Table 2 Analyze of the case according to the four topics approach and judgment of ethical decision

Medical Indications

Patient Preferences

• Define the medical status with a detailed anamnesis: HIV (human immunodeficiency virus) -positive, no activity, no major progressive diseases.

• Patient appears mentally competent and understands the implications of dental indications.

• If the patient rejects tooth extraction, he should be informed about the possible complications.

• Dental Prognosis: a severe decay in the right mandibular second molar with the root involvement. Restorative treatment is not indicated. Tooth extraction needed.

• Family is unaware of his HIV positivity (wants not to tell to the family)

• Goal of dental treatment: Dental care should be provided according to the patient benefits. A protective dental care and recall should be applied.

• A patient consent to a dental treatment, the decision is made in a voluntary manner

Quality of Life

Contextual Features

• Patient has high level of dental pain.

• Patient is unemployed and has financial support from his mother. No problem in terms of financial issues. The patient was able to afford the extraction and prosthetic treatment afterwards.

• With appropriate treatment, he can return to normal life and has no complications about having a severe decay.

• Family is unaware of their son HIV+

• AIDS was categorized on the list of illnesses requiring obligatory notification and seropositive means potentially infectious.

• Patient is HIV + and a serious infection may occur.

• The medical status of the patient is recorded to patient files confidentially to be shared by related faculty members.