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Original Article PatientsAo request for tooth extraction and a review of its ethical implications: A cross-sectional survey Sharmila S Department of Dental Surgery.
Government Medical College and Hospital Thiruvallur.
Thiruvallur District.
Tamilnadu.
India Corresponding Author:
Sharmila S .
29@gmail.
Received : 17-Dec-2023 Revised : 05-Feb-2024 Accepted : 25-Feb-2024 Published online: 28-Apr-2024 Background: Tooth loss leads to functional disability, compromises aesthetics, and reduces quality of life.
Tooth mortality reflects untreated dental disease and is considered a crude but useful measure of the dental status of a community.
There are many contributing reasons for tooth mortality, and a patientAos individual request for the extraction of teeth is one of them.
Objective: The objective of this study was to assess patientsAo decisions regarding extraction, the various factors that influence extraction, and its ethical implications.
Methods: A cross-sectional survey was conducted among 120 randomly selected subjects visiting the outpatient Department of Oral and Maxillofacial Surgery.
Tamil Nadu Government Dental College.
Chennai.
Tamil Nadu.
Data were collected using a self-administered recording form.
Descriptive data collected were measured in proportion and Results: Among the participants, 40 were male, and 80 were female.
Based on the dentistAos decision, 78.
90% of extractions were carried out, and 21.
1% were based on a patient request, despite the choice of alternative treatment being given to them.
Pain, problems with mastication, long waiting periods for dental appointments, poor understanding of explanations given by the dentist, and fear of alternative modes of treatment were found to be the reasons for patientsAo requests.
Pain was found to be the most common reason for the request, followed by problems with mastication and an unaesthetic Conclusion: Socioeconomic status and education level strongly influence a patientAos request for extraction.
Even though alternate strategies instead of extraction were available, considering the patientsAo autonomy, treatment was carried out.
Educating, motivating, and providing care at the preventive level can reduce irrational requests for tooth Keywords: PatientsAo requests.
Extraction.
Ethics.
Tooth mortality Background Tooth loss leads to functional disability, compromises aesthetics, and influences quality of life.
Tooth loss, especially total tooth loss, is the dental equivalent of .
Tooth extraction is considered a crude indicator of the dental status of a community.
Tooth extractions are the result of various geographical and cultural factors that differ between regions within a country and from country to country.
Extraction may be indicated in caries, periodontally compromised teeth, and severe trauma, which are not amenable to conservative management.
Furthermore, a significant percentage of young patients have their premolars excised for orthodontic reasons.
Ae.
In all these circumstances, the dentist will make the diagnosis, and after the patient has been sufficiently informed, the pa- tientAos role is limited to giving consent to the treatment that is being recommended.
However, in several cases, it is not the dentist who recommends extraction but the patient who expresses their desire for the procedure .
Tooth mortality is of public health importance.
Functional rehabilitation is necessary to combat tooth mortality.
However, the cost of healthcare increases exponentially, and patientAos satisfaction decreases proportionately from the primary to tertiary level of prevention.
Thus, preventive strategies must be implemented to minimize tooth loss and the burden on the healthcare system.
Except for the ideal indications for dental extraction, the scientific literature reveals various other factors contributing to tooth mortality.
One such reason is patientsAo requests or demands for extraction, which are not under the dentistAos Scientific Dental Journal A Volume 8 A Issue 1 A Januari-April 2024 Sharmila.
S : Reasons for extraction of tooth: A cross-sectional survey treatment plan.
Therefore, the present study was planned to assess whether a patientAos request for extraction is a contributing factor to tooth mortality and to discuss its ethical implications.
Material And Methods This cross-sectional survey was designed to assess the reasons for requests for tooth extraction.
A convenient sampling of 120 subjects was recruited from outpatients attending for tooth extraction at the Department of Oral and Maxillofacial Surgery.
Tamilnadu Government Dental College and Hospital.
Chennai.
Tamil Nadu.
India The study period was limited to one month for the designated sampling.
Subjects with known psychiatric disorders and who were under medication for the same, as well as children below the age of 18 years were excluded from the study.
The study was conducted in accordance with the Declaration of Helsinki and International Medical Research 2006, and the protocol was accepted by the institutional review board.
The purpose of the study was explained to the subjects, and written informed consent was obtained.
A self-designed questionnaire was developed by the investigators and tested for face and content validity by a panel of experts.
The internal consistency of the questionnaire was assessed among a pilot sample of 20 participants from the study population (CronbachAos alpha value was 0.
The questionnaire included demographic data, along with the case history of the participants.
Socioeconomic status was assessed and categorized based on education, occupation, and income via the Kuppusamy Socio Economic Scale.
12 Indication for the extraction or not, patientAos choice of treatment, treatment done, and the reasons given by the patient for extraction of the tooth were recorded.
A combination of open- and closed-ended questions was used in the data collection Statistical Analysis The data were analyzed using IBM SPSS Statistics for Windows, version 20 (IBM Corp.
Armonk.
USA).
Descriptive data were tabulated in percentage and proportion, and to minimize type II error and to make higher specifications of the analysis, the power of the study was set at 90%.
Result A total of 120 subjects agreed to participate in the study.
