Patient Satisfaction in Medicine and Dentistry

Esthetic Crown Lengthening and Minimally Invasive Laminate Veneers to Resolve Altered Passive Eruption

Background

Altered passive eruption (APE) in the esthetic zone can be an esthetic concern to the patient. To restore adequate crown dimensions, crown lengthening procedures may be necessary.

Methods

The present case is a report of a patient with an unsatisfied smile due to a complaint of short clinical crowns. The periodontal diagnosis was APE and deviated maxillary anterior midline. A mock-up was made to assist the provider in evaluating the patient's esthetic concerns and acceptance of the proposed treatment plan.

Results

Esthetic crown lengthening and ultrathin ceramic laminate veneers were used to treat an APE type I subdivision B, resulting in a gingival display reduction and in final PES/WES scores of 10.

Conclusion

The use of periodontal plastic surgery in conjunction with ultrathin ceramic laminate veneers was mandatory to restore an unesthetic smile. The proposed treatment reduced the gingival display significantly and increased the crown height to length proportions reaching an esthetic smile and patient satisfaction.

Investigating Patient Satisfaction Through Web-Based Reviews of Norwegian Dentists: Quantitative Study Using the Meaning Extraction Method

BACKGROUND

Challenging encounters in health care professions, including in dentistry, are relatively common. Challenging encounters can be defined as stressful or emotional situations involving patients that could impact both treatment outcomes and patients' experiences. Through written web-based reviews, patients can share their experiences with health care providers, and these posts can be a useful source for investigating patient satisfaction and their experiences of challenging encounters.

OBJECTIVE

This study aims to identify dominant themes from patient-written, web-based reviews of dentists and investigate how these themes are related to patient satisfaction with dental treatment.

METHODS

The study data consisted of 11,764 reviews written by dental patients, which included 1- to 5-star ratings on overall satisfaction and free-text comments. The free-text comments were analyzed using Linguistic Inquiry and Word Count software, and the meaning extraction method was used to group words into thematic categories. These themes were used as variables in a multilevel logistic regression analysis to predict patient satisfaction.

RESULTS

Eight themes emerged from the analyses, of which 6 (75%)-explanation (odds ratio [OR] 2.56, 95% CI 2.16-3.04; P<.001), assurance (OR 3.61, 95% CI 2.57-5.06; P<.001), performance assessment (OR 2.17, 95% CI 1.84-2.55; P<.001), professional advice (OR 1.81, 95% CI 1.55-2.13; P<.001), facilities (OR 1.78, 95% CI 1.08-2.91; P=.02), and recommendation (OR 1.31, 95% CI 1.12-1.53; P<.001)-increased the odds of high patient satisfaction. The remaining themes (2/8, 25%)-consequences of treatment need (OR 0.24, 95% CI 0.20-0.29; P<.001) and patient-centered care (OR 0.62, 95% CI 0.52-0.74; P<.001)-reduced the odds of high patient satisfaction.

CONCLUSIONS

The meaning extraction method is an interesting approach to explore patients' written accounts of encounters with dental health professionals. The experiences described by patients provide insight into key elements related to patient satisfaction that can be used in the education of dental health professionals and to improve the provision of dental health services.

Bounded rationality in healthcare: unraveling the psychological factors behind patient satisfaction in China

Introduction

Patient satisfaction is a crucial metric to gauge the quality of medical services, but the psychological factors influencing patient satisfaction remain insufficiently explored.

Methods

This study examines these psychological factors by applying the theory of bounded rationality to 1,442 inpatients in Hangzhou, China, whose data were collected using a questionnaire. One-way ANOVA, correlation analysis, and hierarchical regression were used to analyze patient satisfaction and its associated factors. Additionally, the path analysis of the structural equation model revealed the mechanisms behind the key psychological factors that influenced patient satisfaction.

Results

Medical risk perception, the social cognition of the medical environment, and social desirability bias had significant positive impacts on patient satisfaction. By contrast, negative emotions had a significant negative impact on patient satisfaction. Notably, patients' negative emotions had both a suppressive effect and a positive moderating effect on the relationship between medical risk perception and patient satisfaction. Similarly, social desirability bias had a suppressive effect on the correlation between the social cognition of the medical environment and patient satisfaction, albeit with a negative moderating effect.

Discussion

These results suggest that when evaluating and improving patient satisfaction, accounting only for the factors that directly influence medical service quality is insufficient, as the indirect and moderating effects of patients' negative emotions and the social cognition of the medical environment must also be considered. Medical service providers should thus address patients' negative emotions, establish good doctor-patient relationships, optimize service environments, provide managers with medical risk education and training on negative emotions, and prioritize patient-centered care. Additionally, the government and relevant health departments should optimize medical policies, enhance fairness and accessibility, and create a positive social cognitive environment through public education and awareness campaigns.

