Losing a first tooth is an important sign that your child is growing up! You can create a special certificate for children who have lost their first tooth as a way to celebrate this special event.

To create the Smile Certificate fill out the form below.

  Child's First Name :  
  Date of tooth loss :  /  /   
  Gender :  Female 
 Gender Neutral

* In accordance with CDA privacy policy, we will not collect personally identifiable information from any person we know to be under the age of 18. Please submit only the child's first name.