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During a routine dental hygiene recare appointment for a 15-year-old female patient, you notice that she has plaque around the mandibular first premolar areas.  These two teeth are rotated and in linguoversion.  The patient has spoken to you about her concern about the unappealing appearance of her “lower” teeth and what can be done to make her smile more flattering.  Additionally, she states that she finds these two areas very difficult to floss and brush.  Both you and the dentist recommend to her and to her parents the possibility of orthodontic treatment for this area.  The family has insurance coverage and is faithful about keeping recall appointments and other treatment such as sealants and restorations.  However, the father is reluctant to obtain information regarding an orthodontic referral.  The father protests and refuses to discuss the treatment, citing his spiritual belief that prohibits “changing creation” and “science’s interference with Mother Nature.” 

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DH 257

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