Patient Satisfaction with the Quality of Oral Rehabilitation Dental Services: A Comparison between the Public and Private Health System

Measuring satisfaction can help us understand patients' expectations and adopt individualized treatment according to their expectations. In the current study, we applied the DPQ (Dental Practice Questionnaire) to analyze the degree of patient satisfaction regarding medical services in the public and private sector in a Romanian city from the central region. A group of 200 patients, 100 patients from the public sector and 100 patients from the private sector, participated in the survey. The results showed significant differences in response when patients were stratified by age, gender, visit frequency and length of time attending the same practice. Significant differences between public and private practices were encountered. Moreover, the degree of patient satisfaction was found to be related to appointment promptness/length of time and the confidentiality/ability to listen/knowledge/respect shown by the dentist, while patients' recommendations to others were influenced by dentists' explanations and warmth, followed by the appointment system and confidentiality. Patient satisfaction with oral rehabilitation dental services plays an essential role in maintaining patients' addressability, but there is a multitude of factors that can influence patients' opinions. Further analysis of the evolution of the influencing factors (causing satisfaction or dissatisfaction), in time, could provide deeper insights into the links between patient satisfaction and these factors.

Patient-reported outcomes following dental implant rehabilitation according to reason for missing teeth: A survey from a Norwegian population 8 years following treatment

AIM

The aim of this study was to assess patient-reported outcomes (PROs) 8 years after dental implant rehabilitation in a sample with tooth loss due to periodontitis (TLP) and a sample with missing teeth for other reasons (MTOR).

MATERIALS AND METHODS

The Norwegian National Insurance Scheme registry of subsidized dental implant therapy was searched, and patients (n = 3083) rehabilitated with dental implants in 2014 were mailed a questionnaire. PROs were described by relative frequencies, and the TLP and MTOR subsamples were compared using chi-square test. Multiple linear regression analyses were used to investigate variables potentially predicting PROs.

RESULTS

Of the respondents (n = 1299), more than 90% were partly or fully satisfied with the treatment outcome. Complications were reported by 44.2%. Patients who lost teeth due to periodontitis (n = 784) reported greater oral function improvement and better pre-treatment information, and were more likely to experience complications when compared with patients who lost teeth for other reasons (n = 515). Age, level of education, self-funded cost, pre-treatment information, history of complications and the reason for missing teeth were found to predict PROs.

CONCLUSIONS

In a Norwegian population rehabilitated with dental implants in 2014, satisfaction with the treatment outcome and the aesthetic outcome was high, irrespective of the reason for missing teeth. Self-report of complications and lack of pre-treatment information were the strongest predictors of inferior patient satisfaction and also predicted inferior oral function.

'We have no services for you… so you have to make the best out of it': A qualitative study of Myalgic Encephalomyelitis/Chronic Fatigue Syndrome patients' dissatisfaction with healthcare services

INTRODUCTION

People should have access to healthcare services that are effective, safe and secure, patient-centred, and coordinated and continuous. One group that has consistently reported negative experiences and feels dissatisfied with services are patients with Myalgic Encephalomyelitis (ME)/Chronic Fatigue Syndrome (CFS). The objective of this study was to develop a deeper understanding of the experiences of dissatisfaction among ME/CFS patients and explore the reasons for such dissatisfaction.

METHODS

We conducted in-depth interviews with 48 people from 24 households (comprising patients and family members), providing insight into the experiences of 37 ME/CFS sufferers in Norway. The participants were purposively sampled and included persons of different ages, genders, time since having the condition (3-30 years), and severity.

RESULTS

Four main themes were developed: (1) 'Nonexistent services' cover patients' experience that healthcare services had nothing to offer them after receiving their ME/CFS-diagnosis. (2) 'Nonpersonalised services' documents experiences where patients did receive services, which in theory was appropriate for relieving a specific health problem, but in practice were experienced as inappropriate because they were not adapted to the patient's need. (3) 'Slow services' address patients' experience of getting services too late (or too little) to be useful. (4) 'Wrong services' comprise patients' experiences of being offered and/or 'forced' to accept services that they felt were inappropriate for their health problems.

CONCLUSIONS

Providers' lacking knowledge of the condition and lack of precise recommendations for follow up may partly explain unsatisfactory experiences. Providers' belief (or disbelief) in the condition could furthermore influence caregiving. Also, systemic issues in the healthcare sector, like high workloads and bureaucracy, can negatively affect care provision. Finally, users' unsatisfactory experiences may also be due to a lack of patient involvement in the design of such services. Further research should investigate how patients can be involved in service design, and also providers' perspectives on caregiving and the barriers they experience for providing high-quality care.

PATIENT OR PUBLIC CONTRIBUTION

The ME-patient organisation suggested research topics to the call from which this study got funding. Patients and caregivers provided feedback during analysis and interpretation of data.

Exploring Predictors of Patient Satisfaction in Dental Services: A Secondary Analysis Study

Purpose

Understanding the factors that influence the level of patient satisfaction with dental services and identifying the strengths and weaknesses in dental clinics will subsequently increase patient satisfaction and contribute to improving dental care quality. This study aims to evaluate the variables that impact patients' satisfaction with dental services received in specialized dental care centers of the Ministry of Health in Saudi Arabia.

Patients and Methods

Secondary data at the national level from a patient experience program were used in this study. Completed Press Ganey® surveys submitted by patients during the first half of 2022 were included. The effect of the different domains (access to dental clinic, moving through dental visit and dentist) on the overall assessment rating of patient satisfaction was assessed using Pearson's correlation coefficient (r) and multiple linear regression models.

Results

A total of 964 surveys were completed and subsequently analyzed. The overall assessment rate of patient satisfaction was 73.4%. All items of the domains showed highly significant correlation levels (P < 0.001). However, the Dentist domain exhibited the highest correlation with the overall assessment rate of ‎patient satisfaction.

