The Ethical Dilemma of Tooth Extraction on Patient Request [Letter]

Dear editor

I am writing to address a critical ethical issue highlighted in my recent article titled “Common Reasons for Permanent Tooth Extraction and Its Correlation with Demographical Factors in Kabul, Afghanistan”, published in Clinical, Cosmetic and Investigational Dentistry (2024). The article observed a concerning increase in tooth extractions based on patient requests, particularly among individuals from lower socioeconomic backgrounds.

Our study, conducted at the National Curative and Specialized Stomatology Hospital, revealed that socioeconomic status and education significantly influence patients’ decisions to request tooth extractions. Patients from disadvantaged backgrounds frequently choose extraction due to limited access to affordable dental care and a lack of awareness about alternative treatments.¹ This trend not only perpetuates poor oral health outcomes but also exacerbates existing health disparities.²

The financial burden of tooth extraction, encompassing the direct costs of the procedure and subsequent restorative or orthodontic treatments, is considerable, particularly for those with limited financial resources.^3,4 Moreover, the esthetic and functional consequences of unnecessary tooth loss, including impaired chewing function, bone loss, and diminished quality of life, are substantial.⁵

As dental professionals, we have an ethical responsibility to provide patients with comprehensive information about the implications of tooth extraction and to explore all viable treatment options. Performing extractions solely based on patient requests, without a thorough clinical assessment and discussion of alternatives, undermines our commitment to long-term patient care.

To address these challenges, it is crucial for healthcare systems and policymakers to enhance access to affordable dental services and to implement educational campaigns that emphasize the importance of oral health. Additionally, empowering dentists to engage in open dialogues with patients about the long-term effects of tooth extraction and promoting preventive and restorative treatments are essential steps toward addressing this issue effectively.

In conclusion, the practice of tooth extraction on patient request presents a multifaceted ethical challenge. By tackling underlying socioeconomic factors and emphasizing patient education, we can move towards a more ethical and equitable dental care system that better serves the needs of all patients.