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Bangladesh Journal of Medical Science Vol. 14 No. 02 April’15

Original article

Patient’s satisfaction with orthodontic treatment at King Khalid University, College Of Dentistry, Saudi Arabia 
Shahrani I1, Tikare S2, Togoo RA3, Qahtani F4,  Assiri K5, Meshari A6

Abstract:
Introduction: Patient satisfaction is important for ensuring patient’s adherence in orthodontic 
treatment.	As	teaching	institutions,	dental	college	clinics	must	constantly	strive	to	find	a	balance	
between	satisfyingthe	needs	of	the	patients	and	ensuring	proper	training	of	the	students.	The	ob-
jective	of	the	present	studywas	to	assess	dental	patient’s	satisfaction	with	orthodontic	treatment	
and	related	services	at	King	Khalid	University,College	of	Dentistry	(KKU	COD),	Saudi	Arabia.	
Materials and methods:	A	19	item	closed	end	questionnaire	was	developed	and	pretested	to	as-
sess	patient’s	satisfaction	with	orthodontic	care.	The	questionnaire	items	were	designed	under	
three	domains:	1)	Reception	and	work	environment,	2)	doctor-patient	relationship,	and	3)	treat-
ment expectations and satisfaction. The study sample consisted of all patients consulting the or-
thodontic	clinics	during	the	time	frame	of	the	survey	and	those	who	were	willing	to	participate.	
Results:	A	total	of	72	patients	completed	the	survey	within	the	time	framework.	The	mean	age	
of	the	patients	was	21.2	±	8.06	of	which	males	were	69.5%	and	Females	30.5%.	The	highest	
subscale	score	was	found	to	be	with	patient’s	treatment	expectations	and	satisfaction	(92.6%)	
followed	by	reception	and	work	environment	(89.3%)	and	Dentist-patient	relationship	(82.7%).	
The	overall	patient’s	satisfaction	for	orthodontic	services	among	the	patients	was	found	to	be	
87.1%.	Conclusion:	There	was	a	high	dental	patient’s	satisfaction	with	orthodontic	services	at	
COD	KKU,	Saudi	Arabia	as	a	teaching	institution.The	dentist-relationship	wasfound	to	be	key	
factor in determining dental patient’s satisfaction. 
Keywords: orthodontic treatment; patient satisfaction; Saudi Arabia

Corresponds to: Dr. Ibrahim Al Shahrani, Assistant Professor, Division of Orthodontics, Department of 
Preventive Dental Sciences, King Khalid University College of Dentistry, Kingdom of Saudi Arabia. 
Email: ishahrani@gmail.com

1. Dr. Ibrahim AlShahrani, Assistant Professor, Division of Orthodontics, Department of Preventive Dental 
Sciences, King Khalid University College of Dentistry, Kingdom of Saudi Arabia

2. Dr.	Shreyas	Tikare,	Lecturer,	Division	of	Dental	Public	Health,	Department	Preventive	Dental	Sciences,
King Khalid University College of Dentistry, Kingdom of Saudi Arabia

3. Dr.	Rafi	A.	Togoo,	Associate	Professor,	Division	of	Pedodontics,	Department	of	Preventive	Dental	Sci-
ences, King Khalid University College of Dentistry, Kingdom of Saudi Arabia

4. Fahad Al Qahtani, Intern student, King Khalid University College of Dentistry, Kingdom of Saudi Arabia
5. Khalid Assiri, Intern student, King Khalid University College of Dentistry,
Kingdom of Saudi Arabia
6. Ahmad	Al	Meshari,	Intern	student,	King	Khalid	University	College	of	Dentistry,
Kingdom of Saudi Arabia

Introduction
Satisfaction	 is	 the	 contentment	 one	 feels	 when	 on	
fulfilment	of	a	desire,	need,	or	expectation1. Over the 
past	decade,	consumer	satisfaction	has	gained	wide-
spread	recognition	as	a	measure	of	quality	in	many	
public sector services. The service relationships of 
doctors	with	patients	are	now	commodities2,3. As the 
health	care	industry	shifts	towards	a	consumer-ori-
ented approach in the delivery of care dentists are 
now	considered	as	service	providers	and	dental	pa-

tients as customers4.
Patient	satisfaction	is	an	important	and	widely	ac-
cepted	measure	of	health	care	efficiency5. It provides 
crucial	 information	 on	 what	 the	 patient’s	 expecta-
tions	are	and	how	they	perceive	the	quality	of	care,	
which	may	be	different	from	that	of	all	staff	provid-
ing that care. Giving the patient an opportunity to 
voice their opinions about the care they receive can 
influence	the	whole	quality	improvement	agenda	and	
provide an opportunity for organizational learning 

