Tooth loss can have a negative impact on a patient’s quality of life. However, many patients cannot afford the treatment necessary to restore their dentition optimally. Their final choice may be dictated by what they can afford rather than consideration of the advantages, disadvantages or biological sacrifices associated with proposed options. At the same time, clinicians often express feelings of helplessness and stress when confronted with having to decide on, and provide treatment that is within the patient’s financial means, rather than according to what they deem to be “best practice”. This paper uses a patient case to illustrate how the four-principle approach proposed by Beauchamps and Childress (1983) can be used during treatment planning, and to justify the final decision making process.