New study illuminates dental discrimination in Syria

Fraser Macdonald, Dental Tribune International

Thu. 3. July 2025

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DAMASCUS, Syria: As health workers, dentists are occasionally placed at risk of disease transmission, since they are exposed to bloodborne infections of pathogens such as HIV, TB and Hepatitis B and C. At the same time, however, individuals carrying these conditions possess both a need and the human right to seek dental care. As shown in a recent study from Syria, the intersection of these two perspectives, while we might hope to see surrounded with technical expertise, empathy and tolerance, may in fact be fraught with tension. The study has found that most clinicians working in the capital Damascus actually refuse to treat patients with these diseases.

To explore how dental clinicians in Syria approach the matter of refusing or providing treatment to patients with a variety of conditions, the team of researchers from Damascus University undertook an extensive survey of 246 dentists from across the city. Their results showed a significantly high rate of treatment refusal. In the case of prospective patients with HIV/AIDS, 78% of dentists answered that they would refuse treatment. For patients with TB, 71.5% of dentists would refuse treatment, while for Hepatitis B and C the figure was 39.8%.

These figures alone underline the crucial point that for people with these conditions, especially HIV, seeking regular dental care is far from a straightforward process and may be met with considerable resistance. In terms of refusal to treat patients with this specific condition, the Syrian figures are significantly higher than the 46.5% refusal rate found among Jordanian dentists or the 5% refusal rate reported in an American study.

The comparatively high figures raise the question as to what forces and conditions are driving this rejection. As reported in the study, the primary reason for refusing patients with TB was fear of infection transmission to dental staff (29.0%). For HIV/AIDS patients, the most cited reason was the need for special protective procedures (32.4%), followed by the need for enhanced sterilisation procedures (27.7%). Taken at face value, these responses suggest that Syrian dentists are refusing to treat patients with a variety of conditions due to definitively technical factors: dentists refuse because they are simply not practically equipped.

So, are dentists justified, or indeed legally and ethically entitled, to impose such rejection on these vulnerable patients? To gain some insight into this issue it is useful to consult the FDI Dental Ethics Manual. It both ensures the dentist’s right to refuse dental care except in the case of emergencies or humanitarian reasons and, at the same time, cautions that if dentists are not obligated to give any reason for refusing a patient, such a loophole may allow discrimination to run rampant. The possible conclusion to be drawn from this is that wherever the profession either explicitly or tacitly obligates dentists to treat patients with transmissible diseases like HIV, TB or Hepatitis B and C, procedural reasons may be used to partially cover an underlying fear, which may easily escalate into discrimination. The key for future research in both the Syrian setting and abroad is to critically move beyond stated answers to understand the deeper forces of fear and control that could lurk behind such high rates of rejection and seek to mitigate them as far as possible.