Influence of perceived provider performance on satisfaction with oral health care among adolescents

OBJECTIVE: To investigate satisfaction with dental care received at the last dental appointment among adolescents and to analyse factors influencing their satisfaction scores. METHOD: A total of 1146 subjects (mean age 15.8 years) attending secondary schools in Kampala (urban, n = 591) and Lira (rural, n = 555) completed structured questionnaires at school in 2001. RESULTS: A total of 63% and 75% of Kampala and Lira students, respectively, reported attendance to dental clinics during the previous 2 years. The corresponding rates of students who confirmed satisfaction with oral health care services received were 73 and 77. In a logistic regression model, the students of Kampala who attended a dentist more than once, had no painful experience at the visit, evaluated their oral condition positively, were satisfied with the dentist's communication and dentist's information, were more likely to be satisfied with the oral health services received (OR = 1.7, 2.2, 4.1, 2.9 and 4.9, respectively). Regarding rural students, being satisfied with oral condition, dentist's communication and dentist's information were associated with higher odds of being satisfied with oral health care services (OR = 2.9, 1.9 and 2.3, respectively). CONCLUSION: Inter-personal interaction with the dentist is a key determinant in establishing satisfaction with dental care among urban as well as rural adolescents.     

Patterns of oral care in a Washington State dental service population

BACKGROUND: The authors compare patterns of oral health care reported by the Washington Dental Service, or WDS, Seattle, in 1993 and 1999 to assess changes in patient populations, practice characteristics, procedures and treatment costs in the state. METHODS: Data were obtained from dental benefits claims from a population of about 1.25 million people. Variables of interest included patient age and other demographic information, character of dental practice, dental procedures and treatment costs that combined WDS payment and patient copayment. RESULTS: The results showed high agreement (97 percent) between the database and randomly surveyed patient records. For both 1993 and 1999, general dental offices were responsible for more than 80 percent of patient care. Single crowns (21 percent), restorative services (15 percent) and dental prophylaxis (13 percent) made up about half of the costs of dental care. Broad categories of service were similar in 1993 and 1999, and anticipated major declines in restorative procedures related to caries were not apparent. The mix of services varied considerably by patient age and between generalists and specialists in both years. CONCLUSIONS: Patterns of oral health care among this insured patient population largely remained unchanged from 1993 to 1999, with some shifts in specific procedures and specialty care. During this period, dentists saw more patients and performed fewer treatments per patient, while total treatment costs per patient increased. CLINICAL IMPLICATIONS: Patterns of oral health care in the United States are projected to undergo major changes linked to improved oral health, declining trends in caries and periodontal diseases, scientific advances in treatment approaches and a patient population that is living longer. Changes in care patterns during this six-year period may reflect patient and provider preferences, as well as the influence of reimbursement policies. Dental benefits databases can serve as a critical resource for monitoring such changes.     

Distribution of dental therapists and assistant dental officers trained under the Tanzania-Danida Dental Health Programme 1981-1993.

The purpose of the present study was to describe the production of Dental Therapists and Assistant Dental Officers trained in Ministry of Health institutions in Tanzania during more that ten years of support from the Danish International Development Agency (Danida) through the Tanzania-Danida Dental Health Programme and to investigate their distribution and location. A total of 169 Dental Therapists and 38 Assistant Dental Officers have been trained from 1981 to 1993, representing more than 70% of the training capacity of the schools for training of oral health personnel under Ministry of Health. The distribution of both Dental Therapists and Assistant Dental Officers according to working station was, however very similar to that found before the Danida support began. Two out of every three Dental Therapists in government service were stationed in district clinics or non-government clinics at the district level. The same was true for one out of every three Assistant Dental Officers. It is concluded, that the intentions laid down in Tanzania's National Plan for Oral Health 1988-2002 of first staffing the district hospitals and, later on, the health centres with Dental Therapists have not yet been fulfilled.     

