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 Table of Contents  
Year : 2022  |  Volume : 14  |  Issue : 3  |  Page : 209-214

Dental care service quality assists in comprehensive clinical dental risk management: A narrative review

1 Doctoral Study Program in Dental Science, Surabaya, Indonesia
2 Doctoral Study Program in Dental Science and Department of Dental Public Health, Faculty of Dental Medicine, Universitas Airlangga, Surabaya, Indonesia

Date of Submission22-Aug-2021
Date of Decision07-Apr-2022
Date of Acceptance08-Apr-2022
Date of Web Publication28-Jun-2022

Correspondence Address:
Prof. Darmawan Setijanto
Jl Mayjen Prof. Dr. Moestopo, No. 47, Surabaya, East Java 60132
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/jioh.jioh_221_21

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Aim: There are numerous studies developed to assess the service quality in health care. Risk management in health care is viewed as the most difficult duty during the delivery of health services, as healthcare risks have a significant impact on the wellbeing of patients, clients, visitors, and healthcare employees and can disrupt the smooth delivery of health services. The aim of this study is to review the literature associated with the critical contribution of risk management theory in measuring the quality of dental services. Materials and Methods: The main search engines used for the literature review were PubMed central and ScienceDirect. Articles were limited to those published within the past 5 years. The article type was review articles. Result: The initial search retrieved 30 articles. After a full‐text review of all the articles, only 10 were included. The review article contributes to the knowledge that the involvement of risk management theory in the assessments of service quality can affect the increasingly high quality of service and avoid a harmful effect on patients in dental practices. More risk management procedures were used in dental treatment, which had a favorable impact on the quality of service provided to patients. Conclusion: The application of risk management theory in dental practices can continuously improve patient care while also lower the incidence and severity of accidents that could lead to medical malpractice or professional liability lawsuits.

Keywords: Dental Care, Health Risk, Health Service, Health System and Access, Quality of Health care

How to cite this article:
Mirandani D, Setijanto D. Dental care service quality assists in comprehensive clinical dental risk management: A narrative review. J Int Oral Health 2022;14:209-14

How to cite this URL:
Mirandani D, Setijanto D. Dental care service quality assists in comprehensive clinical dental risk management: A narrative review. J Int Oral Health [serial online] 2022 [cited 2023 Feb 1];14:209-14. Available from:

  Introduction Top

Dental services are unique product delivery. There are many various products delivered in clinical dentistry, including the use of diagnostic support tools and dentists’ abilities. Dental services require repeat visits for the comprehensive treatment process. That is why the delivery of dental services is unique.[1]

Patient satisfaction is frequently used to assess the quality of healthcare services. For dental care services, identifying important determinants of a patient happiness and increasing the healthcare service quality are equally critical. The following are critical features of good service delivery for increasing healthcare service quality: provide high-quality, effective services that are safe and centered on the requirements of patients. Health services must be well managed with a minimum wastage of resources to be accountable for overall performance and results.[1]

Patient satisfaction concepts require a strong theoretical foundation for understanding and devising techniques for measurement in the traditionally service-oriented dental medicine approach. There are numerous studies developed to assess the service quality in health care. The Service Quality (SERVQUAL) model, often known as the gap model, was created to evaluate the service quality of general businesses and is now widely used to analyze the service quality in health care. It aids in calculating the gap between patient expectations and perceptions.[2],[3]

Risk management in health care is viewed as the most difficult duty during the delivery of health services, as healthcare risks have a significant impact on the wellbeing of patients, clients, visitors, and healthcare employees and can disrupt the smooth delivery of health services.[4] One of the most important results is that there are three categories of risks: predictable hazards that organizations are aware of, risks that an organization is aware of but that are caused by chance, and risks that organizations are unaware of.[5]

This investigation aims to determine the influence of the risk management methods on customer satisfaction with service quality dimensions and make a combination measuring instrument between Service Quality (SERVQUAL) and risk management.

  Materials and Methods Top

The articles reviewed were retrieved from reliable scientific sources within the past five years. The search engines used were PubMed central and ScienceDirect as shown in [Figure 1]. The keywords used were as follows: health service, risk management, dental care, and service quality.
Figure 1: PRISMA flow chart

Click here to view

Search strategy

The following search terms were used: (“dental care” [MeSH Terms] OR (“dental” [All Fields] AND “care” [All Fields]) OR “dental care” [All Fields] OR (“dental” [All Fields] AND “service” [All Fields]) OR “dental service” [All Fields]) AND (“qualities” [All Fields] OR “quality” [All Fields] OR “quality s” [All Fields]) AND (“risk management” [MeSH Terms] OR (“risk” [All Fields] AND “management” [All Fields]) OR “risk management” [All Fields]).