DOI: http://dx.doi.org/10.3329/bjms.v14i2.17837 
Bangladesh Journal of Medical Science Vol.14(2) 2015 p.146-150



147

Patient’s satisfaction with orthodontic treatment at King Khalid University, College of Dentistry, Saudi Arabia

and development6.
With the advent of information era, information dis-
semination has assumed unimaginable proportions. 
Scientific	 information	 has	 now	 reached	 the	 public	
domain	 and	 public	 is	 now-a-days	 well	 informed	
about dental care. The dental patient visiting a den-
tist might harbour certain expectations regarding 
the provision of oral health services. Satisfaction of 
dental patients is the ultimate motive of oral health 
care professionals. Patient satisfaction is important 
for ensuring patient’s adherence in orthodontic treat-
ment7,8.
Provision of oral health services by dental institu-
tions constitutes an important component of the 
oral health care delivery system in Saudi Arabia. 
As teaching institutions, dental college clinics must 
constantly	strive	to	find	a	balance	between	meeting	
the needs of the patients and those of the students. 
The	recent	past	has	witnessed	a	sudden	increase	in	
the number of dental institutions in the Kingdom 
of Saudi Arabia9. Although the universities aim at 
providing good dental services for its patients and 
spends a considerable amount of money and human 
resources, little information on patient satisfaction is 
available. Theprivate dental practice set-ups collect 
fees for services offered and are usually more con-
cerned	about	their	patient’s	satisfaction.	The	objec-
tive	of	the	present	study	was	to	assess	dental	patient’s	
satisfaction	with	orthodontic	services	at	King	Khalid	
University,College	of	Dentistry(KKU	COD),	Saudi	
Arabia	as	part	of	the	continuous	quality	improvement	
programme.
Materials and methods
The	present	study	was	conducted	at	the	Orthodon-
tic SpecialtyClinic, College of Dentistry, KKU. A 19 
item	closed	end	questionnaire	was	developed	to	as-
sess	patient’s	satisfaction	with	orthodontic	care.	The	

questionnaire	items	were	designed	under3	domains:	
Reception	and	work	environment,	doctor-patient	re-
lationship, treatment expectations and satisfaction. 
The	responses	for	10questions	had	four	point	Likert	
scale,	4	questions	had	dichotomous	response	and	rest	
had	simple	multiple	choice	options.	All	items	were	
reviewed	many	times	and	checked	for	face	validity	
before	 subjecting	 for	 reliability	 analysis.The	 ethi-
cal	approval	was	obtained	from	the	Ethical	Review	
Board,	KKUCOD	(KKUCOD/ERC24/2013).
The study sample consisted of all patients consult-
ing the orthodontic clinics during the time frame of 
the	survey	and	those	who	were	willing	to	participate.	
The	questionnaires	were	distributed	at	the	OPD	reg-
istration	by	the	clinic	receptionist.	The	patients	filled	
out	the	questionnaire	in	the	waiting	rooms	of	ortho-
dontics	clinics.	Each	patient	was	allowed	to	complete	
the	questionnaire	once	and	was	asked	to	submit	the	
same	only	at	the	end	of	their	treatment	(final	visit	in	
case	of	multiple	appointments).	The	patient’s	feed-
back	 response	 was	 collected	 for	 two	 months	 from	
the	start	date	of	the	survey.	Given	that	there	were	no	
independent	interviewers	and	dental	staff	allowed	as-
sisting	in	the	completion	of	the	questionnaire.	The	
collected	data	was	entered	into	the	computer	(Micro-
soft	Excel)and	further	analysed	using	Smith’s	Statis-
tical	Package	Version	2.80.
Results
A	total	of	72	patients	completed	the	survey	within	
the	time	framework.	The	mean	age	of	the	patients	
was	21.2	±	8.06	of	which	males	were	69.5%	and	Fe-
males	30.5%.	Graph	1	shows	patient	responses	as	to	
who	suggested	orthodontic	treatment	for	them.	It	can	
be	seen	that	majority	of	the	patients	were	either	di-
rected	by	a	dentist/dental	specialist	(n=30)	or	they	
were	self-motivated	with	parental	suggestion	(n=38).	
Only	 few	 patients	 (n=4)	 were	 seeking	 orthodontic	



