Trust vs truth

      Steven is the son of your physician, and you frequently see his parents around town. You would not characterize Steven as a rebellious young man but rather a typical 14-year-old who values his growing independence from his parents. He was initially opposed to fixed orthodontic therapy to resolve his impinging deep bite malocclusion, but the treatment of his brachyfacial profile and the excessive gingival display is not amenable to aligner therapy. After your explanation of the risks of tissue damage because of his malocclusion, he concedes to correction using ceramic appliances. His treatment begins smoothly with the typical frequency of fractured brackets expected in a patient with adolescent eating habits that violate your “no-no list.” As treatment progresses, you and your staff notice an atypical increase in staining of his dentition, as well as a change in the color and texture of the dorsum of his tongue. When he arrives late for an appointment, which precludes his usual opportunity to brush his teeth, your suspicion that he has developed a smoking habit is confirmed. The odor of cigarettes from his clothing permeates the operatory.
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        • Behnke S.
        • Warner E.
        Confidentiality in the treatment of adolescents.
        Am Psych Assoc. 2002; 33: 44
        • Williams R.
        Trust Sayings – “Trust is the easiest thing in the world to loose, and the hardest thing in the world to get back.” —R. Williams.
        (Available at:)
        Date accessed: September 26, 2021