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

Dental EHR-infused Persona Ontologies to Enrich Dental Dialogue Interaction of Agents

The quality of patient-provider communication can predict the healthcare outcomes in patients, and therefore, training dental providers to handle the communication effort with patients is crucial. In our previous work, we developed an ontology model that can standardize and represent patient-provider communication, which can later be integrated in conversational agents as tools for dental communication training. In this study, we embark on enriching our previous model with an ontology of patient personas to portray and express types of dental patient archetypes. The Ontology of Patient Personas that we developed was rooted in terminologies from an OBO Foundry ontology and dental electronic health record data elements. We discuss how this ontology aims to enhance the aforementioned dialogue ontology and future direction in executing our model in software agents to train dental students.

A Systematic Literature Review of Quality Management Initiatives in Dental Clinics

By considering the recently proposed definitions and metrics, oral healthcare quality management (OHQM) emerges as a distinct field in the wider healthcare area. The goal of this paper is to systematically review quality management initiatives (QMIs) implementation by dental clinics. The research methodology approach is a review of 72 sources that have been analyzed using the Context-Intervention-Mechanism-Outcome Framework (CIMO). The analysis identifies five mechanisms that explain how quality management initiatives are implemented by dental clinics. The simplest QMIs implementations are related to (1) overall quality. The next ones, in terms of complexity, are related to (2) patient satisfaction, (3) service quality, (4) internal processes improvement, and (5) business outcomes. This paper is the first attempt to provide a critical review of this topic and represents an important advancement by providing a theoretical framework that explains how quality management is implemented by practitioners in this field. The results can be used by scholars for advancing their studies related to this emerging research area and by healthcare managers in order to better implement their quality management initiatives.

Does staff-assessed care quality predict early failure of dental fillings? A prospective study

OBJECTIVES

The aim of this study was to evaluate staff-assessed care quality as an indicator of register-based measures of care quality at dental clinics, more specifically register-based measures of survival of dental fillings and initiation of preventive treatments for caries patients.

METHODS

This prospective study includes data from cross-sectional workplace psychosocial risk assessment surveys at dental clinics and register data on survival of dental fillings, and initiation of preventive treatment for caries patients obtained from the Swedish Quality Registry for Caries and Periodontal Disease (SKaPa) Demographic background data on the age, gender, income level and place of birth of patients was obtained from Statistics Sweden (SCB). The data were analysed using discrete-time multilevel survival analysis and multiple linear regression analysis.

RESULTS

The results showed that staff-assessed care quality rated by the total staff or by dental nurses at the clinic predicted the risk of replacement of dental fillings made due to a caries diagnosis during the 3-year follow-up period, controlling for potential confounding due to patient demographic characteristics (age, sex, income and country of birth). In contrast, the better the staff-assessed care quality at the clinic, the smaller the proportion of the patients received preventive care in addition to operative caries therapy when controlling for potential confounding due to patient demographics. Care quality assessed by dentists at the clinic did not predict either of these outcome measures.

CONCLUSIONS

Premature failure of dental fillings is costly for both patients and society, which leads to a need for relevant measures for following dental care quality. Our findings indicate that staff-assessed care quality - a cheap and easy measure to collect and follow continuously in dental practice - can be used to monitor aspects of quality in real time in order to facilitate continuous improvement and quickly amend quality problems. Also, it can be used for integrating quality improvement in systematic work environment risk management.

Satisfaction with Orthodontic Care Provided in a University Orthodontic Clinic

Objective:

To evaluate patients’ satisfaction with their orthodontic care at the Department of Orthodontics of University of Athens.

Materials and Methods:

The study sample comprised of 100 individuals whose orthodontic treatment had been completed during the period May to October 2010. A questionnaire was designed and piloted before the telephone interviews were carried out. Questions concerned socio-demographic characteristics, reason for seeking care at the Dental School, level of satisfaction with treatment outcome, fees paid for treatment, and various aspects of organisation of care provision, assessed on 1-very dissatisfied to 5-very satisfied Likert type items.

Results:

Satisfaction score was particularly high as far as treatment outcome (53% were “very satisfied” and 31% were “satisfied”), dentist’s response to an emergency (81% were “very satisfied”), and personnel’s behavior at initial examination (81% were “very satisfied”) were concerned. Factors appearing to require improvement were the waiting time from initial examination to the beginning of treatment, the waiting room and the duration of treatment. Overall satisfaction was found to be significantly associated with total duration of treatment, fees paid by patients, treatment outcome, the behaviour of personnel who conducted first clinical examination, and dentist’s response to an emergency. Overall satisfaction was confirmed as the vast majority of patients (97%) would recommend the Orthodontic Clinic.

Conclusion:

While the Orthodontics Clinic enjoys overall highly satisfied patients, there is scope for improvement of organizational aspects of care provision like the waiting time between the initial examination and the beginning of treatment, the waiting room and the duration of treatment.

