Table 3 Codebook for the Principle parent code

Principle

Ideas, rules, propositions which explain the judgement(s)

Professional imperative

Recognizing the standards, customs or habits stemming from “the profession” or from academia

Describing not medically indicated decisions and “excuses”;

Not considering non-scientific opinions;

Comparing cosmetic dentistry to hair salons

Standard care

Standards recognized by both the wider public and the profession, including the given sociocultural or legal environment

Legal reasons for a certain course of action;

Avoiding action due to fear of legal backlash.

Impact

The impact of an intervention is weighed to determine whether it is ethically acceptable

Emphasizing that tooth extraction is irreversible;

Comparing oral epidemiology in areas with and without artificial water fluoridation;

Advocating minimally invasive treatment

Patient needs

References to any type of benefit for the patient;

Emphasis to do no harm;

Acts of paternalism

Unethicality of extracting teeth when medically not indicated;

Claiming that the ethicality of an action is based on the diagnosis

Plurality

Acknowledging alternative moral systems, ideals, habits; Including plurality of groups and individuals

Comparing ritual tooth extraction performed by the Nuer people to tooth extraction performed prior to orthodontic interventions in Western societies;

Locality Rule in the USA;

Claiming that if one dentist refuses extraction, a different dentist will grant the patient’s request

Individual decision-making

Acknowledging individual freedom of choice, individual responsibility for health, or body identity

Emphasizing patient autonomy;

Claiming tooth loss to be the individuals’ responsibility;

Describing the oral cavity as an intimate area