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Shahrani	I,	Tikare	S,	Togoo	RA,	Qahtani	F,		Assiri	K,	Meshari	A

treatment as suggested by their friends/relatives. 
Graph	2	shows	patient	responses	for	reason	to	choose	
university orthodontic clinic for their treatment. The 
graph	clearly	indicates	that	majority	of	the	patients	
(n=53)	had	confidence	in	academic	facilities.	A	very	
few	(n=14)	patients	chose	the	university	dental	clin-
ic as their choice for orthodontic treatmentsincethe 
same treatment is expensive in private dental clinics. 
The	remaining	patients	(n=5)	were	referred	from	the	
local dentists.
The internal consistency of the total scale satisfac-
tion	questionnaire	was	satisfactory.	Cronbach’s	alpha	
was	found	to	be	0.77.	Table	1	shows	the	mean	and	
the standard deviation sub scale scores for patient’s 
satisfaction	 with	 orthodontic	 services.	 The	 highest	
sub	scale	score	was	found	to	be	with	patient’s	treat-
ment	expectations	and	satisfaction	(92.6%)	followed	
by	 reception	 and	 work	 environment	 (89.3%)	 and	
Dentist-patient	relationship	(82.7%).	The	overall	pa-
tient’s satisfaction for orthodontic services among 
the	patients	was	found	to	be	87.1%.
Discussion
Our	findings	show	that	majority	of	the	patients	chose	
to get treated here at KKU because they had high 
confidence	in	academic	facilities.	Many	factors	go	
into	choosing	whether	private	dental	clinics	or	 the	
academic	dental	clinics	are	the	right	one	for	seeking	
the treatment. There are some pros and cons to be-
ing treated at academic dental clinics. On the other 
hand	 there	are	some	undeniable	potential	benefits:	
the	residents	and	fellows	are	well	supervised	which	
means that patients could be consulted and examined 
by several different people. Academic dental clinics 
also place a strong emphasis on research, and tend to 
provide	new	ways	of	treating	patients	with	cutting	
edge	facilities	which	highly	subsidized	or	free.
Previous	investigations	have	indicated	that	the	qual-
ity of treatment outcomes and overall patient satis-
faction	are	of	great	importance	in	influencing	a	gen-

eral dentist to refer a patient to an orthodontist10-13. 
In	our	study	significant	numbers	(n=30,	41.6%)	of	
patients	were	referred	by	the	general	dentists,	which	
can	be	attributed	to	high	quality	treatment	outcomes	
at	 KKU.	 Almost	 equal	 to	 the	 number	 of	 referred	
patients	(n=38,	52.7%)	were	those	who	directly	re-
ported	to	KKU	since	high	confidence	they	have	with	
academic facilities.
Patient satisfaction after orthodontic treatment is 
influenced	by	a	number	of	factors7,8,14,15. The inves-
tigations of patient satisfaction after orthodontic 
treatment	have	shown	a	wide	range	of	satisfaction	
levels16-18.	The	use	of	different	questionnaires	to	as-
sess	satisfaction	makes	comparison	with	other	stud-
ies	difficult.	Our	questionnaire	tries	to	measure	the	
level	of	satisfaction	as	well	as	performance	of	qual-
ity	attributes	related	to	orthodontic	treatment.	It	was	
observed in our survey that the highest satisfaction 
rank	is	with	the	patient’s	expectations	of	treatment	
results	 followed	 by	 work	 environment	 and	 recep-
tion	 and	 dentist-patient	 relationship.	 However,	 the	
patient’ssatisfaction	isrelatively	ranked	according	to	
total subscale percentage values. Although, the least 
ranked	 sub-scale,	 dentist-patient	 relationship	 indi-
cates high degree of satisfaction. This fact is evident 
with	undoubtedly	high	sum	satisfaction	score	of	the	
survey investigation. 
The	inclination	of	all	doctors	towards	patients	is	usu-
allyto meet the desired treatment expectations. The 
technical competence of the dentist is often cited as 
a	key	determinant	factor	contributing	to	patient’s	sat-
isfaction19,20.	Our	patients	were	highly	satisfied	with	
technical aspects of the treatment. This fact can be 
attributed	 to	 patient–centred	 treatment	 procedures	
done	with	due	consideration	to	the	current	principles	
of ethics and good clinical practice thereby ensuring 
reliable	and	best	quality	services	to	the	public.	This	
also	 reflects	 the	 dedication	 and	 enthusiasm	 of	 the	
dental	faculty	and	technical	staff	towards	the	same	

