Dental makes it a positive end result.

JV 10-27-11

I think Courtney is a great dental hygenist. She has alot of energy, does a great job, and knows her stuff.

MC 10-27-11

My appointment was at 4:30, I was running late due to traffic. I called and I believe her name was Jeannine. She was great. She reassured me that my late arrival was not an inconvenience for anyone! The administrative assistant at desk, was also very kind and polite. Excellent, flexible with appointments Thanks so, so much. What a great team! Thank you!

CD 10-28-11

Loved the whole team. Courtney was amazing! Very passionate about her work

KR 10-28-11

Jeanine is always so friendly and welcoming!

RG 10-30-11

Everyone was great and actually dont mind coming to the dentist office. Great job.

Anonymous 11-7-11

Staff was great...Yelena was great as well. Thanks

BM 11-16-11

Love Stacey. She is always gentle, kind and keeps me entertained so the time flies by quickly.

RE 11-17-11

Dr. Ronkin is a tremendous asset. He is very helpful. Courtney is a terrific hygenist. I think the world of her and am graeful for the care she provides.

BD 11-28-11

Everybody was great from front desk people to Sandy, Courtney, and, of course, Dr. Shwartzman. Considering a year ago I was totally dental phobic, I can't believe how comfortable everybody has made me feel. Lucky to have such great workers.

JL 11-29-11

The staff and especially my hygienist make my visit enjoyable despite the fact that I hate going to the dentist.

DM 11-30-11

everyone who greeted me was welcoming,those who treated me were efficient and timely.

VP 12-3-11

very good experience! everyone was super friendly and seemed very capable.

RP 12-9-11

Stacy is great!!!!!

JC 12-11-11

I had a wonderful visit. Everyone was very conscientious.

KR 12-14-11

Everyone was polite and professional . didn't have to wait . the service was explained and i'm very happy with the result .

DM 12-15-11