Geriatric oral health issues in Africa: Tanzanian perspective

A review of oral health issues for the elderly in Tanzania is presented and conclusions drawn from the analysis are applied to the broader African situation. It must be remembered that life expectancy (at birth) in Tanzania has been below or equal to 50 years, which places adults aged 35+ years in the elderly group of citizens. Access to professional care is limited, especially in rural areas, resulting in most people seeking care only when in severe pain and often leading to extraction. People aged 40+ years, who live in rural areas, are at higher risk of destructive periodontal disease and it is recommended that oral health education, focusing on behaviour change should be initiated from childhood. Innovative training programmes for primary health workers already working in rural areas can improve both access to professional care and accurate preventive oral health messages. Health professional training programmes should emphasise the importance of good oral health to overall health. Such an emphasis will help galvanise health care workers in the delivery of services. The ultimate goal for the government, health professionals and educators should be to move the Tanzanian people toward a greater understanding of oral health and the prevention of oral diseases, a goal which might also be set elsewhere in Africa.     

A study of the reasons for irregular dental attendance in a private dental college in a rural setup.

The mouth is regarded as a mirror and the gateway to health. Integration is required between the dental practitioner and the patient, if good dental health is to be attained. Various treatment modalities of late frequently require appointments, which are more than one in number for completion of the entire treatment program. This study was taken up to determine the impact of reported dental attendance patterns of patients on the oral health and treatment quality in teaching hospitals and also on the quality of life in rural areas. AIMS AND OBJECTIVES: 1. To assess the reasons for irregular dental care in the patients attending the clinics in teaching hospitals. 2. To assess the satisfaction of the patient as regards the treatment rendered in the teaching institutes. 3. To correlate the gender of the patient with the regularity in the recall attendance. MATERIALS AND METHODS: A hospital-based cross-sectional study was conducted using a systematic random sampling method and every alternate subject was selected from the patients attending the OPD of Department of Periodontics and Community Dentistry. The data was collected using the interview method with the help of a structured, pretested questionnaire. RESULTS AND CONCLUSION: Out of 288 patients, 94 failed to attend the recall appointments. In these 94 patients, various reasons for not attending recall were assessed and lack of time was found to be the most common reason for non-attendance. Relationship between age and reasons for not reporting was found to be significant (P < 0.01). Patient satisfaction survey showed that 51.54% of the patients were satisfied with the dental treatment rendered. The present study also showed that males are more prompt in attending recall appointments as compared to females. A positive and significant correlation between literacy and patient reporting status was found (P< 0.01).     

The 'secret' of success. Part 2

Practice success is defined across the four 'dimensions' of oral health, patient satisfaction, job satisfaction and financial profit. It is suggested that the 'secret' of success in dental practice is to make patient (customer) satisfaction the primary focus. Not a very earth shattering or surprising 'secret' perhaps! This is hardly a new idea, and not a concept restricted to dental practice. This principle applies to all businesses. This series of articles reviews evidence from across a broad spectrum of publications: from populist business publications through to refereed scientific papers, this 'secret' seems to be confirmed. The evidence for which aspects of our service are most important in achieving patient satisfaction (and therefore success) is explored. Clinical Relevance: Good oral health outcomes for patients are defined as the primary purpose of dental practice and, therefore, an essential dimension of success. The link between positive patient perceptions of general care and their own oral health to practice success is explored.     

The 'Secret' of success part 1

Practice success is defined across the four'dimensions' of oral health, patient satisfaction, job satisfaction and financial profit. It is suggested that the 'secret' of success in dental practice is to make patient (customer) satisfaction the primary focus. Not a very earth shattering or surprising'secret' perhaps! This is hardly a new idea, and not a concept restricted to dental practice. This principle applies to all businesses. This series of articles reviews evidence from across a broad spectrum of publications: from populist business publications through to refereed scientific papers, this'secret' seems to be confirmed. The evidence for which aspects of our service are most important in achieving patient satisfaction (and therefore success) is explored. Good oral health outcomes for patients are defined as the primary purpose of dental practice and, therefore, an essential dimension of success. The link between positive patient perceptions of general care and their own oral health to practice success is explored.     

The 'secret' of success. Part 3

Practice success is defined across the four 'dimensions' of oral health, patient satisfaction, job satisfaction and financial profit. It is suggested that the 'secret' of success in dental practice is to make patient (customer) satisfaction the primary focus. Not a very earth shattering or surprising 'secret' perhaps! This is hardly a new idea, and not a concept restricted to dental practice. This principle applies to all businesses. This series of articles reviews evidence from across a broad spectrum of publications: from populist business publications through to refereed scientific papers, this 'secret' seems to be confirmed. The evidence for which aspects of our service are most important in achieving patient satisfaction (and therefore success) is explored. Clinical Relevance: Good oral health outcomes for patients are defined as the primary purpose of dental practice and, therefore, an essential dimension of success. The link between positive patient perceptions of general care and his/her own oral health to practice success is explored.     