There were 80 female and 40 male participants.
The mean age of the subjects was 39.
91 years, with a standard deviation of 12.
75 years.
Scientific Dental Journal A Volume 8 A Issue 1 A Januari-April 2024 The present study revealed that dental caries .
was found to be the most common reason for tooth extraction, followed by periodontal disease .
70%) and impacted third molar extraction .
10%).
Socioeconomic status of the subjects revealed that 63.
3% of the subjects belonged to the upper lower class, 21.
7% belonged to the lower middle-class group, 11.
7% belonged to the upper middle class, and 3.
3% belonged to the lower-class group.
An indication for extraction was found 7% of the subjects.
In the remaining 28.
3% of the subjects alternative treatments would have been carried A total of 78.
90% of extractions were carried out based on the dentistAos decision, and 21.
1% were carried out based on the patientAos request, despite the choice of alternative treatment being given to them (Table .
Persistent pain was reported by all participants as the primary reason for irrational requests for tooth extraction .
%), followed by problems with difficulty in mastication .
74%) and time constraints for alternative treatment .
3%).
The other reasons for requests for extraction of teeth were inaccessibility .
5%), negative previous experience .
5%), fear of other dental procedures .
3%), and postponement of other treatments .
3%).
Among the participants, 7.
7% had a belief in myths and taboos toward the extraction of teeth, while 3% did not follow any myths.
The various reasons for requests for extraction of teeth are shown in Figure 1.
Discussion Review of the literature shows dental caries and periodontal disease, were the leading cause for tooth extraction which was similar to the current study.
13Ae15 Studies pertaining to patientsAo requests for extraction will bring to light the hidden factors contributing to tooth mortality.
The treating dentist must exercise caution when deciding whether to comply with a patientAos request for extractions because it involves both ethical and legal considerations.
A recent systematic review to assess the reasons for tooth extraction in adults has implied that there are limited studies to assess the reasons for extraction of teeth on non-dental and non-medical The mean age of the subjects in this study was 39.
years, which was consistent with that of a similar study.
Majority of subjects who requested extraction were of the upper lower class, and their literacy levels were at the primary school level.
Unbearable pain warranting immediate extraction was the most common cause of Sharmila.
S : Reasons for extraction of tooth: A cross-sectional survey masticatory problem time constraint 30% 5.
Figure 1: Reasons for request for extraction of teeth
Table 1: Demographic details Demographics Age
Sex
Male
Female Socio economic status
Upper-middle class
Lower-middle class
Upper-lower class
Lower class
Is the tooth indicated for extraction? Yes
N (%)
Mean Ae 39.
SD A 12.
Treatment indicated Extraction Other 88 .
Dentist decision for extraction and patient agreement 91 .
Dentist decision for alternative treatment vs.
patient request for Belief in myths and taboos about Yes 29 .
tooth extraction.
A study in NigeriaAos secondary care setting showed that permanent relief from pain is the main cause for requests for extraction.
17 In contrast, a recent study done by Broers et al.
revealed that the most common reasons were financial and severe dental fear.
18 In this study, financial reasons were not taken into account because the study was conducted in a teaching institution that provides free dental procedures.
Poor understanding of explanation given by the dentist and fear of time delay for alternate management contributed to patientsAo requests in the present study.
Ethical Implications Major principles of ethics, such as nonmaleficence, beneficence, autonomy, justice, truthfulness, and confidentiality, should be taken into utmost consideration when considering a patientAos request.
Patients should not be bystanders in their treatment but active participants.
Informed consent, as both an ethical and a legal concept, is an essential component in this regard.
In the present study, even though the alternative strategies were available and explained to the patient, considering the patientAos autonomy, extraction was carried out.
Written informed consent was obtained from all patients prior to extraction of the teeth.
Psychological reasons, such as dental phobia and other psychological disorders, should also be assessed, considering the request for tooth Separate counseling sessions should be given to patients to address their psychological fears and pho- Scientific Dental Journal A Volume 8 A Issue 1 A Januari-April 2024 Sharmila.
S : Reasons for extraction of tooth: A cross-sectional survey bias toward other dental treatments, which will also help in undue tooth mortality.
As the survey was conducted in a government hospital setting where treatment is carried out free of cost, the contribution of unaffordability for tooth mortality cannot be assessed, and the results of this study cannot be generalized to patients undergoing extractions in a private setting.
the results of this study offer valuable insight into the treatment needs of dental patients and will function as a baseline strategy for effective oral health management.
Dentists should not consider all irrational requests for tooth extraction and should try to explain all possible alternate treatment modalities to save the tooth.
The availability of alternative dental treatments, as well as behavioral interventions in most cases, will render extraction unjustifiable.
A study with a large sample size and a qualitative approach may bring to light the rational and irrational request for extraction of teeth.
Preventive strategies must be implemented to minimize tooth loss and, ultimately, the burden on the healthcare system.
Finally, appointing a dental surgeon at the grassroots level to maximize preventive and restorative treatment will help reduce tooth mortality.
Financial support and sponsorship:
Nil patients of the International Faculty of Dental Medicine of Rabat.
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Conflicts of interest:
Nil
References