What If Parents Refuse Extractions?

Recently, there was a post in Orthotown that most orthodontists would think was a four bicuspid extraction case.  The parents refused to have extractions done, and the orthodontist who posted was wondering what the members of the group would do if it were their case.

Here is the post from Orthotown:

http://www.orthotown.com/MessageBoard/thread.aspx?s=6&f=693&t=309675

Here are a few of the images from the article.

Now when parents disagree with me in a similar kind of situation, I try to remember to ask them why they made the comment about "no teeth out."  Two responses I've had over the years have been (1) "you treated my other daughter and when she had teeth out for braces, her thumb went numb", and (2)"I had teeth out when I was younger and I still have gaping holes."  On the second comment, I asked the mother if she had braces when she was younger and she related that she did not.  I then opened Dolphin Aquarium and showed her what would happen when the braces were placed in conjunction with extractions.  Of course, the extractions sites were all closed. That was all it took for the mother to say, "Oh, OK.  I understand.  I'm fine with teeth out."  In the first comment, I talked a little about the fact that it was very unlikely that the two events were related and the parents agreed with me and went ahead with extractions.

So it is very important for you to ask follow up questions when parents say something that is not the expected response.  Depending on the response I get after asking the parents to explain their comment, I will often follow up by telling them that my responsibility as a professional is to help them make a decision with which they are comfortable, whatever decision that is.  I then go on and explain that we would like to get records today and then have them back at 4:30PM some evening so they will be the last patients of my day and I can then explain in detail my rationale without any time constraints.  Usually, when they understand the issues involved, they will go along with my recommendations.  Not always though, and as you can imagine, it frequently happens when I mention surgery.  Nonetheless, I've done the professional thing and explained the issues involved and allowed them to come to an informed consent about treatment.  Of course, if I feel strongly about, for instance, extractions, and they don't go along, I have every right to refuse to treat and to help them find another practitioner.  That is my right as a professional but at least they hopefully feel good about what I've tried to do for the benefit of their child.