Factors associated with the use of emergency dental care facilities in a French public hospital

This study was undertaken to qualitatively analyze patients’ profiles and to identify the sociodemographic and oral health factors associated with emergency visits to the public dental service in Montpellier, France. A cross‐sectional survey was conducted in the dental care service at Montpellier Hospital. Socioeconomic and clinical variables were compared between the patients using the emergency dental care service and those utilizing the general dental services, which were by appointment. An evaluation of the results indicated that younger patients and people from lower socioeconomic groups used the emergency dental service more frequently. Unemployed people (OR = 1.60) and manual workers (OR = 1.86) were also more likely to use this service. The need for treatment of caries was significantly higher in the group that used the emergency service. It appeared that the two groups of patients had different attendance behavior and showed significantly different socioeconomic and oral health status.     

Satisfaction with oral status among adult school-attending Saudi women with and without posterior fixed partial dentures.

To conduct a preliminary investigation of the relationship between patient satisfaction with oral status and the presence of posterior fixed partial dentures (FPD). METHOD AND MATERIALS: A total of 150 women with intact anterior dental segments, randomly drawn from women's schools for adult education, participated (mean age, 33.8 years; SD, 10.4; range, 20 to 63 years). Each woman was assisted in completing a questionnaire on aspects of her oral health beliefs and satisfaction with oral function, and underwent an on-site clinical examination. Subjects were categorized according to general prosthodontic status: those with missing posterior teeth and no FPDs (MN), those with FPDs (PR), and those who were fully dentate (FD). Their responses to the questionnaire were compared. RESULTS: Value placed on oral health did not differ among the groups. Satisfaction with overall oral status, chewing function, and appearance did not differ between MN and PR, although overall satisfaction and appearance were each significantly greater in FD than in MN (P <.001 and P <.05, respectively). Overall satisfaction was negatively correlated with the mean number of missing teeth (P <.01), although perception of chewing ability did not differ among the groups, nor did it differ in relation to the number of posterior occluding pairs of teeth. CONCLUSIONS: The hypothesis that individuals with fixed prosthodontic replacements of their missing posterior teeth are more satisfied with their oral status than those without such replacements was not confirmed, while the question of the importance of patient satisfaction as a positive outcome of oral health care is raised.     

Use of clinical services compared with patients' perceptions of and satisfaction with oral health status

OBJECTIVES: To examine the relationship between rates of clinical service use and self-reported perception of and satisfaction with oral health status. METHODS: Dental services provision rates were calculated using health maintenance organization electronic data for members 55 years of age and older with at least four years of eligibility between 1990 and 2000. A mail survey yielded 986 responses (response rate = 65.7%). Poisson regression was used to examine the relationship between service utilization rates and self-reported perception of and satisfaction with oral health status, controlling for age, education, sex, and marital status. RESULTS: Perceptions of oral health status and levels of satisfaction with oral health status generally were closely associated. Greater dissatisfaction with oral health status and perception of poorer oral health status were associated with higher usage of nonpreventive dental services. Less satisfaction with oral health status was associated with higher restorative services usage and lower preventive services usage and slightly associated with periodontal service usage. Perception of a less favorable oral health status was strongly associated with higher restorative and periodontal services usage, but had only a weak association with preventive services usage. CONCLUSIONS: Dental plan members' service use is associated with their perception of their oral health status and their level of satisfaction with it. Future work should seek to clarify whether opinions on oral health status and satisfaction are a result of clinical experiences over time or whether the behavior and the values associated with seeking and obtaining care instead shape opinions on status and satisfaction.     

The 'secret' of success part 4

Practice success is defined across the four'dimensions' of oral health, patient satisfaction, job satisfaction and financial profit. It is suggested that the'secret' of success in dental practice is to make patient (customer) satisfaction the primary focus. Not a very earth shattering or surprising 'secret' perhaps! This is hardly a new idea, and not a concept restricted to dental practice. This principle applies to all businesses. This series of articles reviews evidence from across a broad spectrum of publications: from populist business publications through to refereed scientific papers, this'secret' seems to be confirmed. The evidence for which aspects of our service are most important in achieving patient satisfaction (and therefore success) is explored. CLINICAL RELEVANCE: Good oral health outcomes for patients are defined as the primary purpose of dental practice and, therefore, an essential dimension of success. The link between positive patient perceptions of general care and their own oral health to practice success is explored.     