Judgment of the Quality of Restorative Care as Predictors of Restoration Retreatment: Findings from the National Dental PBRN

The primary aim of this study was to test the hypothesis that a patient's subjective assessments of the dentist's technical competence, quality of care, and anticipated restoration longevity during a restorative visit are predictive of restoration outcome. This prospective cohort study involved 3,326 patients who received treatment for a defective restoration in a permanent tooth, participated in a baseline patient satisfaction survey, and returned for follow-up. Of the 4,400 restorations that were examined by 150 dentists, 266 (6%) received additional treatment after baseline. Reporting satisfaction with the technical skill of the dentist or quality of the dental work at baseline was not associated with retreatment after baseline. However, patients' views at baseline that the fee was reasonable (odds ratio [OR], 1.6) was associated with retreatment after baseline, whereas satisfaction at baseline with how long the filling would last (OR, 0.6) was associated with less retreatment. These findings suggest that retreatment occurs more often for patients who at baseline are satisfied with the cost or who at baseline have less confidence in the restoration. The authors found no associations between restoration retreatment and the patients' baseline evaluations of the technical skills of their dentists or perceptions of quality care.

KNOWLEDGE TRANSFER STATEMENT

Dental patients' ratings of their dentist's skills were not related to a restoration needing retreatment. Patients focus on other aspects of the dental visit when making this judgment.

Satisfaction with dental care among patients who receive invasive or non-invasive treatment for non-cavitated early dental caries: findings from one region of the National Dental PBRN

BACKGROUND

The objectives were to: (1) quantify patient satisfaction with treatment for early dental caries overall, and according to whether or not (2a) the patient received invasive treatment; (2b) was high-risk for dental caries, and had dental insurance; and (3) encourage practitioners to begin using non-invasive approaches to early caries management.

METHODS

Ten practitioners recorded patient, lesion, and treatment information about non-cavitated early caries lesions. Information on 276 consecutive patients with complete data was included, who received either non-invasive (no dental restoration) or invasive (dental restoration) treatment. Patients completed a patient satisfaction questionnaire and were classified as dissatisfied if they did not "agree" or "strongly agree" with any of 14 satisfaction items.

RESULTS

Patients had a mean (± SD) age of 41.8 (±15.8) years, 64% were female and 88% were white. Twenty-five percent (n = 68) were dissatisfied in at least one of the 14 satisfaction items. Satisfaction levels did not significantly vary by patient's gender, race, caries risk category, or affected tooth surface location. Overall, 11% (28 of 276) received invasive treatment; satisfaction did not differ between patients who had invasive or non-invasive treatment. Seven patients received invasive treatment at their request even though that was not what their practitioner recommended; 5 out of 6 were satisfied with their treatment nonetheless.

CONCLUSIONS

About one-fourth of patients treated for non-cavitated early caries were dissatisfied with at least some aspect of their dental care experience. Satisfaction of patients who received invasive treatment did not differ from those who received non-invasive treatment.

Components of patient satisfaction with a dental restorative visit: results from the Dental Practice-Based Research Network

BACKGROUND

The authors conducted a study to identify components of patient satisfaction with restorative dental care and to test the hypothesis that certain dentist, patient and procedure factors are associated with patient satisfaction.

METHODS

Practitioner-investigators (P-Is) from 197 practices in The Dental Practice-Based Research Network (DPBRN) recruited consecutively seen patients who had defective permanent-tooth restorations that were replaced or repaired. At the end of the treatment visit, P-Is asked each participant to complete a satisfaction survey and mail it directly to a DPBRN regional coordinator.

RESULTS

Analysis of the results of 5,879 satisfaction surveys revealed three satisfaction components: interpersonal relationship-comfort factors, material choice-value factors and sensory-evaluative factors. Satisfaction was highest among patients who received care in a private practice model, whose restorations were repaired rather than replaced and whose restored teeth were not molars.

CONCLUSION

These data suggest that a patient's judgments of a dentist's skills and quality of care are based on personal interactions with the dentist, the level of comfort the patient perceives while receiving care and any experience of posttreatment sensitivity in the treated tooth. These conclusions have direct implications for management of patient care before, during and after the procedure.

PRACTICE IMPLICATIONS

By taking a patient-centered approach, dentists should seek to understand how patients evaluate and rate the service provided, thereby enabling themselves to focus on what each patient values most.

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.

Avaliação do nível de satisfação de pacientes em tratamento ortodôntico em relação à atuação do ortodontista

