Abstract
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.
Keywords: patient satisfaction, dental restoration failure, dental care, clinical competence, pain, costs and cost analysis
Introduction
Evaluation of the quality of dental treatment usually incorporates practitioner-centered clinical effectiveness as well as the assessment of a patient’s experiences. Patient satisfaction is one way to measure the quality of patient-centered care and can serve as a proxy for the overall patient experience (Spreng et al. 1996; Oliver 1997). The placement or replacement of dental restorations is the most commonly performed procedure by general dentists (McDaniel et al. 2000; Mjör et al. 2000) and is therefore an appropriate procedure to test for associations between a patient’s subjective experience and more objective clinical outcomes (Goedhart et al. 1996). Technical competence of the dentist is often cited as a key determinant of dental satisfaction, with many studies placing it at the top, or near the top, of contributory factors (Goedhart et al. 1996; Calnan et al. 1999; Tamaki et al. 2005).
We are able to find only 1 published report that compared the objective quality of restorative treatment based on clinical outcome with the patient’s perception of that quality. In that report, Abrams and colleagues recruited 117 patients before an initial examination in a university dental clinic and compared their satisfaction ratings of previous dental care with a standardized index of restoration quality of their existing restorations (Abrams et al. 1986). Neither the summary score from the 5-item measure of patient satisfaction nor the item asking about satisfaction with the quality of past treatment were significantly associated with the restoration index score. One interpretation of these results is that patients are unable to evaluate the technical quality of their dental care. Limitations of the Abrams study were that the restoration index considered all restorations (regardless of their history) and that many of the patients were scheduled because of problems with older restorations; consequently, more problem restorations existed. In addition, recent visits were more likely to have influenced their recall of past satisfaction, and these visits may not have involved restorative treatment.
The primary aim of this study was to test the hypothesis that a patient’s subjective judgments of the dentist’s technical competence, quality of care, and anticipated restoration longevity during a restorative visit are predictive of restoration outcome, as measured by whether or not the restoration was retreated after baseline. In addition, we tested whether the dentist’s report of the patient’s experience was associated with the restoration outcome.
Materials and Methods
This prospective cohort study was performed within the National Dental Practice-Based Research Network (Gilbert et al. 2013). At the time of this study (2008 to 2011), the network was composed primarily of clinicians from 5 regions: Alabama/Mississippi; Florida/Georgia; dentists in Minnesota, either employed by HealthPartners in Bloomington, Minnesota, or in private practice; Permanente Dental Associates (PDA), in cooperation with Kaiser Permanente’s Center for Health Research in Portland, Oregon; and dentists from Denmark, Norway, and Sweden. Practice structures differed some by network region. Results from previous studies confirmed that dentists in practice-based research networks have much in common with dentists at large (Makhija et al. 2009a, 2009b). The institutional review boards of each participating region approved the study. The written informed consent of all human subjects who participated in this investigation was obtained after the nature of the procedures had been explained fully. The study conforms to the STROBE guidelines for cross-sectional studies. Copies of the questionnaires and summary of the dentists’ demographic and practice characteristics are also available at http://www.nationaldentalpbrn.org/study-results.php (“Longitudinal Study of Repaired or Replaced Dental Restorations”).
The overall project involved collecting data on the restoration procedures, assessing patient satisfaction with the restorative visit, and a longitudinal follow-up of the restorations. Once the study was started, every patient scheduled to have a repair or replacement of a restoration on a permanent tooth was asked to participate until each practitioner enrolled 50 restorations. During each visit, patients were given the Satisfaction Survey Form, along with a stamped envelope, and instructed to complete the survey the next day. The competed satisfaction survey was mailed directly to the network regional coordinators to ensure that dentists remained masked to patient satisfaction ratings. At the end of the dental restorative procedure, the dentist completed a form about the visit that was forwarded to the regional coordinators.
The restorations that were repaired or replaced at baseline were scheduled to be recalled after 12 mo. Upon return, restorations were characterized for quality according to defined criteria. Acceptable: The restoration is of satisfactory quality and is expected to protect the tooth and the surrounding structures or has 1 or more features that deviate from ideal conditions, but it does not need to be replaced or repaired. Not acceptable: Additional treatment is necessary because future damage to the tooth and/or surrounding tissues is likely to occur or is occurring. If a serviceable or intact restoration had been replaced because it was incorporated into a larger restoration, it was recorded as acceptable.