Conclusion

The dentist acts as the most significant predictor of patient satisfaction.

Psychometric properties of Iowa Anesthesia Satisfaction Scale Turkish version

BACKGROUND

The Iowa Satisfaction with Anesthesia Scale (ISAS) is a valid and reliable measurement tool developed to evaluate patient satisfaction with anesthesia care during different surgical interventions. It is adapted to various languages and used in many studies. Considering the satisfaction of the patient with anesthesia applied in surgical procedures, the presence of such a measurement tool is crucial.

AIM

From this point of view, the study aimed to evaluate psychometric properties of the ISAS by adapting it to Turkish culture.

METHODS

In this study, a descriptive, methodological and cross-sectional design was used. A total of 210 patients who underwent surgery under general or regional anesthesia were in the study.

RESULTS

ISAS Turkish version (ISAS-T) shows good reliability which is obvious with a Cronbach's alpha value of 0.80. The correlation levels of the items with the ISAS total score were calculated between .45 and .73. Test-retest reliability was calculated as 0.83. CFA analysis was applied to the one-dimensional 11-item final version of ISAS. The uni-dimensionality of the 11-item scale was confirmed on a Turkish patient sample. The fit indices for the model obtained were calculated as χ2/sd = 2.342, RMSEA = .80, SRMR = .04, CFI = .90, GFI = .92. The fit indices of the model have good and acceptable fit values.

CONCLUSION

Based on the psychometric evaluation, ISAS-T is a valid and reliable measurement tool for measuring patient satisfaction with anesthesia applied during different surgical procedures.

Patient Satisfaction in Dental Healthcare Settings at Saudi Ministry of Health: A Descriptive Study

Background

Patient satisfaction is crucial for assessing healthcare quality and identifying strengths and weaknesses in healthcare organizations. In Saudi Arabia, the Ministry of Health (MOH) implemented the Patient Experience Measurement Program to enhance patient experience and healthcare quality. This study aimed to identify specific aspects of patient satisfaction with dental visits in Saudi Arabia to improve dental care quality and inform dental services development.

Methods

The study used a standardized self-administered questionnaire (Health Links/Press Ganey) and analyzed surveys from patients who visited MOH-specialized dental clinics in Saudi Arabia during the first half of 2022. The dental section comprised 20 questions across five domains, with patients rating their experience on a 5-point Likert scale. Statistical analysis was performed using IBM SPSS Statistics 25.

Results

A total of 964 patients were surveyed. The overall patient satisfaction with dental settings was 3.61 out of 5.0 (72.2%). The highest satisfaction score was for personal issues with the dental clinic domain (3.93/5; 78.6%), while the least satisfaction score was for access to the dental clinic domain (3.29/5; 65.8%). Among all items, the cleanliness of the facility showed the highest satisfaction score (4.11/5; 82.2%). The least satisfaction was for the ease of contacting the dental clinic (2.71/5; 54.2%).

Conclusion

The study found high levels of satisfaction among Saudi patients with dental services provided through MOH facilities across various component domains. This highlights the crucial role of dentists in ensuring high-quality dental care and serves as an indication of the overall healthcare quality in MOH facilities.

THE DENTAL PROFESSION EXPERIENCES HIGH PREVALENCE RATES OF BURNOUT AND EMOTIONAL EXHAUSTION

ARTICLE TITLE AND BIBLIOGRAPHIC INFORMATION

Moro JDS, Soares JP, Massignan C, Oliveira LB, Ribeiro DM, Cardoso M, Canto GL, Bolan M. Burnout syndrome among dentists: a systematic review and meta-analysis. J Evid Based Dent Pract. 2022 Sep;22(3):101,724. doi: 10.1016/j.jebdp.2022.101724. Epub 2022 Apr 2. PMID: 36162888 SOURCE OF FUNDING: University funds.

TYPE OF STUDY/DESIGN

Systematic review with meta-analysis.

Comparisons of Clients' and Caregivers' Satisfaction Across Conventional, Virtual, and Hybrid Speech-Language Therapy Services in Malaysia

Purpose

This study compared the satisfaction of recipients of conventional speech-language therapy (C-SLT), speech-language teletherapy (SLTT), and hybrid speech-language therapy (H-SLT), and determined sociodemographic factors that affect their satisfaction.

Patients and Methods

Participants were clients and caregivers of a speech-language clinic at a public university. Services were primarily provided by student clinicians, who were undergoing supervised clinical training. An online survey was distributed, which consisted of three sections: Background Information, Overall Satisfaction in SLT, and Satisfaction in SLTT. All participants completed the first two sections, while the third section was completed only by those who experienced SLTT or H-SLT.

Results

Most of the respondents were caregivers (89.7%), female (79.4%), of Malay ethnicity (80.9%), have received tertiary education (77.9%), within the low-income category (66.2%), held a job (76.5%), and resided in central West Malaysia (83.8%). Many participants experienced C-SLT (51%), followed by H-SLT (34%), and SLTT (15%). There were no significant differences in the overall satisfaction of the participants across three modes of services delivery (F[2,67] = 0.02, p = 0.95), and in the satisfaction with teletherapy between the H-SLT and SLTT groups (t = 0.90, p = 0.38). Income was the only sociodemographic factor that was correlated with the satisfaction level in teletherapy (r = 0.37, p = 0.04).