Questionnaire Domains 
Mean 
Score SD 

Maximum 
Score 

Satisfaction 
Per cent Ranking 

Reception and Work 
Environment (4) 14.2917 1.5873 16 89.3 2 
Dentist-Patient Relationship 
(7) 22.3333 3.2501 27 82.7 3 
Treatment Expectations and 
Satisfaction (6) 14.8194 1.5136 16 92.6 1 
Sum Satisfaction Sore (17) 51.4 5.0738 59 87.1 

Table 1: Total and sub-scale mean patient’s satisfaction scores



149

Patient’s satisfaction with orthodontic treatment at King Khalid University, College of Dentistry, Saudi Arabia

end.	However,	very	few	patients	demonstrated	cer-
tain	levels	of	dissatisfaction	with	the	dentition	after	
orthodontic	treatment	which	might	be	because	of	pa-
tient compliance or unrealistic expectations.
The	patient’s	first	ever	experience	of	health	care	fa-
cility is at the hospital reception. A dental reception-
ist has responsibilities of courteous communication 
with	patients	and	effective	office	administration.	Our	
survey	results	with	orthodontic	patients	revealed	av-
erage sense of satisfaction as compared to the other 
two	dimensions.	Majority	of	them	not	very	satisfied	
with	 the	 waiting	 period	 and	 duration	 for	 comple-
tion of treatment. The dental care delivery system 
in KKU is based on scheduled appointments, and 
dental faculty carry out dental treatment only during 
the specialty practice sessions. These factors prob-
ably lengthen the treatment period compared to the 
patient’s expectations. 
A	 doctor–patient	 relationship	 is	 important	 in	 the	
practice of dentistry and is essential for the delivery 
of	high-quality	care	in	the	diagnosis	and	treatment.	
The	 patients	 are	 likely	 to	 be	 more	 positive	 when	
effort	is	made	to	build	good	relationships	with	pa-
tients	and	not	where	effort	 is	focused	on	technical	
excellence alone. The importance of interpersonal 
factors	(personality	and	communication)	for	dental	
patient	satisfaction	is	most	frequently	cited	in	the	lit-

erature21-23. 	Our	results	suggest	that	the	patients	were	
relatively	less	satisfied	regarding	interaction	with	the	
orthodontist.	Most	of	the	patients	who	participated	
in	this	study	were	dissatisfied	with	the	explanation	
of the procedure during treatment. This may be ex-
plained because the procedures are so common and 
clear, the orthodontists do not see the importance of 
talking	about	them	and	explaining	them	to	their	pa-
tients.	Providing	the	patient	with	further	explanation	
of their treatment options should be highlighted to 
achieve	high	level	of	satisfaction	with	service	pro-
vided.
In	conclusion,	there	was	a	high	dental	patient’s	satis-
faction	with	orthodontic	services	at	COD	KKU,	Sau-
di Arabia as a teaching institution. The importance of 
establishing social relationship and verbal communi-
cation should be strongly emphasized. To obtain ad-
equate	patient	feedback	in	a	reasonable	time,	regular	
surveys monitoring patient satisfaction are needed to 
determine	the	main	weakness	in	various	other	servic-
es provided in King Khalid University. Continuous 
evaluations of data from such surveys are essential in 
monitoring the changes in patient satisfaction levels. 
Acknowledgements
The	authors	thank	all	the	patients	for	taking	part	in	
the survey and sharing their valuable experiences, 
thereby	making	this	study	a	success.



150

Shahrani	I,	Tikare	S,	Togoo	RA,	Qahtani	F,		Assiri	K,	Meshari	A

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