Patient and Dentist Satisfaction Measures
The preliminary set of questions was designed by several experts in restorative dentistry and then field-tested using 9 dentists and 39 persons with a restoration-related dental visit within the previous year. The final patient instrument, which consisted of 20 patient-answered items, is described in detail in an earlier publication (Riley et al. 2012). Response choices were very satisfied, satisfied, neutral, dissatisfied, or very dissatisfied. A dentist version that asked about selected aspects of the treatment and visit was also developed (Riley et al. 2014). An earlier report of this study provides greater detail of procedural, material, and tooth factors that were tested and that contributed to the need for retreatment of the restoration (Gordan et al. 2015).
Statistical Analysis
The dependent variable for this study was “additional treatment” and was operationalized as restorations that were classified as acceptable after baseline and were coded no treatment = 0 and those that were classified as not acceptable and received treatment (repair, replacement, endodontic, and extraction) = 1 at the follow-up. We will use the term retreatment as we refer to this set second of restorations.
The study had 2 sets of predictor variables that reflected 1) the patient’s viewpoint and 2) the dentist’s viewpoint of the patient during the restorative procedure. The first set of variables included a patient’s assessment of the technical competence of the dentist and quality of the care received and other aspects that might influence this evaluation (comfort during the procedure, interpersonal relationship factors, and perceived value of the services). Dentists were asked how the patients would rate their technical abilities and about other aspects of their experience (comfort during the procedure, interpersonal relationship factors, and overall satisfaction).
Two binary logistic models were used to test the study hypotheses, with generalized estimating equations to adjust for clustering within dentists and restorations within patients. The prediction model included variables found to be significant predictors of treatment for the original defective restoration (repair = 1, replacement = 0), tooth (molar = 1, premolar or anterior = 0), and fractured restoration (fractured restoration = 1 when the primary reason for the defect and coded = 0 when fractured restoration was not the primary reason for the defect; Gordan et al. 2015). Information about patient (sex, age), dentist (sex, years in practice), and practice model was entered in an initial step and included in subsequent testing if they were significant at P ≤ 0.15.
Results
In the original study of defective restorations, complete data were received on 7,286 patients in the patient satisfaction component of this study. Network regional coordinators received a total of 5,879 surveys from patients, which resulted in a compliance rate of 81% (Riley et al. 2012). Postbaseline data were provided on 4,648 patients involving 6,059 restorations. Of the subset of 4,648 patients who completed the follow-up visit, 3,326 patients (involving 4,400 restorations) also returned the baseline patient satisfaction survey and are the subject of the following analyses. Of these 4,400 restorations, 266 (6%) required retreatment postbaseline as follows: 51 (1%) were repaired, 117 (3%) were replaced, 59 (1%) teeth received endodontic treatment, and 39 (<1%) were extracted. The mean (SD) number of months from baseline to the follow-up evaluation was 11.4 (3.5).
Patients completing both the satisfaction component and the follow-up visit were treated by 150 network dentists (39 women and 111 men) who practiced in a broad range of service models (102 private/small groups, 40 large groups, and 8 public health settings). The dentists had a mean (SD) of 10 (10) y of practice experience, ranging from 1 to 50 y at study onset. Patient demographic and restoration variables are presented in Table 1.
Table 1.
Descriptive Statistics for Patient Demographic and Restoration Variables.