PEO analysis

The following research question was established by PEO analysis:

P (problem): patients, dental care

E (exposure): risk management, customer satisfaction

O (result of interest): dental service quality, risk matrix

Inclusion criteria

  • Articles were limited to those published within the past 10 years;

  • The article types were review articles and research articles;

  • Free full text;

  • Only English language;

  • No duplicate studies;

  • Study subjects include risk management, service quality, and customer satisfaction;

  • Study factor or exposure: all types of customer satisfaction, service quality, risk management.

  • Exclusion criteria

    Articles not related to the topic of the following study were not included.

    Outcome of the study

    The outcome of study was the quality of care and risk management.

      Results Top

    During the selection process, a total of 16 papers were retrieved. After screening the full-text articles, only 10 articles were included. These 10 articles were selected in the review; significant findings and conclusions were extracted and grouped, to formulate the themes made in this study. The included articles are summarized in [Table 1].
    Table 1: Summary of selected study

    Click here to view

    Patient satisfaction in dentistry can assist in identifying the strengths and limitations of dental services, as well as improving treatment quality and, moreover, assisting the improvement of treatment quality and better future planning. The commitment to providing high-quality service and achieving patients’ satisfaction becomes an essential issue for dental healthcare providers.[6],[7]

    Risk and quality appear to be inextricably linked, despite the fact that public discussion of their correlation appears to be infrequent. Clean and competent staff, as well as informative patient files, are beneficial characteristics of service quality. Only a few risk management measures, such as management support and commitment, training and education, and continuous improvement, had a substantial impact on service quality.[8]

      Discussion Top

    Dental care services are unique product delivery. First, dental care services must be detailed, perfect, and artistic. Second, dental care services show the entire delivery process experienced by patients with full awareness. Third, dental care product delivery services satisfaction is judged by function and esthetics with a comprehensive perspective.[8]

    The products delivered in dental care services have many variations, from the relief of pain, endodontic, functional dental fillings, esthetic dental fillings, tooth extractions, loose tooth treatment, odontectomy, and other preventive services. One diagnosis can have multiple treatments. Therefore, the input, process, and output of dental care services will determine patient satisfaction.[6],[7],[9]

    The use of diagnostic support tools, the ability of doctors to diagnose, the availability of safe treatment tools, and the security and convenience of the room as inputs will determine the quality of dental care services, on the process side: the ability of the dentist to establish a treatment plan, explain to the patient, respect the patient’s right to participate in the discussion to determine treatment, and establish treatment strategies. Giving detailed, perfect treatment and lege artist are very important for patients to decide for return treatment. It is also essential for the dentist to provide posttreatment explanations and give directions for follow-up.[6],[7],[10]

    Dental services are mostly outpatient services that require repeat visits to continue the treatment process or ensure treatment services have been completed. The patient’s experience when receiving dental services, starting from the input, treatment process, and posttreatment will determine patient satisfaction and intention to return treatment. That is why the delivery of dental services is very unique.[2],[11-13]

    Customer satisfaction and service quality

    The uniqueness of dental service delivery requires several approaches, satisfaction theory, and risk management approaches to ensure the quality of dental services. The measurement of patient-centered SERVQUAL method is perfect because it can analyze the gap between expectations and reality in the treatment input, during the treatment process, and after treatment.[1],[6],[11],[14],[15]

    The Picker Principles of Patient-Centred Care (PCC) are used in the NHS to assess quality in clinical effectiveness, safety, and patient experience with the latter model. They were most satisfied with the dentist’s work, then there are the services of the dental assistant, and the centre’s physical appearance and accessibility.[4],[16],[17] Customer satisfaction contributes to improved treatment quality and planning for the future.[3]

    Patient satisfaction is a multidimensional concept that considers the patient’s educational background, lifestyle, medical history, and expectations.[8],[16],[18] Patients need dental treatment to reduce discomfort, have regular oral health exams, improve dental esthetics, and, in some cases, get full-mouth occlusal rehabilitation. Patients frequently value accessibility and convenience when choosing a dentist, preferring denta l facilities close to their homes or easily accessible by public transportation. Patients frequently seek medical centers because of the doctor’s professional ability, technological expertise, and reputation.[15],[19],[20]

    SERVQUAL has been used as a technique for assessing the quality of dental care in various studies.[6],[20] The clinic’s managers should take steps to improve service quality in all dimensions, particularly responsiveness and empathy, by properly planning, prioritizing services, and monitoring processes-related patients’ expectations.[6] Patients have high expectations and needs in terms of empathy (approach to the patient), assurance, and response. The ability to communicate, which is a component of empathy, is critical in reducing patients’ unhappiness (e.g., disease explanation, dental treatment, and medical records confidentiality). The guests in Holland, on the other hand, discovered that dental personnel’s communication abilities were underestimated when compared with other components of treatment quality. Another factor affecting dental service quality was the dimensions of physical condition, reliability, and assurance.[14]