OBJETIVO: devido à crescente preocupação dos profissionais em adquirir novos pacientes e mantê-los satisfeitos com o tratamento, o presente estudo tem por objetivo avaliar o nível de satisfação de pacientes em tratamento ortodôntico em relação à atuação do ortodontista. MÉTODOS: foram avaliados 60 questionários preenchidos por pacientes em tratamento ortodôntico com profissionais especialistas em Ortodontia, da cidade de Curitiba-PR. Os pacientes foram divididos em dois grupos: o grupo 1 compreendia 30 pacientes que se consideravam insatisfeitos e se transferiram de profissional nos últimos 12 meses; os 30 pacientes participantes do grupo 2 consideravam-se satisfeitos e estavam em tratamento ortodôntico com o mesmo profissional há pelo menos 12 meses. RESULTADOS E CONCLUSÕES: após a realização da análise estatística pelo teste qui-quadrado, foi possível concluir que os fatores estatisticamente relacionados com o nível de satisfação dos pacientes avaliados, considerando a atuação do ortodontista, foram: titulação, recomendação do profissional, motivação, classificação técnica, interação profissional/paciente, e relacionamento pessoal com o paciente. Na avaliação do tratamento ortodôntico, os fatores que determinaram diferenças estatisticamente significativas no nível de satisfação dos pacientes foram: quantidade de pacientes atendidos simultaneamente e integração do paciente durante as consultas

Satisfação com o atendimento odontológico: estudo qualitativo com mães de crianças atendidas na Universidade Federal de Santa Catarina

Esta pesquisa objetivou conhecer a percepção de mães em relação ao atendimento odontológico prestado em clínicas de odontopediatria da Universidade Federal de Santa Catarina (UFSC), bem como sua concepção sobre como seria o dentista "ideal". O método utilizado foi o qualitativo, tipo estudo de caso. A coleta de dados foi feita através de entrevista semi-estruturada e a população estudada constituiu-se de sete mães de crianças atendidas em clínicas de odontopediatria da UFSC. Observou-se que, para as mães entrevistadas, o dentista ideal deveria reunir habilidades afetivas, psicomotoras e cognitivas, tais como: gostar do que faz, ser atencioso e amigável, fornecer informações claras sobre saúde bucal, resolver os problemas bucais do paciente e manter-se atualizado. Os aspectos interpessoais foram fundamentais para a satisfação com o atendimento na universidade, além da capacidade técnica dos alunos e a facilidade para conseguir uma vaga no serviço de odontopediatria. Sugere-se maior entendimento, por parte dos profissionais, dos aspectos que envolvem a relação dentista-paciente, de maneira a associar fatores afetivos aos cognitivos e psicomotores no dia-a dia da prática odontológica.

The patient assessment questionnaire: A new instrument for evaluating the interpersonal skills of vocational dental practitioners

This paper describes a pilot study aimed at evaluating a new instrument, the patient assessment questionnaire (PAQ), which uses patient ratings for the assessment of communication skills and professionalism in vocational practitioners (VDPs). The PAQ was developed as part of an assessment system designed to address all round competence. Acohort of 99 VDPs took part in the study. Questionnaires were distributed to consecutive patients in the general dental service at two time points in the training year. Data from the pilot study was analysed to determine whether the PAQ fulfilled the criteria for robust assessment. Results provide evidence of high levels of reliability, validity and feasibility of the PAQ instrument. All indications to date suggest that the PAQ will prove to be a valuable assessment tool. It is currently being evaluated as part of the system used to assess the all round competence of dental graduates undertaking vocational training in Scotland.

Current issues in dental practice management. Part 3. Attracting and keeping patients

This paper, the third in a series of articles exploring some of the management issues facing dentists today, examines the importance of maintaining a motivated, well-trained and properly rewarded staff team.

A review of patient satisfaction: 2. Dental patient satisfaction: an appraisal of recent literature

This paper examines the way patient satisfaction is perceived in the dental literature. The majority of studies carried out since the early 1980s concentrate on patient perceptions of various service quality attributes and the role that sociodemographic variables play in determining satisfaction. Recent work concerning attribution theory suggests that two concepts, duty and culpability, may be central to explaining this process.

Quality of dental care: the view of regular attenders

Patients' perceptions play an important role in assessing the quality of dental treatment. This study investigated 56 possible quality aspects on their importance as judged by regular attenders. A nationwide sample of 5000 Dutch people was contracted, 1328 persons meeting our selection criteria filled out the questionnaire and responded. The results show that hygiene of instruments and the availability of the dentist in case of emergency were considered the most important. It was concluded that in general these patients judged technical and functional aspects of dental care to be of more importance than communicative and informative aspects. Differences in perceptions were found according to sex and, to a lesser extent, to education, means of insurance and place of residence. But, on the whole, response patterns were homogeneous.

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.

Comparison of dental needs with the treatments actually received

The main purpose of the study was to determine the types, causes, dental needs, and follow-up treatments of the chief complaints of a socioeconomically disadvantaged population of patients attending a public dental hospital. Around half of the 301 patients examined were 45 years of age and older, and the vast majority were of caucasian origin. The most common dental complaints in 259 patients were toothache, broken teeth, lost fillings, and painful, broken or loose dentures. The most frequent causes of the chief complaints were judged to be dental caries, and inadequate restorations and removable prostheses. On examination, most of the patients also had one or more other unsatisfactory restorations or removable prostheses, especially in the 35 years and over age group. Deep periodontal pockets were also found most often in this age group. After four to six months, of the 259 patients with chief complaints, 113 had had their complaints treated and 45 had not, 47 patients were given a different form of treatment from that proposed, while 31 treatments were uncompleted, and 23 patients could not be followed up.