Dentist said he'd report me

[Shmee1988]

So, my son is 13, he has adhd and suspected autism (awaiting assessment). Unfortunately his adult teeth have not grown straight at all. Some are almost twisted in his mouth and some have erupted on top of others. He was referred to an orthodontist 3 years ago. The wait list for NHS treatment is loooong and he finally had his first appointment yesterday. He is not thrilled at the prospect of braces but after alot of discussion he has realised its important and ideal to get it all done whilst hes still at school when some of his peers will also have them. The orthodontist did all of the Xrays and said he needs braces and qualifies for this on the NHS. He then turned to my son and said 'would you like braces?' to which my DS replied 'no'. The orthodontist then said he woukd need to see us again in 2 years time as my DS doesn't want braces so he wont fit them. I asked to have a private word with him and explained that part of DS sen is that he is very literal and that when he asked him if he would LIKE braces, he answered the question literally as if he was being asked if he would like to have to have braces and that he was not refusing treatment. He didn't care and told me that I need to start the referral process all over again and that it would be almost 5 years before he can get them fitted on the NHS due to the wait time. I asked him if I could have another word with DS so that son could explain he wasnt saying he wouldn't have them and he said no. He then went on to say that if I bought my son back and he still said he wouldn't like braces, he will report me. I thanked him for his time and left but I was so upset. Ds was upset and now that upset had turned to anger. Is he suggesting that advocating for a child to receive necessary treatment is akin to abuse if the child is anxious about it? Aren't all kids anxious about braces? I want to take this further and complain. Especially as my son will be almost an adult by the time his next appointment comes around. Opinions please? Thanks in advance.

I'm a dentist with a child with ASD. I'm slightly torn on this one. I understand your anger I'd be furious.
The orthodontist used the wrong question and then failed to acknowledge the literal answer he got back.
We are required to have undergone Autism awareness training as part of our ongoing professional development. Just because someone has done the training doesn't mean they're good at it.
Orthodontics is often difficult for kids to tolerate even without any potential sensory issues or neurodiversity. The child needs to want it hence the direct (albeit very badly phrased) question.
If this orthodontist is going to be the one doing the braces assuming you contact the practice/practice manager/PALS whichever route you go down and he is reoffered to start now, do you want him being the orthodontist? Does he have the skillset to ensure your DS copes well and is happy undergoing the treatment?

I agree with others, he’s bang out of order for being so dismissive. You explained your DS takes things literally and that’s a well known ASD trait. Of course you would prefer him to have them sooner rather than later as it will be worse when he’s older and at least as you say, other kids will have them now. He’ll be more self conscious as an adult and then you’ll have to pay (or he’ll have to pay himself) If he doesn’t have braces then he’ll likely feel self conscious of his smile etc…. So having them sooner is the best option.

I’m raging on your behalf OP and I’d be calling the surgery tomorrow to explain that your sons well being is your priority!

They’re twisted and erupted on top of each other. Given his difficulties, it’s very likely that he’ll end up in a maxillofacial operating chair in five years time, wishing he’d had the braces.

It doesn’t benefit his wellbeing to try and force a treatment on him that he doesn’t want and is not medically necessary.

Hi OP,
I am a healthcare professional (not a dentist but very similar profession with Pxs). Our guidance laws are so wishy washy, if a px who has mental capacity has refused something we are physically not allowed to administer that treatment (even if SEN, as long as they have mental understanding and capacity).
Now the dentist in question went around this in a very wrong way, you are the parent and it should have been a 3 way conversation.
However if a px says no or we feel a px (sorry this means patient) has been co-erced we have to refuse otherwise we can be sued/have future complaints where a px has clearly said no and we’ve proceeded.
In your case I would probably get in contact with the practice manager and explain your situation, they can look into things further for you, you might need to get a letter from the GP to explain your child’s needs.
I know it’s absolutely ridiculous and the dentist should have explained this better but there is now a massive sue culture and everyone is unfortunately having to protect themselves from future complaints.

Really? I can’t find that in any of the OP’s posts!
This is what the dentist said…
“Yes, I tried and he interrupted me and told me that I couldn't force him. I wasnt trying to force him, I was reminding him of the conversations wed have and why it is important.”
Edited to add… forgot to quote PP 🙄

The patient didn’t say any such thing (that I can see)
I think you may have misread.
OP actually said … “Yes, I tried and he interrupted me and told me that I couldn't force him. I wasnt trying to force him, I was reminding him of the conversations wed have and why it is important.
It was the dentist that mentioned forcing..

I don’t think any kid would want bracses would they?! But they can see the bigger picture as to why and how. He had already agreed with OP but when asked directly he said no because he took it literally.

