A Teenager, His Mother, and a Language Barrier

Correct answer: A. Discuss the risks and benefits of veneers, including the irreversible tooth reduction, and explore what specifically he dislikes

• A. CORRECT. The teeth are sound and the alignment is excellent, so there is no clinical indication. But dismissing the request outright misses the point — the appropriate response is an informed discussion. Veneers require IRREVERSIBLE enamel reduction on healthy teeth, commit a 14-year-old to a lifetime of replacements, and are being requested at an age when the gingival margins have not yet stabilised. Understanding what he actually dislikes often reveals a concern that whitening, minor reshaping or simply reassurance can address.
• B. A flat refusal without explanation abandons the patient's concern and damages trust. His autonomy is exercised THROUGH information, not by withholding it.
• C. Choosing a material without first establishing whether ANY restorative intervention is justified reverses the order of reasoning. Composite is more conservative, but 'less harmful' is not the same as 'indicated'.
• D. The orthodontic result is described as excellent. Referring back offers nothing and implicitly frames a normal outcome as a failure.

Note: Elective irreversible treatment on a healthy dentition in an adolescent deserves particular caution. Cosmetic dissatisfaction at this age frequently resolves; enamel does not grow back.

Correct answer: C. Arrange a qualified professional interpreter, in person or by telephone or video

• A. Ad hoc family interpreters — and a MINOR in particular — are not acceptable. They lack clinical vocabulary, they filter and soften information, and they carry no accountability. Using a child as an interpreter also places an inappropriate burden on them.
• B. Written material and gestures cannot convey risks, alternatives and prognosis, and cannot support a two-way conversation in which the parent asks questions.
• C. CORRECT. Valid informed consent requires that the parent genuinely UNDERSTANDS the diagnosis, the options, the risks and the alternatives. That obligation belongs to the practice, not the family, and it is met by a QUALIFIED interpreter — in person, by telephone, or by video. Under Title VI of the Civil Rights Act, practices receiving federal funds must provide meaningful language access at no cost to the patient.
• D. Having the patient interpret his own treatment discussion to his consenting parent is worse still: he has an obvious interest in the outcome, and it corrupts the consent process entirely.

Note: Document which interpreter service was used and how. If the parent declines a professional interpreter and insists on a family member, record that refusal explicitly.

Correct answer: C. Veracity

• A. Autonomy is undermined as a CONSEQUENCE — a patient deceived cannot consent freely — but the act itself is a lie, and veracity is the principle that governs lying.
• B. Beneficence is the duty to act for the patient's benefit. It is offended here, but only downstream of the untruth.
• C. CORRECT. VERACITY is the duty of truthfulness. Telling a patient that elective cosmetic treatment on sound teeth is clinically necessary is a false statement made to induce acceptance of treatment — the direct breach is truthfulness. In the ADA Principles of Ethics it appears as the section on Veracity: the dentist shall not represent care in a false or misleading manner.
• D. Justice concerns the fair distribution of care and resources, and treating people equitably regardless of who they are. It is not the principle at stake in a misrepresentation.

Note: Related pairings that recur on this exam: non-maleficence → informing a patient of an exposure incident or an error; beneficence → using skills for community health; justice → equitable access and non-discrimination; autonomy → informed consent, confidentiality and the right to refuse.