15 y.o. boy w/ pathognomonic dental erosion from bulimia or vomitting from alcohol abuse. won't admit. doesn't want dad to know. how do i tx/refer?

Check liability: I would check with my liability carrier first. They have a risk management team. My first thought is he is under 18 and the father has a right to know if he is paying the bill. I would also call my local dental society and ask for advice. They have contacts with the state dental society for ethical questions too. Good luck.

Multidisciplinary TX: I would explain to the parent that the child may be having some acid reflex and may need to see a physician for proper diagnosis and treatment, and i would recommend counseling with a psychiatric as well. Treating the behavior of the child should make it easier to treat and maintain the results and the recurrence of the problem. Good luck not an easy call.

Tricky: Getting teenagers to admit to something is challenging. Probably will try to get social work or support groups involved in a non threatening approach.

My opinion-: Starting point should be to have him seen by a physician for his overall health & well being. As a parent you must insist on this. Discuss all the issues with the physician privately & before the appointment. Your physician should know how best to handle this & will be more likely to have some affect on getting your son into appropriate counseling and treatment. The father has the right to know.

Since he is a minor: Involved in what can be a life threatening disorder (bulimia can cause irreversible damage). I would tell the teenager that you are mandated to get him help & that his parents have the right to know about his condition. You could get social services involved, but i think contacting the father is the 1st step. He needs help, whether his problem is alcoholism (which i doubt) or bulimia.

In. my state to allow untreated pathology is considered to be child abuse. If the child has an untreated eating disorder, the services of a mental health practitioner is required. Alcoholism in a child must be reported, and we are bound to do so. Reporting your suspicions to the appropriate child abuse system will help the child get the help he needs. He's not yet competent to direct his own care.