Minimally Invasive Laminate Veneer Therapy for Maxillary Central Incisors

Minimally invasive dentistry is a considered process that requires the clinician to be prepared with the ideal sequence and the tools needed. This report describes a well-planned ultraconservative approach using only two ceramic laminate veneers for the maxillary central incisors to significantly improve the patient's overall smile. A 30-year-old female presented with the chief complaints of having diastemas between the central and lateral incisors as well as incisal wear. Diagnostic wax-up and mock-up were performed, and the patient approved the minimally invasive treatment with veneers only for central incisors. A reduction guide aided the conservative tooth preparations, and hand-crafted feldspathic veneers were bonded under total isolation with a rubber dam. The two final conservative veneers significantly improved the smile and fulfilled the patient's expectations. Following proper planning and sequencing, predictable outcomes were obtained and fulfilled the patient's esthetic demands. Minimally invasive restorative dentistry with only two single veneers can impact the entire smile frame. Overtreatment in the esthetic zone is unnecessary to meet a patient's esthetic expectations.

FOR PERI-IMPLANT SOFT TISSUE AUGMENTATION, SOFT TISSUE SUBSTITUTES MAY IMPROVE PATIENTS' SURGICAL AND POSTOPERATIVE EXPERIENCE COMPARED TO AUTOGENOUS GRAFTS

ARTICLE TITLE AND BIBLIOGRAPHIC INFORMATION

Thoma DS, Strauss FJ, Mancini L, Gasser TJW, Jung RE. Minimal invasiveness in soft tissue augmentation at dental implants: A systematic review and meta-analysis of patient-reported outcome measures. Periodontol 2000. 2022 Aug 11. doi:10.1111/prd.12465. Online ahead of print. PMID: 35950734.

SOURCE OF FUNDING

Not reported.

TYPE OF STUDY/DESIGN

Systematic review with meta-analysis.

Patients' and family caregivers' experiences and perceptions about factors hampering or facilitating patient empowerment for self-management of hypertension and diabetes in Cameroon

BACKGROUND

Noncommunicable diseases like hypertension and diabetes require long-term management, and are financially draining for patients and their families bearing the treatment costs, especially in settings where the inadequacy or non-existence of the health insurance system prevails. Patient empowerment-focused interventions have been shown to improve adherence to therapeutic regimens and decrease unnecessary health care utilization and costs. This study aims to examine enabling and impeding factors to the development of patient empowerment in a resource-limited setting like Cameroon.

METHODS

We used qualitative methods entailing three levels of investigation and involving a public primary healthcare hospital in Yaoundé, Cameroon. Data were collected through 40 semi-structural interviews with patients having hypertension or diabetes and their family caregivers, one focus group discussion with six patients, 29 observations of consultations of patients by specialist physicians, seven observations of care received by inpatients from generalist physicians, and nine documents on the management of hypertension or diabetes. A novel approach combining thematic and lexicometric analyses was used to identify similarities and differences in barriers and facilitators associated with patient empowerment at different levels of the healthcare delivery system in Cameroon.

RESULTS

Barriers generally outnumbered facilitators. There were particularities as well as commonalities in reported facilitators and barriers linked to patient empowerment from different experiences and perspectives of outpatients, inpatients and their family caregivers, given the healthcare services and organization of health personal and resources that deliver healthcare services to meet the health needs of patients with hypertension or diabetes in Cameroon. While specific factors identified by patients were directly related to the self-management of their disease at the individual level, family caregivers were mainly focused on factors present at organizational and central levels, which are indirectly related to the management of the diseases and beyond the control of patients and families.

CONCLUSIONS

The preponderance of individual-level factors linked to patient empowerment more than those at the central and hospital/organizational levels calls for due attention to them in the multilevel design and implementation of patient empowerment interventions in resource-limited settings like Cameroon. Accounting for patient's and families' perspectives and opinions may be key to improving healthcare delivery.

Oral health-related quality of life in patients with osteoarthritis of the temporomandibular joint-Results of a systematic review

OBJECTIVES

The aim of this systematic review was to assess the oral health-related quality of life (OHRQoL) of patients with osteoarthritis (OA) of the temporomandibular joint (TMJ).

METHODS

This systematic literature search applied the search terms "oral health-related quality of life AND osteoarthritis of jaw OR arthritis of temporomandibular joint AND oral health-related quality of life" in PubMed, Medline, Web of Science and Scopus. Eligibility criteria were publication until 31 August 2021, examination of children or adults with OA of TMJ, reporting of any OHRQoL measurement and a full text in English language. Two different, independent and experienced reviewers performed this systematic literature search. The analysis of respective data was qualitative. For quality appraisal, the available checklist from the Agency for Healthcare Research and Quality (AHRQ) was applied.

RESULTS

Out of 102 findings, eight studies were included in qualitative analysis. Seven clinical investigations were performed in adults aged between 34 and 43 years. The other included study was performed on children. The quality of two studies was moderate, and six studies were evaluated as of high quality. Most studies applied the 14-item short form of the oral health impact profile (OHIP 14) for assessment of OHRQoL. OHIP 14 ranged between 9.24 and 38.86 points in means of sum score. Comparison with healthy individuals revealed worse OHRQoL of OA patients in two studies. Associations between OHRQoL with either oral health, general quality of life or disease-related parameters were rarely reported and heterogeneous. Five of the included studies reported subscales of OHIP 14, showing an impairment in all subscales.

