Extraction as a systemic answer to a shortage of resources, not as inevitability
Writing in Global public health, Benzian and Naidoo argue that extraction dentistry in underfunded systems is not a clinical necessity but a pattern of governance that turns lasting harm into routine.
Extraction as policy, not as a clinical decision
Extracting a tooth is one of the most common procedures in dentistry, and it is especially frequent in underfunded health systems where preventive, restorative and rehabilitative services remain scarce. Benzian and Naidoo, writing in Global public health, argue that this is neither a technical nor an economic inevitability but a form of care that systematically produces harm.
The authors borrow the concept of debilitation from Jasbir Puar and apply it to oral care. The logic they describe repeats across borders: injury is normalised, repair is withheld, and disability is not resolved but managed. Extraction thus becomes an organised answer to a constraint on resources, while the absence of restoration and rehabilitation leaves a lasting consequence. Leaving out population-level preventive strategies closes the circle, because disease and tooth loss return predictably.
A separate part of the analysis concerns stigma. When tooth loss is explained by personal responsibility, structural injury is turned into individual failure. The authors argue that this psychological dimension also holds back civic mobilisation, because it is hard to demand systemic change for something the patient has learned to experience as their own fault. The paper proposes a typology of structural debilitation in dental care and calls for the debate to shift from clinical shortcomings to the governance of the system, in line with the commitments of universal health coverage and the right to health.
Limitations
This is a conceptual analysis rather than empirical research. The paper offers a framework of interpretation and a typology, without measurements of its own on the frequency of extractions by country.
For the practice
- When you offer a patient extraction as a reasonable option, separate the clinical indication from the financial one; the patient has a right to know which of the two is actually deciding.
- Record refused restorative plans and the reason for refusal, because without such data the systemic pattern never shows up in the numbers.
- The question carries over to the Croatian context through the scope of compulsory insurance cover: what is not covered pushes the choice towards extraction.