Quality of care: compared perceptions of patient and prosthodontist

An artificial-intelligence-based method for assessing service quality: insights from the prosthodontics sector

Purpose

The prosthodontics sector is facing major challenges because of scientific and technological advances that imply a clearer definition of lines of action and decision making processes. Measuring quality of service in this sector is a complex decision problem since the perceptions of three main players need to be considered: patients, dentists and dental technicians. This study sought to develop an artificial-intelligence-based (AI-based) method for assessing service quality in the dental prosthesis sector.

Design/methodology/approach

Using strategic options development and analysis (SODA), which is grounded on cognitive mapping, and the measuring attractiveness by a categorical based evaluation technique (MACBETH), a constructivist decision support system was designed to facilitate the assessment of service quality in the dental prosthesis sector. The system was tested, and the results were validated both by the members of an expert panel and by the vice-president of the Portuguese association of dental prosthesis technicians.

Findings

The methodological process developed in this study is extremely versatile and its practical application facilitated the development of an empirically robust evaluation model in this study context. Specifically, the profile analyses carried out in actual clinics allowed the cases in which improvements are needed to be identified.

Originality/value

Although already applied in the fields of AI and decision making, no prior work reporting the use of SODA and MACBETH for assessing service quality in the prosthodontics sector has been found.

A survey of dentulous and edentulous patient preference among different denture esthetic concepts

STATEMENT OF PROBLEM

Most esthetic preference research and anatomical average analysis come from dentulous populations. If edentulous patients have a different preference, application of this data during denture construction is problematic.

PURPOSE

The aim of this survey was to compare dentulous and edentulous respondent preference among three different denture esthetic concepts.

MATERIAL AND METHODS

A questionnaire and test booklet of standardized full-face digital photographs were used. It included three arrangements during maximum smile for six subjects. Dentulous and edentulous respondents were asked questions about their preference among the three randomly ordered concept photographs for each of the six subjects. A total of 167 dentulous and 269 edentulous questionnaires were analyzed descriptively and with Chi-squared tests to compare the esthetic preference of the respondents.

RESULTS

There was no statistically significant difference overall between dentulous and edentulous preference. Respondent preference varied significantly depending upon subject set and gender. Preference data compared closely to previous research.

CONCLUSION

Within the limitations of this survey, dentulous and edentulous respondent preference among the three esthetic concepts was not significantly different. Questionnaire respondents continued to frequently prefer appearances that are far from the anatomical average.

A Survey of Edentulous Patient Preference among Different Denture Esthetic Concepts

STATEMENT OF PROBLEM

Despite the fact that solutions to functional problems are available, successfully restoring the appearance of an edentulous patient remains a challenge.

PURPOSE

The aim of this survey was to determine if edentulous respondents could differentiate among three denture esthetic concepts and if there was an overall preference among the three.

MATERIALS AND METHODS

Six edentulous test subjects were selected based on age and smile criteria. One wax tooth arrangement was completed according to each of the three esthetic concepts for a total of three wax tooth arrangements per test subject. The three esthetic concepts followed were natural, supernormal, and denture look. Standardized full-face digital photographs were made of each arrangement (three) during maximum smile for each subject (six). These 18 photographs were included in a questionnaire. Respondents were asked questions about their preference among the three randomly ordered concept photographs for each of the six subjects. A total of 147 completed questionnaires were analyzed.

RESULTS

Ninety-six percent of respondents were able to differentiate among the three esthetic denture concepts. Natural tooth arrangements were preferred by 55% of the respondents, supernormal tooth arrangements were preferred by 19%, and the denture look arrangements were preferred by 26%.

CONCLUSION

Within the limitations of this survey, the questionnaire respondents differentiated between the three esthetic denture concepts. The tooth arrangement most closely resembling the anatomical average was selected by 55% of the respondents. Preference for a particular concept changed when responses to each test subject set were considered individually. Demographic factors do not significantly affect patient preference.

CLINICAL SIGNIFICANCE

Three esthetic concepts for complete denture construction have been differentiated. Questionnaire respondents preferred appearances that are far from the anatomical average 45% of the time.

Restoring dentate appearance: A literature review for modern complete denture esthetics

Despite the fact that solutions to functional and comfort problems are often available, successfully restoring the appearance of an edentulous patient remains a challenge. This review of the literature demonstrates the limited amount of useful evidence-based information available for restoration of dentate appearance in edentulous individuals. The English language peer-reviewed literature from 1880 to the present was reviewed. Articles were identified through previous literature reviews, an extensive hand search, and a search of MEDLINE using the key words esthetics and denture esthetics. Three main areas of information were found: published guidelines for achieving natural appearance, patient preference studies, and studies that have collected and analyzed anatomic norms.