CONCLUSIONS

There are hints that patients with OA of the TMJ show a reduced OHRQoL. More studies are needed, especially regarding oral health, disease-related parameters and pain intensity and its potential influence on OHRQoL.

Clinical Practicum Assessment for Biomedical Science Program from Graduates' Perspective

The clinical practicum for biomedical science students aims to provide graduates with the knowledge and skills required to work in diagnostic laboratory settings. This study examines graduates' perspectives on content, teachers and clinical training and their satisfaction rates based on the skills gained during training. The study was conducted on females who graduated from Qatar University between 2015 and 2020. We used a previously validated questionnaire called CPAT-QU. Telephonic interviews were conducted and were analyzed using SPSS. The results showed a high satisfaction rate, of 80%, for the content and organization of the clinical training. The participants' main concerns included the evaluation criteria, as 8.7% were not satisfied. The students suggested increasing the length of the training in order to obtain experience that was more practical. The students' satisfaction with the teachers was 70% in terms of their attitude, command of knowledge and ability to convey knowledge. In total, 69.5% of the graduates claimed that their instructors were interested in teaching and 4.4% claimed their instructors conveyed disinterest in teaching. The Qatar University graduates were satisfied with the content of their clinical training. However, they reported some gaps in this training. Identifying these gaps will help in restructuring clinical training to improve student experience.

Diagnostic Mock-Up as a Surgical Reduction Guide for Crown Lengthening: Technique Description and Case Report

Background and Objectives: The report describes a technique using a diagnostic mock-up as a crown-lengthening surgical guide to improve the gingival architecture. Materials and Methods: The patient's primary concern was improving her smile due to her "gummy smile" and short clinical crowns. After clinical evaluation, surgical crown lengthening accompanied by maxillary central full-coverage single-unit prostheses and lateral incisor veneers was recommended. The diagnostic mock-up was placed in the patient's maxillary anterior region and used as a soft tissue reduction guide for the gingivectomy. Once the planned gingival architecture was achieved, a flap was reflected to proceed with ostectomy in order to obtain an appropriate alveolar bone crest level using the overlay. After six months, all-ceramic crowns and porcelain veneers were provided as permanent restorations. Results: A diagnostic mock-up fabricated with a putty guide directly from the diagnostic wax-up can be an adequate surgical guide for crown-lengthening procedures. The diagnostic wax-up was used to fabricate the diagnostic mock-up. These results suggested that it can be used as a crown-lengthening surgical guide to modify the gingival architecture. Several advantages of the overlay used in the aesthetic complex case include: (1) providing a preview of potential restorative outcomes, (2) allowing for the appropriate positioning of gingival margins and the desired alveolar bone crest level for the crown-lengthening procedure, and (3) serving as a provisional restoration after surgery. Conclusions: The use of a diagnostic mock-up, which was based on a diagnostic wax-up, as the surgical guide resulted in successful crown lengthening and provisional restorations. Thus, a diagnostic overlay can be a viable option as a surgical guide for crown lengthening.

Challenging encounters in clinical dentistry: a qualitative study investigating online reviews of patient satisfaction with Norwegian dentists

OBJECTIVE

Mapping key themes that characterize challenging and positive encounters in dental practice using online reviews of patient satisfaction.

MATERIALS AND METHODS

11,764 online patient reviews of dental encounters, consisting of an overall satisfaction rating (1-5 stars) and a free-text response, were collected from the web-site Legelisten.no. The reviews were split into two sets: reviews from patients with low satisfaction (1-2 stars) representing challenging encounters vs. patients with high satisfaction (4-5 stars) representing positive encounters. A qualitative thematic analysis was used to analyse the text materials in the datasets.

RESULTS

Five key themes to both challenging and positive patient encounters were identified: (1) Interpersonal factors, (2) Patient factors, (3) Dentist factors, (4) Situational factors, and (5) Consequences. These themes are discussed in light of their role in challenging and positive patient encounters, as well as previous studies of online reviews and patient satisfaction.

CONCLUSIONS

Based on the patients' experiences with dental encounters, challenging encounters seem to arise when dentists' personality traits and communication skills fail to match the patients' expectations or preferences. It appears central to patient satisfaction that dentists are able to shift between different communication styles in order to adapt to the personality and preferences of the patients.