| Patient Variable | % (n) |
|---|---|
| Sex | |
| Male | 42 (1,389) |
| Female | 58 (1,937) |
| Race | |
| Caucasian | 93 (3,079) |
| African American | 5 (165) |
| Other | 2 (74) |
| Not specified | <1 (8) |
| Baseline restoration | |
| Repaired | 25 (1,074) |
| Replaced | 75 (3,232) |
| Not specified | 2 (94) |
| Primary reason for baseline treatment | |
| Fracture | 36 (1,563) |
| Secondary caries | 41 (1,806) |
| Other | 23 (1,016) |
| Not specified | <1 (15) |
| Tooth type receiving restoration | |
| Upper molar | 25 (1,104) |
| Lower molar | 29 (1,254) |
| Upper premolar | 14 (609) |
| Lower premolar | 12 (525) |
| Upper anterior | 16 (693) |
| Lower anterior | 5 (215) |
| Number of surfaces in baseline restoration (n = 4,400) | |
| 1 | 22 (963) |
| 2 | 34 (1,502) |
| 3 | 18 (782) |
| 4 | 7 (289) |
| 5 | 20 (864) |
Patients’ Viewpoint Predicting Restoration Outcome
Reporting satisfaction at baseline with the quality of the dental work (P = 0.46) or technical skill of the dentist (P = 0.93) was not associated with retreatment of the restoration postbaseline. Reporting satisfaction at baseline that the fee was reasonable for the service provided was associated with increased retreatment by the follow-up visit (odds ratio [OR], 1.6; P = 0.007). Reporting satisfaction at baseline with how long the filling will last (OR, 0.6; P = 0.006) was associated with a lower percentage of retreatment. Other variables were not associated with retreatment (Table 2).
Table 2.
Patients’ Baseline Viewpoints as Predictors of Whether the Restoration Received Treatment after Baseline.
| Satisfaction Variables | B (SE) | P Value | OR (95% CI) |
|---|---|---|---|
| Predicting restoration received additional treatment | |||
| Limited pain during the procedure | –.166 (.392) | 0.671 | 0.8 (0.4 to 1.8) |
| Limit my fear and anxiety | –.027 (.287) | 0.925 | 1.0 (0.6 to 1.7) |
| Quality of the dental work | –.306 (.417) | 0.463 | 1.2 (0.5 to 2.0) |
| Technical skill of the dentist | –.036 (.431) | 0.934 | 1.0 (0.4 to 2.4) |
| Fee was reasonable for the service provided | .471 (.175) | 0.007 | 1.6 (1.2 to 2.1) |
| How long the filling will last | –.480 (.175) | 0.006 | 0.6 (0.4 to 0.8) |
| Friendliness of my dentist | .790 (.407) | 0.113 | 1.5 (0.8 to 2.9) |
| Cared about me as a person | –.127 (.417) | 0.761 | 0.9 (0.4 to 2.0) |
The outcome was scored as 0 = no treatment received for the restoration at any time during follow-up; 1 = some postbaseline treatment was received. Predictor variables were scored strongly disagree, disagree, or neither agree or disagree = 0; agree or strongly agree = 1.
CI, confidence interval; OR, odds ratio.
Dentists’ Viewpoint Predicting Restoration Condition
The dentist reporting at baseline that the patient would rate his or her technical abilities as good or excellent was not associated with a restoration retreatment by the follow-up visit (P = 0.17). The dentists’ agreement at baseline with the statement that the patient was experiencing pain during the procedure (OR, 1.3; P = 0.008) was associated with increased risk of retreatment (Table 3). The dentists’ agreement at baseline with the statement that the patient was satisfied or extremely satisfied with all aspects of the treatment and visit (OR, 0.7; P = 0.005) was associated with decreased risk of retreatment. Other variables were not associated with retreatment.
Table 3.
Dentists’ Baseline Viewpoint as a Predictor of Whether the Restoration Received Treatment after Baseline.
| B (SE) | P Value | OR (95% CI) | |
|---|---|---|---|
| Predicting restoration required additional treatment | |||
| Procedure was painful for the patient todaya | 0.39 (0.17) | 0.01 | 1.3 (1.2 to 1.8) |
| The patient was anxious during the procedure todaya | –0.23 (0.13) | 0.15 | 0.8 (0.6 to 1.1) |
| The patient perceived me as friendlya | 0.01 (0.35) | 0.97 | 1.0 (0.5 to 2.0) |
| How would the patient rate your technical abilities for this restorative procedure?b | 0.43 (0.32) | 0.17 | 1.5 (0.8 to 2.8) |
| How satisfied was the patient with all aspects of the dental treatment and visit?c | –0.49 (0.20) | 0.01 | 0.7 (0.5 to 0.8) |
The outcome was scored as 0 = no treatment received for the restoration at any time during follow-up; 1 = some postbaseline treatment was received.
CI, confidence interval; OR, odds ratio.
Items were scored strongly disagree, disagree, or neither agree or disagree = 0; agree or strongly agree = 1.
Items were scored poor, fair, or neutral = 0; good or excellent = 1.