Construction faults, age, gender, and relative medical health: factors associated with complaints in complete denture patients

STATEMENT OF PROBLEM

Many practitioners will experience a situation, whereby a patient with newly fabricated complete dentures continues to experience difficulty in adapting to them. This can lead to a protracted period of discouraging "adjustment appointments" that may not result in the eventual resolution of the problem. Therefore it is often concluded that there is some patient factor, either age, gender, medical, or psychologic status that is hindering the success of treatment.

PURPOSE

This study examined a group of 100 patients who experienced ongoing difficulties with their new complete dentures, to determine possible underlying causes.

MATERIAL AND METHODS

A retrospective study was conducted with information derived from patient records. All patients were treated by the same prosthodontist after having been referred specifically for their denture problems. Information regarding patient age, gender, medical and psychological histories, and information pertaining to the dentures at the time of presentation was derived from patient records.

RESULTS

Statistical analysis comparing age, gender, and medical and psychologic status with the number or type of patient complaint failed to show any significant relationships. Significant relationships were observed when denture design faults or the condition of a patient's mucosa were compared with patient complaints.

CONCLUSIONS

This study suggests that in most instances, complete denture patients present with complaints only when there is a real design fault or a tissue problem.

A comparison of patient satisfaction and dentist evaluation of overdenture therapy

It has been argued that the retention of some teeth in the jaws as overdenture abutments prevents negative feelings about the loss of natural teeth. This study set out to evaluate how satisfied a group of patients were with wearing overdentures, and to compare their subjective evaluations with those of a dentist using objective criteria to examine the prostheses. A questionnaire was developed using questions adapted from several other studies. It was pretested, modified and used on all patients who were members of a longitudinal study of overdentures that started in 1974, and who returned on recall. At the end of 9 months, 101 subjects had completed the questionnaire and examination. The mean age of the patients was 65.9 years with an age range of 35 to 88 years. There were 68 men and 33 women in this study and 62 of them were satisfied with their dentures; 33 were satisfied, but felt they had some faults. Only 6 were unhappy about wearing the overdentures. The average length of time the dentures had been worn was 6.9 years, with a range of 1 to 15 years. The most frequent complaints were loss of retention (65.4%) and discomfort (62.2%) of the mandibular dentures. A number of correlations were evaluated and some significant relationships were found between dentist and patient evaluation of the dentures. The best predictor of patient satisfaction with denture wearing was the patient's perception of retention and appearance. In the maxilla the patient's ability to chew and the dentist's evaluation of occlusion were also significant predictors. In the mandible the only other factors apart from retention and appearance were patient comfort and age.

Dentist-patient communication: a review of relevant models

A review of the literature on dental treatment was conducted and models presented of the doctor/dentist-patient relationship. These models are listed and divided into two subgroups, empirical and normative models. The models are scrutinized with focus on the dentist-patient communicative relationship exclusively. Different doctor/dentist-patient relationships are described. External factors influencing these relationships are defined. An analysis of dentist-patient communication is made, and a new model of dentist-patient communication is suggested, which states that what is done and what is said during dentist-patient encounters will have an impact on outcome. Three different purposes of dentist-patient communication are presented. The process of attaining these is discussed. It is concluded that a theory of communication is lacking in the dental context, and the need to develop a reliable and valid interaction analysis system for the patient-dentist communication is confirmed.

Factors associated with successful denture therapy

PURPOSE

The purpose of this investigation was to evaluate complete denture patients at pretreatment and postinsertion, 6 months and 18 months after denture delivery in order to develop an explanatory model of successful denture therapy to better understand patient acceptance of complete dentures.

MATERIALS AND METHODS

Sixty complete-denture patients treated at a dental student clinic were followed through denture therapy and for 18 months thereafter. Subjects were examined and completed pretreatment questionnaires and posttreatment interviews. Three outcome measures of denture success were tested, and factors considered substantive in achieving a successful denture outcome were examined using multivariate analyses.

RESULTS

At post-insertion, 76.7% of subjects were satisfied with their dentures, 74.6% said their expectations were met, and 66.7% said they adjusted easily to their new dentures; reports at 6 and 18 months were similarly high. Logistic regression findings suggest that psychological and interpersonal factors are more important determinants of denture satisfaction than anatomic or clinical factors.