Commonalities among dental patient-reported outcomes (dPROs)—A Delphi consensus study

Improvement of patients’ oral health-related quality of life (OHRQoL) is the main goal of oral health care professionals. However, OHRQoL is not a homogenous construct and how to assess it is challenging because of the large number of currently available instruments. Investigating available instruments and what they have in common would be necessary for consolidation and standardization of these instruments into a smaller set of tools. If the OHRQoL dimensions including Oral Function, Orofacial Pain, Orofacial Appearance, and Psychosocial Impact are the fundamental building blocks of the dental patient’s oral health experience, then these dimensions should be measured by generic multi-item dPROMs. In this study, a panel of 11 international dentists use the Delphi consensus process to determine how well 20 of these instruments measured the four OHRQoL dimensions. All 20 dPROMs questionnaires assessed at least one OHRQoL dimension while all four OHRQoL dimensions were measured by at least one dPROM instrument, i.e., the four OHRQoL dimensions were essential components of the patient’s oral health experience. This shows that the currently available generic multi-item dPROMs have a lot in common, in that they share Oral Function, Orofacial Pain, Orofacial Appearance, and Psychosocial Impact as targeted dimensions. Based on these commonalities, it is plausible and desirable to move towards a single four-dimensional metric to assess oral health impact in all clinical, community-based, and research settings. This step is necessary to advance evidence-based dentistry and value-based oral health care.

Development and Validation of a Clinical Practicum Assessment Tool for the NAACLS-Accredited Biomedical Science Program

Student perspectives on their final year clinical placements in biomedical sciences at Qatar University are assessed using the clinical practicum assessment tool (CPAT), which was developed in-house following accreditation body requirements. The tool, which we call the CPAT-Qatar University (CPAT-QU), covers the three clinical practicum domains: practicum content, preceptors, and competencies. Here, we validate this tool. The CPAT-QU has 27 Likert-scale questions and free-text open questions. CPAT-QU readability was calculated using the Flesch–Kincaid Reading Ease (FKRE) instrument. Content validity was assessed using the average and universal average scale-level content validity indices (S-CVI/Average and S-CVI/UA). For construct validity, 50 employed graduates who had completed the practicum were consented for study participation, and the validity was calculated by a principal component analysis (PCA). Reliability was analyzed by Cronbach’s alpha. The S-CVI/Average and S-CVI/UA were 0.90 and 0.59, respectively, indicating that an adequate proportion of the content was relevant. The PCA extracted two core components, which explained 63% of the variance in the CPAT-QU. Cronbach’s alpha values for the items were within the acceptable range of 0.60–1.00, showing that internal consistency has a good level. CPAT-QU appears to be a useful tool for assessing student perspectives on their clinical placements; however, construct validity needs continuous improvement.

Travel Time for Dental Care Services Based on Patient Preference in South Korea

This study analyzed patient preferences using travel time from residence to dental institution when selecting dental care services. We used data from the Korean Health Panel from 2008 to 2017 and analyzed each dental service episode. Since the distribution of travel time was skewed to the left, median travel time was analyzed. The association of travel time with services was analyzed via the population-averaged generalized estimating equation (GEE) with the Poisson family. The median of the average travel time per episode was longer for non-National Health Insurance (NHI)-covered services and shorter for NHI-covered services. The first quintile of low-income subjects traveled the longest for all services and utilized dental care the most. In the GEE analysis, travel time was approximately three times longer for implant treatment and gold inlay/resin fillings and >2 times longer for orthodontic care than for NHI-covered services. Patients residing in rural counties traveled for longer than residents of large cities. Income was statistically significant; however, the coefficient was close to zero. Travel time was related to the type of service and reflected patient preference. This was more prominent for expensive non-NHI-covered services than for NHI-covered services. The findings suggest patients’ subjective preferences for dental clinic selection are expressed as rational deliberation considering each individual’s situation.

Conventional free-hand, dynamic navigation and static guided implant surgery produce similar short-term patient-reported outcome measures and experiences

