Is the customer King? Ethical and psychological considerations regarding tooth removal

Dental extractions are typically driven by dental necessity, but some requests arise for nondental reasons such as financial, psychological, cultural, or aesthetic factors. Similarly, in orthognathic surgery, patient demands and satisfaction are often shaped by nondental influences, including mental health and cosmetic desires. Both scenarios involve irreversible, invasive procedures, making ethical considerations essential, such as patient autonomy and the principle of nonmaleficence.
Research reveals that patient-initiated extraction requests for nondental reasons account for 3.6-5.9% of cases. In a Dutch survey, 68% of dentists and 81.9% of oral and maxillofacial surgeons (OMFSs) reported encountering such requests, primarily motivated by financial or psychological concerns. While practitioners in this survey performed these extractions in many cases (75.6% by dentists and 61.4% by OMFSs), in a clinical study dentists specialised in mental disorders and OMFSs seldom fulfilled purely nondental requests. Patients often perceived their requests as nondental more frequently than the practitioners agreed to.
A review exploring the impact of mental health conditions on satisfaction after orthognathic surgery uncovered significant gaps in evidence, with studies marked by high bias and limited reliability. This underscores the complexity of addressing patient expectations while adhering to the ethical and clinical standards.
These findings highlight a critical tension; while respecting patient autonomy is paramount, healthcare professionals must weigh the long-term consequences of irreversible procedures. Navigating this delicate balance requires not only clinical judgment, but also a firm ethical stance to ensure that decisions prioritise patient well-being over short-term demands. In such cases, thoughtful dialogue and shared decision making are indispensable tools for achieving ethical and satisfying outcomes.