CONCLUSIONS

Subject characteristics including age, gender, race, income level, education, marital status, and maxillary and mandibular anatomy were not significantly associated with denture success as defined by the three outcome measures used in this study. Although these variables may represent important co-factors in the patient's acceptance of dental services and may affect the way a patient perceives dental care outcomes, statistically significant relationships were not found within our sample. Psychosocial variables, such as pretreatment expectations, satisfaction with the dental care received, and mental health showed a stronger relationship to a successful outcome.

The satisfaction of men with HIV infection attending a dedicated dental clinic: a controlled study

A self-complete questionnaire to assess satisfaction with dental care was administered to two groups of dental patients: men with asymptomatic HIV infection attending a dedicated dental clinic and men, presumed to be HIV negative, attending a general dental practice. Both settings were staffed by the same dentist. Men attending the dedicated clinic expressed satisfaction with the technical competence of their treatment and the affective behaviour of their dentist comparable with satisfaction expressed by participants at the general dental practice. However, men at the dedicated clinic expressed dissatisfaction with the availability of treatment. This may be related to the staffing level at the clinic. Men with asymptomatic HIV infection wanted more dentists who specialized in their needs and thought there was not enough information available on oral health.

Prosthodontic considerations for the transmandibular implant

The transmandibular implant has been designed to provide the patient with a severely atrophic mandible an implant that will bear the masticatory load. Thirteen edentulous patients treated with maxillary complete dentures and mandibular overdentures retained by the transmandibular implant were examined biannually for 2 years. Prosthodontic complications included the development of parafunctional habits, "combination syndrome," and epulis in association with the mandibular denture. Surgery was necessary to control chronic mucosal irritation related to muscle pull in one patient. Among the soft tissue parameters, plaque index, gingival index, and sulcus depth demonstrated statistically significant correlations (Spearman). All patients reported an absence of discomfort and those with previous functional complaints reported the ability to masticate all foods. Patient response to overdenture reconstruction with the transmandibular implant seems to be similar to that observed with the combination case. Oral hygiene appears to be directly related to the soft tissue response.

A comparison of self-assessed satisfaction among wearers of dentures, hearing aids, and eyeglasses

Patient assessment of dental prostheses, hearing aids, and eyeglasses can provide valuable data regarding adaptability of geriatric patients. This article describes a cross-modality evaluation of patient satisfaction with dental, hearing, and vision prostheses. Three hundred ninety-one subjects with recently placed prostheses were evaluated for self-assessed satisfaction and other related information. Patient satisfaction was compared with, age, type of prosthesis, and level of impairment. No statistical evidence of an age-related dissatisfaction with prostheses was found. Significant differences in levels of satisfaction were noted between different types of prostheses. Irrespective of level of impairment, patients expressed greatest satisfaction with dental prostheses and least satisfaction with hearing aids.

Quality assessment of dental restorations: a comparison by dentists and patients

The purpose of this study was to examine the relationship between the patient's and dentist's perception of quality. A group of 117 patients completed a questionnaire which rated their perceptions of the quality of their prior dental treatment. Each patient was given a thorough dental examination, and all restorations were evaluated for 14 criteria of quality. A dental quality index was calculated for each patient, and this was correlated with the patient's overall satisfaction and also with the patient's perception of quality of treatment. Both correlations indicated that no relationship existed between these two perceptions of quality. It was concluded that patients and dentists were looking at different criteria when judging quality of dental care.

Dentist and patient appraisal of complete dentures in a Dutch elderly population

The majority of the Dutch elderly population wears full dentures. According to clinical standards these dentures are often of a poor quality. The treatment demand, however, is small. The purpose of the present study is to describe the quality of dentures by means of clinical criteria on the one hand and judgments of the patients on the other. 131 denture-wearing individuals, with a mean age of 71, participated. A "denture quality" scale was constructed, consisting of five clinical parameters. The judgments of the respondents were recorded in terms of complaints and satisfaction with the dentures. The results show weak or nonsignificant correlations between the denture quality and the subjective measures. After dichotomizing the denture quality score (treatment need vs no treatment need), however, the poorer dentures appeared to be related to more complaints. It was concluded that for planning purposes it seems valid to use clinical figures. On the individual level the prediction of the subjective appraisal of full dentures on the basis of a clinical appreciation appears not to be adequate.