Maiming by design: Structural harm in oral health systems globally.

Abstract

Tooth extraction is among the most common dental interventions, particularly in underfunded health systems where preventive, restorative, and rehabilitative dental services remain scarce. Drawing on Jasbir Puar's concept of 'maiming' tooth extraction is reframed from technical/economic inevitability to care that results in structural harm. Extraction-based oral healthcare reflects a transnational logic in which injury is normalised, repair withheld, and debility managed rather than resolved. The analysis shows how tooth extraction becomes an organised response to resource constraints; absence of restoration or rehabilitation produces lasting debility; and how omission of population-level preventive strategies maintains predictable cycles of disease and loss. Stigma and narratives of personal responsibility recast this structural injury as individual failure, extending maiming into psychological dimensions that constrain civic mobilisation. A typology of structural maiming in dental care makes these dynamics explicit. Recognising the global patterns through which oral harm is produced shifts the discourse from clinical shortcomings to systemic governance, aligning with Universal Health Coverage commitments and the right to health. Extraction-based care persists across countries despite vast differences in wealth and infrastructure, calling for renewed scrutiny of the global political, economic, and institutional conditions that continue to render avoidable harm a global routine in dental healthcare.