Exercise: Case scenarios

This is quite common, and can reflect shyness, discomfort in a medical setting, or simply a developmental phase of wanting to appear detached. Sometimes the phone is a shield against feeling vulnerable.

• Start with only the essential information, keep it simple, and gradually build trust over time.
• Avoid criticism, sarcasm, or commands as these shut communication down.
• Acknowledge the parent’s role but gently set boundaries: “I’d like to hear directly from [teenager's name] first, and then I’ll give you space at the end for any questions.”
• Small moments of autonomy (choosing music, holding the mirror, explaining brushing themselves) help the teen feel included.

Peer influence and social media trends often carry more weight than adult advice. Teens value quick, visible results and doing something “different” can feel like independence and control.

• Start by validating their effort: 

“I see you’re really motivated to take care of your smile—that’s great.” 

“I see that it's very important for you to have a beautiful white smile.“

• Then explain in a clear, visual way why lemon juice and baking soda cause hidden damage: 

“It wears down enamel from the inside, which can’t be repaired once it is gone.”

• Offer safe alternatives and involve them in the choice (e.g., recommending whitening toothpaste or professional options for later). And remember to emphasise collaboration: 

“I want to help you keep your teeth white and strong in the long term, so let’s find a safe way together.”

Every autistic patient is unique, so a pre-visit questionnaire can be very helpful, and parents can guide us on what helps their child. Some ways to individualise care include:

• Adapting the environment: dim the lights, reduce noise, smells, and avoid unnecessary instruments in view.
• Adapting appointment times (to when the clinic is quiet, or when the child feels best) can make a big difference.
• Giving the patient choices like wearing sunglasses or headphones, and asking them if they want breaks.
• Creating predictability and use “tell–show–do” methods: demonstrate first, then proceed slowly.
• If cooperation remains too difficult for the patient, sedation or general anaesthesia may be necessary for safe and effective treatment.

A struggling teen may feel hopeless or think, “Why bother? It won’t matter anyway,” which reduces their willingness to engage in prevention.

• Acknowledge their struggle without judgment: “I can see you’re really tired, it must be tough.”
• Avoid guilt-tripping or lectures, as these increase withdrawal. Instead, focus on small, achievable steps: “Even brushing once a day is better than none. Let’s start there.”
• Reinforce autonomy and agency: “You deserve to feel good about your smile. What feels realistic for you right now?”
• If the signs of depression are significant (e.g. you can see medications listed on their questionnaire), gently encourage the parent or teen to seek professional support beyond dentistry.

Parental lecturing can make the teen feel criticised, embarrassed, or powerless, leading to silence and resistance. And the dental setting can amplify this dynamic, as the teen feels “ganged up on” by two authority figures.

• First, acknowledge the parent’s concern: “I see you really care about your child’s teeth.”
• Then redirect the focus toward teamwork: “Let’s hear from [patient’s name] first, because their perspective is very important.”
• Offer to discuss support strategies with the parent privately afterwards, if needed.

The goal is to protect the teen’s dignity while keeping the parent engaged as a supportive partner, not just a rule-enforcer. I try to calm the parent and remind them that they are still the legal guardian and an important role model. I explain that oral health issues do not appear overnight, but usually develop gradually over time, and that responsibility is shared within the family. 

The idea is not to assign blame, but to encourage teamwork between the parent and the teenager so that positive habits can be built moving forward.

For teenagers, peer culture strongly shapes behaviour, so “everyone does it” feels like social proof, reducing the sense of risk. They value short-term rewards like energy, good taste, and a sense of belonging over long-term health consequences. Humour or minimisation, like “just three a day,” can also be a defence mechanism to avoid feeling guilty or judged.

• Link consequences to things they care about right now: appearance (stains, yellow teeth), sports performance (energy crashes), or social life (bad breath).
• Use visual aids: show enamel erosion photos or compare acid damage to “wearing holes in your favourite sneakers.”
• Offer realistic alternatives: flavoured water, sugar-free gum, or setting a “maximum of one” rule.
• Motivate them to be different. You can encourage them to see this as an opportunity to be different in a positive way. Even if many of their friends drink a lot of energy drinks, there are likely others who would also prefer healthier choices but feel pressured by the majority. By making their own choice, they can show their strength and even inspire others that it’s possible to do things differently, and in a healthier way.
• Reinforce autonomy: “It’s your choice, but I want you to have the best smile and energy for the things you love doing.”