Teeth and molars sometimes extracted without medical necessity

More than half of dentists in the Netherlands extract teeth and molars without a medical reason. This often happens at the request of patients who cannot afford alternative treatments, according to doctoral research by Dyonne Broers at the Academic Centre for Dentistry Amsterdam.

Tooth extraction without medical necessity is not allowed, but Broers highlights a gray area. "If there is a significant abnormality in the tooth or molar, then it is permitted."

Dental care for adults is not covered by the basic health insurance in the Netherlands. To save money, adults often opt to have teeth or molars extracted. This procedure can be done by a dentist for as little as €50. Other treatments are typically more expensive. By having a tooth or molar removed, patients hope to avoid future complications or costs associated with the tooth.

Issues caused by extractions

Minister Agema has expressed concerns about this financial issue. "This is incredibly sad. Poor dental health can lead to other health problems, such as cardiovascular diseases." According to Agema, the Dutch Healthcare Institute is exploring the possibility of reintroducing dental care costs into the basic health insurance package. "It’s very expensive," she says, but she urges people with limited financial resources to contact their municipality, which often has programs for dental care support.

While tooth extraction might seem harmless, Broers warns otherwise. "Every tooth or molar you extract causes the jawbone to shrink. The younger you are, the more it will shrink." This could lead to issues later in life, as there may be less support for dentures.

Offering alternatives

Financial difficulties are not the only reason mentioned in the study. Some people request tooth or molar extractions due to a fear of dentists. "The idea is: then I’ll be done with it." Others persist in requesting an extraction for unexplained pain.

More than 80% of oral surgeons report receiving such requests without medical necessity, and three-quarters of dentists have faced similar requests. The vast majority of these requests are carried out.

"I hope the threshold for extraction is high, but you also have to consider patient autonomy. Patients think it through and make a deliberate choice. However, they often pressure the healthcare provider, and it’s up to the dentist or oral surgeon to guide them and offer alternatives."

Broers believes that the principle of not causing harm to patients is sometimes overlooked and calls for greater attention to this issue. She emphasizes that education for dentistry students should address these concerns. "You can work with patients to address phobias or find more affordable alternatives. If a crown is too expensive, you can explore whether a large filling might be a viable solution."