Design A randomised controlled trial study comparing patient-reported outcome measures (PROMs) and experiences (PREs) using conventional brain-guided (free-hand), dynamic computer-assisted implant surgery (dCAIS) and static computer-assisted implant surgery (sCAIS) for dental implant placement.Case selection Ninety subjects who met the inclusion criteria (that is, at least 20 years of age interested in dental implant treatment) accepted to participate in the trial and were randomly allocated to three groups between August 2019 and October 2020, according to the dental implant placement protocol, by means of block randomisation. The included subjects were required to undertake several self-administered questionnaires concerning: 1) pre-operative expectations (that is, five items evaluating patients' perceptions using a 5-point Likert scale and six items about patients' expectations concerning the planned surgery); 2) post-operative healing complications or events during the immediate post-operative week (that is, pain intensity assessment on a continuous visual analogue scale [VAS] 0-10, oedema or swelling evaluation on four grades ranging from no oedema [Grade 1] to extraoral oedema reaching beyond the surgical zone [Grade 4] and analgesic drugs intake); and 3) post-operative PROMs at a two-week follow-up (six items evaluating the post-operative symptoms experience and eight items measuring overall patient satisfaction using a 5-point Likert scale).Data analysis Kolmogorov-Smirnov test determined a non-normal distribution. Consequently, Wilcoxon signed-rank test assessed the intra-group differences and Kruskal-Wallis test was applied for inter-group comparison using the Statistical Package for the Social Sciences (IBM SPSS version 24; Chicago, IL). Spearman's correlation test evaluated the relation of patients' or implant procedures' characteristics with the maximum mean pain score, analgesic intake and oedema grade. The significance level alpha was set to 0.05. Lastly, Cronbach's alpha was used to evaluate the internal consistency for perceptions (0.53), expectations (0.76) and satisfaction (0.85).Results Only two subjects were excluded for missing the two-week follow-up visit. Both subjects belonged to the dCAIS group. Hence, 88 participants (mean age = 57.7 years) corresponding to 179 implants placed were evaluated. Sex was the only subjects' characteristic with a significant difference as more women were included (60%; p = 0.020). Most of the subjects had one (38%) and two (45%) dental implants at anterior (11%) and posterior sites (80%) with full-thickness flap operation (95%) but without simultaneous guided bone regeneration (57%). In terms of the surgical duration, sCAIS took the longest (89.70 ± 45.75 min), followed by dCAIS (70.95 ± 42.48 min) and brain-guided protocol (70.30 ± 47.08 min). Nevertheless, there was no significant inter-group surgical time difference (p = 0.076). Concerning the pre-operative patients' perspectives on dental implant intervention, most participants believed that implants would permit chew (93%), sound (88%) and appearance (91%) to be as close as with natural dentition. Interestingly, 32% believed that osseointegrated implants require less maintenance than natural dentition and 73% stated that implants last a lifetime. There was a significant difference between the groups regarding the both the amount of time they expected to be in pain postoperatively (p=.035) and the amount of post operative swelling they expected (p=0.006)There was no significant inter-group difference in magnitude of post-operative pain, oedema and analgesic intake. The dCAIS group expected longer to adapt to speaking (p = 0.030). The inter-group analysis of expected chewing difficulties evidenced significant differences (p = 0.040). Regarding the PREs, significant inter-group differences were displayed in duration of post-operative pain (p = 0.010), phonetic limitations (p = 0.038) and impact on routine activities (p = 0.046). After one week, the conventional and the sCAIS groups still had the highest (1.40 ± 2.43) and lowest (0.77 ± 1.85) pain scores. Concerning the self-reported post-operative oedema grading, it peaked on day two and most participants referred intraoral oedema (Grade 2) to extraoral oedema (Grade 3). Again, no significant inter-group difference was detected in the six measured time points regarding pain, oedema or analgesic intake. The highest post-operative oedema at day two was significantly correlated with flap operation (p = 0.030). During the first post-operative week, there was a low mean analgesic intake (5.13 ± 5.52). The first post-operative day had the highest consumption of analgesic drugs and the highest group consumption was by the conventional group. The post-operative healing experience and functional limitations were considered acceptable by most participants. Oedema had the lowest acceptable proportion (59%), followed by oral hygiene care difficulty (64%) and chewing (65%). The only intra-group difference in patients' acceptance was evidenced in the post-operative speaking difficulties of the sCAIS group (p = 0.015). Ninety-two percent of participants were satisfied with the clinical service (median = 5.0) and 89% were satisfied with the overall implant surgery (median = 4.0).Conclusions Placing dental implants with conventional brain-guided, sCAIS or dCAIS protocols obtained a similar post-operative level of patient satisfaction, analgesic intake, oedema and pain. Patients reported the dental implant post-operative symptoms to be acceptable even though they expected a shorter inflammation duration. The highest level of pain and oedema were experienced six hours and two days post-operative, respectively, regardless of the surgical protocol.

Does Emotional Intelligence of Dental Undergraduates Influence Their Patient Satisfaction?

Objectives

The research aimed to investigate if emotional intelligence (EI) scores of dental undergraduates influenced their patients' satisfaction with the treatment received.

Methods

A 33-item EI questionnaire was completed by 46 dental undergraduates in a cross-sectional study. Responses, measured on a five-point Likert scale, were summed to yield EI scores. Patients treated by the same undergraduates were invited to complete a patient satisfaction (PS) questionnaire. EI and PS scores were calculated and compared by undergraduates' gender and the patients' age and education status. The four EI factors (optimism/mood regulation, appraisal of emotions, utilization of emotions, and social skills of students) were correlated with PS using Spearman's correlation test with a significance level set at p < 0.05.

Results

EI scores did not differ significantly between male (N = 23) and female (N = 23) undergraduates (p=0.218). PS was not associated with patients' gender, but those educated to the secondary school level were more likely to be satisfied compared to those educated to the college/university level (p=0.022). Of the four EI factors, optimism/mood regulation was positively correlated with PS (p=0.049).

Conclusion

The results of the study suggest that the EI of the students can influence PS. Practical Implications. Interventions to enhance EI can be developed to improve the patient experience.

Patients' Satisfaction by SmileInTM Totems in Radiotherapy: A Two-Year Mono-Institutional Experience

Background: Patient’s satisfaction is recognized as an indicator to monitor quality in healthcare services. Patient-reported experience measures (PREMs) may contribute to create a benchmark of hospital performance by assessing quality and safety in cancer care. Methods: The areas of interest assessed were: patient-centric welcome perception (PCWP), punctuality, professionalism and comfort using the Lean Six Sigma (LSS) methodology. The RAMSI (Radioterapia Amica Mia SmileIN^{TM (SI)} My Friend Radiotherapy^SI), project provided for the placement of SI totems with four push buttons using HappyOrNot technology in a high-volume radiation oncology (RO) department. The SI technology was implemented in the RO department of the Fondazione Policlinico Universitario A. Gemelli IRCCS. SI totems were installed in different areas of the department. The SI Experience Index was collected, analyzed and compared. Weekly and monthly reports were created showing hourly, daily and overall trends. Results: From October 2017 to November 2019, a total of 42,755 votes were recorded: 8687, 10,431, 18,628 and 5009 feedback items were obtained for PCWP, professionalism, punctuality, and comfort, respectively. All areas obtained a SI-approved rate ≥ 8.0. Conclusions: The implementation of the RAMSI system proved to be doable according to the large amount of feedback items collected in a high-volume clinical department. The application of the LSS methodology led to specific corrective actions such as modification of the call-in-clinic system during operations planning. In order to provide healthcare optimization, a multicentric and multispecialty network should be defined in order to set up a benchmark.