Items were scored not at all satisfied, slightly satisfied, moderately satisfied = 0; very satisfied or extremely satisfied = 1.
Discussion
This study tested for associations between patients’ subjective experiences during a baseline dental visit to treat a defective restoration and postbaseline objective measures of clinical outcome of that restoration. Overall, we found no association between patients’ evaluations of the quality of the work performed or technical skills of their dentists and restoration quality by the follow-up visit, a measure of practitioner-centered clinical effectiveness. We did find evidence that pain experienced by the patient and the lack of patient satisfaction with pain control were predictive of greater risk for additional treatment after baseline.
Overall, the 6% of defective restorations needing retreatment in the first year of this large study may appear high. A recent meta-analytic review of composite restorations by Opdam et al. (2014) reported an average annual failure rate aggregated across 5 y at 1.8% or 8% over the 5-y time period. There may be several reasons for this apparent discrepancy. First, it is important to consider that network dentists did not evaluate the clinical characteristics of the restorations using the United States Public Health Services (USPHS)/Ryge criteria. Rather, one of the goals of this project was to assess the clinical survival of treatment of defective restorations chosen by practicing dentists when using their own idiosyncratic judgment for the need for retreatment. Another factor they may contribute to a higher rate is that we included defective amalgam restorations, which resulted in a higher retreatment rate than other materials (Gordan et al. 2015). The importance of reporting outcome for the first 12 mo after treatment is supported by work by Gordan et al. (2011, 2015), who found changes in USPHS/Ryge criteria to be highest in the first year. It is possible that failure rates in studies in the Opdam et al. review had higher failure rates in the first and second years. On the other hand, another network study of restorations placed on unrestored tooth surfaces reported a similar rate of failure at 6.6% (McCracken et al. 2013).
Our earlier report of this study identified procedural, material, and tooth factors that contribute to retreatment (Gordan et al. 2015). These include whether the defective restoration was repaired compared to replaced, whether the restoration was in a molar tooth compared to an anterior or premolar tooth, if the primary reason for the retreatment was a fracture, or if the restoration was replaced and the replacement material was amalgam. These variables were adjusted in our statistical models in this current study.
Our primary findings were similar to those of Abrams et al. (1986), in that patients’ perception of the quality care and technical skill of the dentist were not associated with whether or not a restoration received retreatment. Studies have shown that a dentist’s technical competence is a high priority for patients (Goedhart et al. 1996; Tamaki et al. 2005). For example, Calnan et al. (1999) found that perceived technical skills were evaluated as the most important components of dental care by approximately 50% of respondents. While patients ultimately judge the quality of services based on their perceptions of the technical aspects of the treatment and how that service was delivered, many professional services are highly complex, and a clear outcome is not always evident.
Although patients’ ratings of the quality of care and technical skill at baseline were not associated with retreatment after baseline, retreatment was associated with the patients’ baseline evaluation of the cost of the treatment. It is possible that patients who price shop for dental care may not receive the best quality of care. Given this scenario, it is conceivable that dentists with a high volume of procedures done within a certain time frame may sacrifice quality by rushing through the procedure to keep the cost down. The cost of care is known to be a determinant of the use of dental services, and it is possible that these patients may have delayed treatment and as a result had poorer oral health and, therefore, were more prone to a poor outcome (Thompson et al. 2014; Davis and Reisine 2015). Whether restoration outcome in this study is a function of patient behavior or practice/treatment factors is unknown, but this is an interesting question. This is also consistent with another significant finding that baseline dissatisfaction with how long the restoration would last was associated with increased likelihood of retreatment. This can be interpreted to indicate that a patient who seeks low cost ultimately has less confidence in the final product (Kress and Silversin 1987). There has been little attention to cost-value comparisons in the restorative dental literature. In general, cost is a factor in overall satisfaction (Calnan et al. 1999), but the Newsome and Wright (1999) review placed cost low on the list of patient priorities.
From the dentists’ perspective, pain during the baseline procedure was associated with the restoration’s postbaseline condition and retreatment. Based on dentists’ reports, approximately 12% of the procedures were painful, and it would appear that one factor that significantly predicts retreatment is “the procedure being painful.” The dentists’ baseline assessment of the patients’ overall satisfaction was also predictive of retreatment. Surprisingly, in an earlier report, we found that pain during the baseline procedure was not associated with patient report of overall satisfaction with that procedure (Riley et al. 2012). We speculated that this was because patients understand the potential to have negative experiences during dental treatment (i.e., the procedure being painful), and because of other overriding positive factors, such as a high level of rapport and trust of the dentist, patients were satisfied.
