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Maiming by design: Structural harm in oral health systems globally
Habib Benzian1,2,3, Sudeshni Naidoo1
1WHO Collaborating Centre for Oral Health, Faculty of Dentistry, University of the Western Cape, Cape Town, South Africa.
Global Public Health
|August 14, 2026
Summary
Tooth extraction is often a routine dental procedure in underfunded systems, but it can cause structural harm and lasting disability. This practice reflects systemic issues, not just individual patient failure.
Area of Science:
- Public Health
- Dental Public Health
- Social Sciences in Health
Background:
- Tooth extraction is a common dental intervention, especially in resource-limited healthcare settings.
- Preventive, restorative, and rehabilitative dental services are often scarce in underfunded systems.
- The concept of 'maiming' reframes extraction as causing structural harm rather than a technical necessity.
Purpose of the Study:
- To analyze tooth extraction as a form of structural harm within global oral healthcare.
- To understand how resource constraints and systemic factors lead to extraction-based care.
- To examine the psychological and civic impacts of normalized oral harm.
Main Methods:
- Conceptual analysis drawing on Jasbir Puar's theory of 'maiming'.
- Examination of extraction-based oral healthcare as a transnational logic.
- Analysis of how resource limitations, lack of restoration, and omission of preventive strategies contribute to harm.
- Typology of structural maiming in dental care.
Main Results:
- Tooth extraction is presented as an organized response to resource constraints, leading to normalized injury and withheld repair.
- The absence of restoration or rehabilitation results in lasting debility.
- Omission of preventive strategies perpetuates cycles of oral disease and loss.
- Stigma and narratives of personal responsibility obscure the structural nature of this harm.
- Structural maiming in dental care is identified and categorized.
Conclusions:
- Extraction-based oral healthcare reflects systemic governance issues rather than clinical shortcomings.
- This approach leads to avoidable harm and lasting debility, impacting individuals and communities.
- Addressing this requires shifting the discourse towards systemic factors and aligning with Universal Health Coverage and the right to health.
- The persistence of extraction-based care globally necessitates scrutiny of political, economic, and institutional conditions.
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