    Risk management instrument implementation

    Risk management in health care has been shown to the most difficult task throughout the delivery of the health services, as healthcare risks have a significant impact on patients’ wellbeing. It increases the likelihood of achieving the goals and allows for the most efficient use of resources. In the healthcare industry, risk management is a must-do activity for lowering the cost of medical malpractice and improving the healthcare services.[3],[21],[22]

    Risk management allows management and team members to plan for unforeseen events, reducing the likelihood of accidents or risks, and allowing processes to function smoothly. It means that, in order to deliver outstanding service, health centers will need to implement risk management strategies in addition to quality management tools. [Table 2] below shows the combined measuring instrument Service Quality Dimensions on patient satisfaction and risk management concept.[3],[23]
    Table 2: Impact of service quality dimensions on patient satisfaction in risk management concept

    Click here to view

    Risk management is a set of operations that help an organization regulate and direct its risk exposure. Risk assessment, risk treatment, risk acceptance, and risk communication are all included. Measuring patient satisfaction in the input, process, and output sectors with service quality is perfect and can explain in more detail the factors that cause risks. Other factors affecting dental service quality are the dimensions of physical condition, reliability, and assurance.[2],[24]

    The lack of a qualified, professional dental nurse with a local grasp of the working environment constitutes a risk to a patient safety in general dentistry practice. This could be as a result of insufficient stand-in selection, training, induction, or clinical supervision. The practitioner, practice, profession, and patient might all pay a hefty price for poor governance, audit, or quality control.[1],[7],[14] In practice, a full risk management system will be required to mitigate this risk. Understanding, analyzing, regulating, and pricing the risk are all steps in the prevention process. The effectiveness of a well-trained team of safety-conscious persons depends on thorough screening, contracting, and training of personnel, as well as proper standards-setting frameworks, resources, regulations, protocols, processes, and checks within a clearly specified command chain.[21],[25],[26]

    Identifying a patient’s dental health literacy contributes to improved communication between a dentist and patient, which is necessary for developing a quality management system in dentistry. A high level of patient involvement is achieved through effective communication. Experts in risk communication have urged dentists to start conversation with their patients about dental office dangers.[1]

    The aim of implementing a risk management program in dentistry practices is to continually improve patient care while lower the frequency and severity of events. Patient satisfaction can aid in identifying the strengths and weaknesses of dental services and in improving the treatment quality. Risk management and quality appear strongly interlinked.

    Study limitation

    The present study had a number of limitations. In this study, it is necessary to redesign the SERVQUAL measuring instrument into a combined measuring instrument with risk management theory. Validity and reliability should be tested for this new assessment instrument.


    The authors thank the Department of Dental Public Health, Faculty of Dental Medicine, Universitas Airlangga, Surabaya, Indonesia that kindly participated in this review.

    Financial support and sponsorship

    None to declare.

    Conflicts of interest

    There are no conflicts of interest.

    Authors’ contribution

    DS: concept, design, and article writing; DM: definition of intellectual content, investigation, and article writing.

    Ethical policy and institutional review board statement

    Not applicable.

    Patient declaration of consent

    There is no patient declaration of consent.

    Data availability statement

    The data set presented within this article has been obtained from 10 review articles. The data were readily available within the articles.

      References Top

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    Sitaraman P, Shanmugasundaram K, Muthukrishnan A Assessment of service quality in special care dentistry department using SERVQUAL model. J Indian Acad Oral Med Radiol 2020;32:209.  Back to cited text no. 2
    Ghotbabadi AR, Feiz S, Baharun R The relationship of customer perceived risk and customer satisfaction. Mediterr J Soc Sci 2016;7:161.  Back to cited text no. 3
    Ali DA Patient satisfaction in dental healthcare centers. Eur J Dent 2016;10:309-14.  Back to cited text no. 4
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    Goula A, Stamouli M-A, Alexandridou M, Vorreakou L, Galanakis A, Theodorou G, et al. Public hospital quality assessment. Evidence from Greek health setting using SERVQUAL model. Int J Environ Res Public Health 2021;18:3418.  Back to cited text no. 13
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    Sharifi T, Hosseini SE, Mohammadpour S, Javan-Noughabi J, Ebrahimipour H, Hooshmand E Quality assessment of services provided by health centers in Mashhad, Iran: SERVQUAL versus HEALTHQUAL scales. BMC Health Serv Res 2021;21:397.  Back to cited text no. 17
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      [Figure 1]

      [Table 1], [Table 2]


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