Canadian Dental Patients with a Single-Unit Implant-Supported Restoration in the Aesthetic Region of the Mouth: Qualitative and Quantitative Patient-Reported Outcome Measures (PROMs)

This article contains quantitative and qualitative patient-reported outcome measures (PROMs) collected from nine dental patients, with a single-implant in the maxillary anterior region of the mouth, recruited after obtaining consent documents. The quantitative data were obtained from participants’ demographics, frontal extraoral digital photographs, intraoral scans (IOS) of the maxillary arch, and self-administered questionnaires (where patients judged the overall, appearance, function, and comfort of their single-implant-supported crowns). Objective single-implant aesthetic index mean scores (Pink Esthetic Score/White Esthetic Score [PES/WES]) were obtained after two experienced calibrated clinicians analyzed the photographs and the three-dimensional models generated from the IOS. The self-administered questionnaires used a visual analogue scale (VAS) to obtain the patients’ subjective perceptions. The qualitative data were obtained from in-depth, semi-structured one-to-one interviews. The transcriptions from audio-recorded interview data were managed and coded, with the aid of a Computer-Assisted Qualitative Data Analysis Software (CAQDAS). These data were stored in a public repository that can be easily downloaded from a Mendeley data repository (DOI: 10.17632/sv8t6tkvjv.1).

Factors Affecting Masticatory Satisfaction in Patients with Removable Partial Dentures

(1) Background: The degree of satisfaction with dental treatment varies among patients, and the discrepancy may exist between the patient's subjective evaluation and the objective assessment. Further, the optimal methods for increasing patient satisfaction with mastication remain unclear. This study aimed to identify factors affecting masticatory satisfaction in patients with removable partial dentures. (2) Methods: A total of 132 participants (71.0 ± 9.0 years) were included. Masticatory satisfaction was assessed on a visual analog scale. An oral health survey was conducted to assess the number of functional teeth, missing tooth classification: Kennedy classification, occlusal support: Eichner classification, and removable partial dentures wearing jaw. Objective masticatory performance was assessed using gummy jelly, while subjective masticatory ability was assessed using food acceptance status and oral health-related quality of life. The associations of these factors with masticatory satisfaction were assessed. (3) Results: Masticatory satisfaction among removable partial denture wearers was not significantly associated with gender, age, denture wearing jaw, Kennedy classification, and occlusal support. The degree of masticatory satisfaction was significantly greater with higher levels of masticatory function: masticatory performance, food acceptance score, and OHIP-14 score. The OHIP-14 score was the only significant explanatory variable for masticatory satisfaction in the multiple regression analysis; the strongest associations were with the "psychological discomfort" and "physical disability" subscales (p = 0.02 and p = 0.005, respectively). (4) Conclusions: Masticatory satisfaction among removable partial denture wearers was strongly associated with oral health-related quality of life, in which the ability to eat meals comfortably with removable partial dentures is the most important determinant of masticatory satisfaction.

Understanding the Lived Experience of North American Dental Patients With a Single-Tooth Implant in the Upper Front Region of the Mouth: Protocol for a Qualitative Study

BACKGROUND

Assessment of the subjective experiences of individuals with maxillary anterior (ie, the upper front region of the mouth) single-tooth implants is limited mainly to quantitative measurements of satisfaction with appearance. Interestingly, there is unexplained variability in the relationship between satisfaction and appearance.

OBJECTIVE

This qualitative study protocol aims to explore and better understand the satisfaction with appearance and function in a Canadian population with maxillary anterior single-tooth implants treated at a postgraduate university clinic. Thus, we aim to obtain diversity among participants relating to the identification of esthetically pleasing and displeasing cases from a clinician perspective.

METHODS

A qualitative research design using interpretative phenomenology analysis (IPA) will provide an adaptable inductive research approach. The participants will be recruited, and consent documents, photographs, digital intraoral scans, and self-administered questionnaire responses will be obtained from them. The transcribed verbatim data from audio-recorded, in-depth, semistructured, one-to-one interviews of the participants will be managed, coded, and analyzed thematically with computer-assisted qualitative data analysis software. The IPA will consider the COnsolidated criteria for REporting Qualitative (COREQ) guidelines when applicable.

RESULTS

For the qualitative interview, we plan to include at least eight patients to conduct up to 1.5 hours of open-ended interviews with each participant aided by an interview guide. Ethical approval was granted by the University of British Columbia Behavioral Research Ethics Board (H19-00107) in May 2019. Two American dental foundations funded this study.

CONCLUSIONS

The analysis in this study will elucidate the aspects (including their value) that influence participant satisfaction at different dental implant treatment stages. This will be the first qualitative study on this group of the population to explore and obtain a better understanding of their satisfaction with appearance and function, as well as any other patient-reported outcome measures that could be identified.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

DERR1-10.2196/25767.