Reasons for Tooth Removal in Adults: A Systematic Review.

OBJECTIVE: Most tooth extractions are performed for dental reasons, but there are also nondental and nonmedical reasons for extractions; these include psychological, financial, religious, and cultural reasons as well as simply granting a patient's request. This systematic review was performed to examine the proportion and range of indications associated with tooth removal in context of dental, nondental, and medical reasons. METHODS: A search conducted using PubMed, Embase, and APA PsycINFO identified 6038 studies. Three studies (4396 extractions in total) could be included for the risk of bias assessment and qualitative data synthesis. RESULTS: The reported indications for tooth extraction on dental and medical grounds included caries with the proportion of all extractions ranging from 36.0% to 55.3%, periodontitis from 24.8% to 38.1%, trauma from 0.8% to 4.4%, periapical disease from 7.3% to 19.1%, orthodontics from 2.5% to 7.2%, and other reasons from 4.5% to 9.2%. The proportion for patient requests ranged from 3.6% to 5.9%, but specific information regarding the actual reasons for extraction could not be determined. CONCLUSION: The results suggest that caries and periodontitis are the most common indications for tooth extraction and that studies to reliably estimate the incidence of nondental and nonmedical motivation for extraction are lacking. Given that the final decision on performing or refusing extractions, whether it be based on dental, nondental, or nonmedical reasons, largely rests with the dentist and oral surgeon, detailed guidelines are warranted.

Do patients benefit from orthognathic surgery? A systematic review on the effects of elective orthognathic surgery on psychosocial functioning and patient satisfaction.

The main purpose of this systematic review was to determine the current state of evidence regarding patient satisfaction with, and the impact of, orthognathic surgery on psychosocial functioning of patients 17 yr of age and older. A secondary aim was to determine whether individuals with psychiatric disorders and mental health conditions are more likely to be dissatisfied with the treatment outcome than those without. We systematically searched PubMed, PsycInfo, and Embase for relevant studies (up to 6 June 2016). After selection of articles we determined the Directness of Evidence (DoE) and Risk of Bias (RoB). We identified 3,948 studies (1,053 studies in Pubmed, 2,023 in Embase, and 872 in PsycInfo). Of these, 87 remained after screening of title and abstract, while after full-text screening only nine remained for DoE and RoB assessment. All nine studies had a high RoB and a low or moderate DoE. The quality of the methods of studies, published to date, on the effects of orthognathic surgery on patient satisfaction or the psychosocial impact carry a high RoB. Therefore, these do not allow inferences on the effects of orthognathic surgery on patient satisfaction or their psychosocial functioning.

Deciding about patients' requests for extraction: ethical and legal guidelines.

BACKGROUND: and Overview. Dentists frequently are faced with patients' requests for an extraction, sometimes of the entire dentition. In this article, the authors offer guidelines to help dentists and oral surgeons make decisions regarding such requests for extraction. CONCLUSIONS: In most cases of patients' requesting extractions, the ethical principle of nonmaleficence will play a decisive role in the dentist's decision making. In cases in which the request appears influenced by a specific mental condition such as a phobia of dental treatment, extraction rarely is justifiable. Practice Implications. Dental professionals should keep in mind that they cannot be forced to carry out treatment that is at odds with the ethical principle of nonmaleficence or that is outside of the bounds of accepted treatment. To aid dentists in making treatment decisions in such cases, the authors present a flowchart that integrates possible considerations.