Pathways in multidisciplinary oral health care as a tool to improve clinical performance

PURPOSE: To investigate the optimization of multidisciplinary and interdisciplinary oral health care through the introduction of pathways. MATERIALS AND METHODS: A prospective randomized clinical trial was carried out in a tertiary referral academic institution. Ninety-one patients admitted for multidisciplinary oral health care from January 1, 2001, to March 31, 2003, were randomized to the test group (n = 50) or to the control group (n = 41). Pathways were implemented by means of the Medical Patient Management program, a computerized planning and coordination system specifically developed for a population with multidisciplinary oral rehabilitation needs. The efficiency of pathways in interdisciplinary oral health care was assessed. RESULTS: Statistically significant differences between test and control groups were found for variables regarding the process of care, such as "number of planned versus actual disciplines," "length of planned versus actual treatment," and "average length of a treatment session." For variables regarding patient satisfaction, significant differences between test and control groups were found for questions regarding patient involvement with the treatment and patient satisfaction with the outcome of multidisciplinary treatment. Regarding practitioner satisfaction, the results of the questionnaire indicate that implementation of pathways into everyday clinical practice is desired but remains difficult. CONCLUSION: The findings of this study show that the implementation of pathways in multidisciplinary oral health care improved some aspects of the process of care and increased patient satisfaction. The predictive capability of the Medical Patient Management program in managing oral health care has been demonstrated.     

Utilisation of dental services in Tanzania before and after the introduction of cost-sharing

OBJECTIVE: The objective of this study was to evaluate the effect of cost-sharing, introduced in July 1994, on the utilisation of dental services in Tanzania. METHODS: The study compared dental attendance, demand for dental services and treatment pattern of patients in 17 out of 20 regions of mainland Tanzania in 1993 and 1995, a year before and after the introduction of user fees. OUTCOMES MEASURES: Dental attendance and demand for treatment. RESULTS: Results revealed a 33.2 per cent overall reduction in dental attendance but no effect on either the demand for treatment or treatment pattern. The exceptions were increases in referral cases by 14.5 times and prosthetic work by 3.9 times, and a reduction in surgical cases by 18.8 per cent. CONCLUSIONS: In order to improve attendance and decrease referrals it is necessary to enforce the first line of oral primary health care to meet the simple treatment demands. Furthermore, the revenue generated by cost-sharing should be used to improve services.     

Predictors of change in satisfaction with chewing ability: a 24-month study of dentate adults

People's satisfaction with chewing ability is not determined entirely by their mechanical chewing function. Instead, it is a complex measure that embraces broad physical, social and psychological components. Using data from the Florida Dental Care Study, a prospective longitudinal study of oral health and dental care, this current study aimed to identify the longitudinal relationships between changes in satisfaction with chewing ability and changes in other dimensions of oral health and oral health-related quality of life (OHRQoL). A multidimensional conceptual model of oral health and OHRQoL was applied to guide the analysis. Most dentate people were satisfied with their chewing ability. However, changes in satisfaction with chewing ability were common: nearly 11-22% of subjects experienced improved satisfaction, depending on the interval; while about 12-18% of subjects experienced deteriorated satisfaction by the end of the interval. Changes in satisfaction with chewing ability were significantly associated with changes in other aspects of oral health and OHRQoL. Onset of certain oral health problems/conditions or constantly having such problems was associated with a lower probability of reporting improvement in satisfaction and a higher probability of experiencing deterioration. In contrast, recovery from certain oral health problems/conditions or not having such problems was associated with a higher probability of improvement and a lower probability of deterioration.     

