Dental ethics case 25: the drug-abusing patient--what are my ethical obligations to treat?

A very agitated and nervous 20-year-old presented with severe dental pain, bad breath and complaining about his poor dental appearance. A comprehensive intraoral and radiographic examination revealed 22 carious and erosion lesions. He reported using methamphetamine for the better part of five years and had not experienced problems with the teeth prior to using the drug. The patient’s medical and dental histories along with radiographic and clinical findings lead to a diagnosis of “meth mouth.” Although a detailed treatment plan with various options were offered to the patient, he requested the extraction of the most painful teeth in the left lower mandibular quadrant and has yet to return for further treatment.