My teeth cross over but as a child the dentist said it’s not medically necessary for a brace so that was the end of it and I wish to this day that my parents had pushed him for one, because I’ve always been self conscious of my smile and teeth. Loads of kids had them back then and whilst I wouldn’t have ‘wanted’ one, I would have had one knowing it would make my smile better in the long term.

I’ve not RTFT OP, but honestly, the orthodontist is being ridiculous. I have NT 16 & 13 yr olds, both currently with braces in their mouths. We’re 18 months into treatment and both of them would have responded ‘no’ to the question ‘do you want braces’ if asked 18 months ago. DD especially as she needed 4 extractions beforehand. They still would (obviously) prefer not to have braces - who would?

If asked the question ‘would you like to go ahead with braces’ both would have replied in the affirmative. Clearly those nuances are going to be harder for your son.

No. Just no. You don't have a clue what his teeth look like and even if you did you have no expertise to decide that. You're talking about a very very small number of extreme cases - and if he was that extreme he'd need it anyway! And even maxfacs surgery is almost always actually optional too. Just no.

You can keep saying “no. Just no.”, but you’re incorrect.

Exactly! Most kids would no. It’s like if a nurse said “Do you want to have your blood taken?” I’d say absolutely not but do it anyway as it’s for greater good (as I wince in the chair almost crying, reluctantly giving her my arm 😂)

Based on?... your opinion?
You can keep just making stuff up to suit yourself, too, I guess...

Such a twattish comment. You know what she meant.

OP you definitely need to take this further. Dentist was probably trying to save money, they seem to try and worm out of providing braces whenever they can. And talk to your son and persuade him to answer in his best interests next time.

What we like and what we need are two different things! Like you say does anyone really want/like braces? No. But what we do desire is the result of them so on that basis we agree to the treatment.
You were polite to have even thanked him, threatening to report you for taking a concern in your son's dental care is ludicrous.

The report would be in relation to coercive control, not dental health.

Yep - when the nurse asks me if I’m ‘happy’ for her to continue with my smear test, the answer is obviously a resounding ‘not really’. Would I like her to get it over and done with, that’s a ‘yes please’.

Yes, exactly. A child-friendly question would have been “do you agree to have the braces?”

Definitely follow up. You have a strong case. Your dentist did not take account of your son’s additional needs when seeking consent and treatment is now being withheld on the basis of miscommunication.

If you drop the phrase ‘indirect discrimination’ into your phone call / e-mail of complaint, they may take you more seriously.

We waited 3 years to get to the orthodontist. I nearly fell off my chair when she then asked my daughter if she wanted braces. I mean nobody wants to go through the hassle but the result is worth it. Why do they even ask if you've turned up after a massive long wait?

My kids have had multiple operations with general anaesthetic and they have never asked them if they would like the operation.. no one wants an operation.

Coercive control.. for wanting her son to have nice teeth? I'm not sure this will go anywhere to be honest.

I really feel for you. My son has diagnosed autism and adhd and is also quite literal. If a dentist had asked him if he was happy to have braces he would likely also have said" im not happy,no." A more appropriate question from the dentist would have been " do you agree to have braces on your teeth ?"
You should complain and state that these subtle differences can be vital and ask to see a dentist again. Its outrageous he should have to wait all over again due to a misunderstanding. Good luck.

I agree with you OP. He lacks capacity and cannot consent or withhold consent but most importantly the dentist did not fully explain things or allow time for your son to understand what he was saying. You could argue that if he was refusing treatment it would be hard to force it upon him but again with support it would be feasible. There’s an excellent educational module I’ve just completed put together by the family of Oliver McGowan . He was a young adult with an LD who died due to medics not listening and taking into account his wishes and medical information. you could make an official complaint and mention all of the above but state that if your son can be reviewed under better conditions you will not progress a complaint. If they won’t budge there is a series of steps you can take to progress your complaint further . I think it would go to NHS England next. Mention as you go the failure to make reasonable adjustments and the threats to report you. Hope this gets sorted

Actually, this is a really good point. DD had her appendix out earlier this year, she was asked for her consent to the operation, not if she ‘would like’ the operation.

The Gillick criteria for being able to give consent don’t come into it, as it is not a lifesaving procedure.

No dentist could or should force a patient who doesn’t want braces to have them. He very much can withhold consent.

Incidentally it is so wrong to hand important decisions over to children without talking to them properly and making sure they have the information required to make their choice in their own best interests.

I remember I was asked, age 14 if I wanted braces. I said no. I made that choice based on zero information. It wasn’t explained to me that my teeth would continue to shift in adulthood as my wisdom teeth came in.

My teeth were very mildly crooked as a teen, but by age 27 they were a total mess, and I haven’t got £10k to sort them out. I could have has the op for free as a teen, if only I’d been given the time and information to make a proper decision.

I feel very aggrieved and let down by the dentist for not explaining to me the pros and cons and why it might have been a good idea.