Our study improves upon the methodology used by Abrams et al. (1986) in that 1) this study focused on a single procedure (treatment of a defective restoration); 2) patients rated the dentists’ performance proximal to the procedure, so recall bias was reduced; and 3) the outcome was an objective assessment—retreatment after baseline. A weakness of our study is that outcomes were monitored only the first year, although decrement in restoration quality progressively decreases after the first year (Gordan et al. 2006, 2011). This study was observational in that clinicians selected what they determined was the most appropriate treatment for failed and failing restorations and whether to retreat by the follow-up visit.
Conclusion
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 final product. This study did not support the hypothesis that dental patient perceptions of quality of care are associated with practitioner-determined clinical effectiveness. Consistent with earlier work (Abrams et al. 1986), we found no associations between patients’ evaluation of the technical skills of their dentists and restoration retreatment. Although technical competence of the dentist is often cited as being a key determinant of dental satisfaction, it appears possible that patients focus on other aspects of the dental visit when making this judgment.
Author Contributions
J.L. Riley III, contributed to conception, design, data acquisition, analysis, and interpretation, drafted and critically revised the manuscript; G.H. Gilbert, contributed to conception, design, data acquisition, analysis, and interpretation, critically revised the manuscript; G.W. Ford, contributed to data acquisition, analysis, and interpretation, critically revised the manuscript; J.L. Fellows, B. Rindal, and V.V. Gordan, contributed to conception, design, data acquisition, analysis, and interpretation, critically revised the manuscript. All authors gave final approval and agree to be accountable for all aspects of the work.
Footnotes
This work was supported by National Institutes of Health (NIH) grants U19-DE-22516, U01-DE-16746, and U01-DE-16747. An Internet site devoted to details about the nation’s network is located at http://NationalDentalPBRN.org. Persons who comprise the National Dental PBRN Collaborative Group are listed at http://NationalDentalPBRN.org/users/publications. Opinions and assertions contained herein are those of the authors and are not to be construed as necessarily representing the views of the respective organizations or the NIH.
The authors declare no potential conflicts of interest with respect to the authorship and/or publication of this article.
References
- Abrams RA, Ayers CS, Vogt Petterson M. 1986. Quality assessment of dental restorations: a comparison by dentists and patients. Community Dent Oral Epidemiol. 14(6):317–319. [DOI] [PubMed] [Google Scholar]
- Calnan M, Dickinson M, Manley G. 1999. The quality of general dental care: public and users’ perceptions. Qual Health Care. 8(3):149–153. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Davis DL, Reisine S. 2015. Barriers to dental care for older minority adults. Spec Care Dentist. 35(4):182–189. [DOI] [PubMed] [Google Scholar]
- Gilbert GH, Williams OD, Korelitz JJ, Fellows JL, Gordan VV, Makhija SK, Meyerowitz C, Oates TW, Rindal DB, Benjamin PL, et al. ; National Dental PBRN Collaborative Group. 2013. Purpose, structure, and function of the United States National Dental Practice-Based Research Network. J Dent. 41(11):1051–1059. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Goedhart H, Eijkman MA, ter Horst G. 1996. Quality of dental care: the view of regular attenders. Community Dent Oral Epidemiol. 24(1):28–31. [DOI] [PubMed] [Google Scholar]
- Gordan VV, Riley JL, III, Blaser PK, Mjör IA. 2006. 2-Year clinical evaluation of alternative treatments to replacement of defective amalgam restorations. Oper Dent. 31(4):418–425. [DOI] [PubMed] [Google Scholar]
- Gordan VV, Riley JL, III, Blaser PK, Mondragon E, Garvan CW, Mjör IA. 2011. Alternative treatments to replacement of defective amalgam restorations: results of a seven-year clinical study. J Am Dent Assoc. 142(7):842–849. [DOI] [PubMed] [Google Scholar]