The effectiveness of out-of-hours dental services: I. Pain relief and oral health outcome

OBJECTIVE: To compare the effectiveness of four types of out-of-hours emergency dental service, including both 'walk-in' and telephone-access services. BASIC DESIGN: Questionnaire survey of patients attending weekend emergency dental services, with measurement of self-reported oral health status and dental pain (at attendance and follow-up) and retrospective judgements of change in oral health status. SETTING: Two health authorities in South Wales, UK. SUBJECTS: A total of 783 patients who completed questionnaires at attendance, and 423 who completed follow-up questionnaires. RESULTS: For patients who saw a dentist there were no consistent differences in the effectiveness of the four services, whether measured as pain relief, oral health gain or using patients' retrospective transition judgements about feeling better after their episode of emergency dental care. The proportion of patients reporting no improvement (transition judgements), either an hour after or the day after seeing the dentist, was surprisingly high (30-40% and 23-38% respectively). Although the 'rotas for all' - a telephone-access GDP-provided service for both registered and unregistered patients - achieved both the highest reductions in pain scores and the greatest improvements in dental health status between attendance and follow-up, this effect may reflect health gains due to care received after the episode of emergency dental care. CONCLUSIONS: Neither the setting where emergency dental patients are seen, nor the type of dentist who sees them, appear to have any significant effect on patient-reported health outcomes. Although further exploration of the factors that predict poor pain relief or low oral health gain is required, future research on these services should focus on the process of care and accessibility.     

Oral health in Uganda: the need for a change in focus

This paper reviews the oral health care system of delivery in Uganda as accurately as possible given the limited research base. The paper looks into the evolution of dentistry in Uganda as well as the havoc wrecked on health care in general by two decades of civil strife in an effort to find explanations for the poor performance of the oral health system. Alternative methods of service delivery are suggested drawing from the rich experiences of countries like Sri Lanka and Tanzania. The alternative model highlights the need for a Primary Health Care approach to oral health service delivery implemented in a systematic manner. The paper concludes with a call to all Ugandan oral health workers to take personal and collective responsibility for the improvement of oral health outcomes of 24 million Ugandans through research, advocacy, adherence to professional ethics and continued education.     

Cleft lip and palate care in the United Kingdom--the Clinical Standards Advisory Group (CSAG) Study. Part 2: dentofacial outcomes and patient satisfaction.

OBJECTIVE: To describe facial development and appearance, quality of bone grafts, oral health, and patient/parent satisfaction, with clinical outcome, for children in two age cohorts born with unilateral cleft lip and palate (UCLP) throughout the United Kingdom. DESIGN: Cross-sectional outcome study. SETTING: Fifty National Health Service cleft centers. PARTICIPANTS: Children born with complete UCLP between April 1, 1982, and March 31, 1984, (12-year-olds) and April 1, 1989, and March 31, 1991 (5-year-olds). Data were collected for 239 5-year-olds and 218 12-year-olds. The parents of these children were also interviewed to determine levels of satisfaction with care received. MAIN OUTCOME MEASURES: Skeletal pattern, dental arch relationship, success of alveolar bone grafting, facial appearance, oral health status, and patient/parent satisfaction. RESULTS: Nearly 40% of 5- and 12-year-olds had poor dental arch relations, and 70% of 12-year-olds had midface retrusion. Fifteen percent of 12-year-olds had not received an alveolar bone graft, and only 58% of bone grafts that had been undertaken were successful. Twenty percent of 12-year-olds and 40% of 5-year-olds had untreated dental caries. Less than one-third of subjects had a good facial appearance as judged by a panel of experts. Levels of patient and parent satisfaction were generally high. CONCLUSION: A rigorous evaluation of cleft care in the United Kingdom reveals disappointing outcomes.     

Developing lifetime relationships with patients: strategies to improve patient care and build your practice

AIM: The purpose of this article is to describe three strategies to build a thriving, patient-centered practice and promote oral health throughout a patient's lifetime. BACKGROUND: Compared to previous decades, more dental patients are "shopping around" for dental care and changing dental practices. This trend is due to factors such as acceptance of dental insurance, more comprehensive service offerings by other dentists, and effective marketing campaigns by other dental offices. FINDINGS: Delivering customer service exceeding patient expectations ("WOW" service), advocating patient education, and developing customized home care regimens will help lead to long-term patient retention and promote optimal patient care. DISCUSSION: A dental team making relationship-building a priority conveys respect for their patients' time and well-being. Once trust has been established patients are more likely to be receptive to oral health education and become more compliant with home care regimens. Since a patient's oral health status will likely change over time, it's important to make education and customized treatment planning an integral part of each visit. CONCLUSIONS: By demonstrating a strong commitment to customer service, education, and home care, patients recognize the care providers in a dental practice are interested in their well-being rather than simply treating problems. CLINICAL SIGNIFICANCE: If patients recognize a dental practice is focused on prevention and at-home oral health care, they are more likely to partner with that practice for a lifetime of excellent oral health care.