The question raised is extremely interesting, particularly with my residency in orthodontics beginning soon. I see the ethical concern but I do believe that at the end of the day, you must respect the patient's autonomy. That being said, the treatment selected must also be within the realms of accepted treatment and uphold the ethical principles of beneficience and nonmaleficence. I agree with Dr. Touati stating that an orthodontic consult should be obtained prior to the decision so the patient is fully informed so they can make an educated choice. I definitely would strongly suggest orthodontics and even educate the patient about treatment that would be less visible, such as Invisalign or clear braces. I would also look into practices in which the orthodontists used expedited processes such as Suresmile or another computerized way of placing and adjusting braces. This would address the patient's concern with having braces for an extended treatment period.

Thanks for the insight Dr. Snyder, looking forward to more posts

Is it ever acceptable to refuse a patient treatment? I think of the "do no harm" guidepost but this can be difficult to define!

An excellent, topic, and an important one for dentists at every level of the profession. It is always a careful balance among patient demand, the clinician's ability and experience in managing such conditions, and discussion among other specialists. It would be important to have this patient visit an orthodontist's office first before further prosthodontic treatment is really considered.