- Gordan VV, Riley JL, III, Rindal DB, Qvist V, Fellows JL, Dilbone DA, Brotman SG, Gilbert GH; National Dental PBRN Collaborative Group. 2015. Repair or replacement of restorations: a prospective cohort study by dentists in the National Dental Practice-Based Research Network. J Am Dent Assoc. 146(12):895–903. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Kress GC, Jr, Silversin JB. 1987. The role of dental practice characteristics in patient satisfaction. Gen Dent. 35(6):454–457. [PubMed] [Google Scholar]
- Makhija SK, Gilbert GH, Rindal DB, Benjamin PL, Richman JS, Pihlstrom DJ; DPBRN Collaborative Group. 2009a. Dentists in practice-based research networks have much in common with dentists at large: evidence from the Dental Practice-Based Research Network. Gen Dent. 57(3):270–275. [PMC free article] [PubMed] [Google Scholar]
- Makhija SK, Gilbert GH, Rindal DB, Benjamin P, Richman JS, Pihlstrom DJ, Qvist V; DPBRN Collaborative Group. 2009b. Practices participating in a dental PBRN have substantial and advantageous diversity even though as a group they have much in common with dentists at large. BMC Oral Health. 9:26. [DOI] [PMC free article] [PubMed] [Google Scholar]
- McCracken MS, Gordan VV, Litaker MS, Funkhouser E, Fellows JL, Shamp DG, Qvist V, Meral JS, Gilbert GH; National Dental Practice-Based Research Network Collaborative Group. 2013. A 24-month evaluation of amalgam and resin-based composite restorations: Findings from the National Dental Practice-Based Research Network. J Am Dent Assoc. 144(6):583–593. [DOI] [PMC free article] [PubMed] [Google Scholar]
- McDaniel RJ, Davis RD, Murchison DF, Cohen RB. 2000. Causes of failure among cuspal-coverage amalgam restorations: a clinical survey. J Am Dent Assoc. 131:173–177. [DOI] [PubMed] [Google Scholar]
- Mjör IA, Moorhead JE, Dahl JE. 2000. Reasons for replacement of restorations in permanent teeth in general dental practice. Int Dent J. 50(6):360–366. [DOI] [PubMed] [Google Scholar]
- Newsome PR, Wright GH. 1999. A review of patient satisfaction: dental patient satisfaction: an appraisal of recent literature. Br Dent J. 186(4 Spec No):166–170. [DOI] [PubMed] [Google Scholar]
- Oliver RL. 1997. Satisfaction: a behavioral perspective on the consumer. New York (NY): McGraw Hill. [Google Scholar]
- Opdam NJ, van de, Sande FH, Bronkhorst E, Cenci MS, Bottenberg P, Pallesen U, Gaengler P, Lindberg A, Huysmans MC, van Dijken JW. 2014. Longevity of posteriorcomposite restorations: a systematic review and meta-analysis. J Dent Res. 93(10):943–949. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Riley JL, III, Gordan VV, Rindal DB, Fellows JL, Qvist V, Patel S, Foy P, Williams OD, Gilbert GH; Dental Practice-Based Research Network Collaborative Group. 2012. Components of patient satisfaction with a dental restorative visit: results from the Dental Practice-Based Research Network. J Am Dent Assoc. 143(9):1002–1010. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Riley JL, III, Gordan VV, Hudak-Boss SE, Fellows JL, Rindal DB, Gilbert GH; National Dental Practice-Based Research Network Collaborative Group. 2014. Concordance between patient satisfaction and the dentist’s view: findings from the National Dental Practice-Based Research Network. J Am Dent Assoc. 145(4):355–362. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Spreng RA, MacKenzie SB, Olshavsky RW. 1996. A reexamination of the determinants of consumer satisfaction. J Mark. 60(3):15–32. [Google Scholar]
- Tamaki Y, Nomura Y, Nishikawara F, Motegi M, Teraoka K, Arakawa H, Tsurumoto A, Hanada N. 2005. Correlation between patient satisfaction and dental clinic credibility in regular dental check-ups in Japan. J Oral Sci. 47(2):97–103. [DOI] [PubMed] [Google Scholar]
- Thompson B, Cooney P, Lawrence H, Ravaghi V, Quiñonez C. 2014. Cost as a barrier to accessing dental care: findings from a Canadian population-based study. J Public Health Dent. 74(3):210–218. [DOI] [PubMed] [Google Scholar]