The novel begins with Raina’s forced smile during a dental appointment and ends with her genuine smile at the Sophomore Hop. In between, Telgemeier regularly changes the way she draws Raina’s teeth as she goes from the stunted front teeth after the initial surgery to the top-line-only braces, to a retainer in which the line only goes over her real teeth, to full braces, and finally to the crossbite-fixing braces with a rubber band visible at all times. Raina grins deliriously when her retainer makes her feel “normal” and later comments that it is painful to smile after getting new braces. Telgemeier also depicts the antagonists with smiles, such as the evil grin of the periodontist or the smirk Karin and Nicole have after the pantsing.

Mirrors are important for a preteen girl when it comes to judging her appearance. When Raina uses a handheld dental mirror, Telgemeier often draws her teeth in a more realistic manner that better shows the damage to Raina’s teeth. The girl uses other mirrors to check herself as well. As a child, she finds her appearance funny, but as she grows older, she becomes more anxious about her looks. During the periodontist visit, Raina faints after catching a glimpse of her damaged gums in the mirror.