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  • Measure Summary
  • NQMC:005235
  • Feb 2009

Dental plan members' experiences: adult dental plan members' ratings of their dental plan.

CAHPS Dental Plan Survey. Rockville (MD): Agency for Healthcare Research and Quality (AHRQ); 2009 Feb 10. 9 p.
Items in the reporting composites and overall ratings for the CAHPS Dental Plan survey. Rockville (MD): Agency for Healthcare Research and Quality (AHRQ); 2009 Feb. 2 p.

View the original measure documentation External Web Site Policy

This is the current release of the measure.

The measure developer reaffirmed the currency of this measure in May 2016.

Primary Measure Domain

Clinical Quality Measures: Patient Experience

Secondary Measure Domain

Does not apply to this measure


This measure is used to assess adult dental plan patients' perceptions of their dental plan. Patients rate their dental plan a scale from 0 to 10, where 0 is the worst dental plan possible and 10 is the best dental plan possible.

Note: Typically, the percentage of ratings for the group 9 and 10 is used for consumer-level reporting; higher percentages indicate better quality. Additionally, frequency distributions encompassing all groups of ratings (i.e., 9 and 10, 7 and 8, 6 or lower) are available for plans or providers to use for quality improvement purposes.


Patient satisfaction is a common subject in the dental literature, and this partly seems to result from the unique nature of dental care. Patients tend to suffer from a fair amount of anxiety related to dental care - most notably with respect to the pain and discomfort associated (at least subjectively) with many dental procedures. One survey in Kentucky found that 40% of the population reported dental fear, with 17% reporting high dental fear. In that same study, 52% of the population were of the opinion that "pain" was the main reason that people were afraid of the dentist.

The literature also shows that the level of distress, anxiety, or fear appear to influence patients' evaluations of dentists' behaviors and patients' satisfaction with care. Level of anxiety has even been shown to influence the kind of communication style preferred by the patient.

Pain itself is an important dimension of the dental patient experience, and it has been shown to influence care-seeking and compliance with treatment, increase feelings of helplessness, and predict patterns of health service utilization; patients' descriptions of pain can influence clinical judgments and treatment decisions (e.g., how much pain relief is offered to the patient). Patients view pain as a "discrete assessable component" of dental treatment.

Communication has been shown to be a significant influence on patient satisfaction. Several studies emphasize the importance of dentist-patient interaction during the dental encounter - especially in terms of what has been labeled "communicative involvement" in one study. Communicatively involved dentists appear attentive, perceptive, and responsive to patients' comments and needs; they establish rapport, discuss treatment plans and options, and help elaborate and confirm the patient's understanding of their treatment encounter. This kind of open, interactive communication has been shown to improve the patient's overall satisfaction with their dental provider.

In addition, it has been generally shown that a dentist's "chairside manner" significantly influences dental care outcomes such as patients' satisfaction, anxiety, and willingness to return for further treatment. Patients who receive incomplete, general, or impersonal information regarding their condition of treatment tend to perceive their dentist as hostile. This desire for information reflects the desire patients have to play a collaborative role in decision-making regarding their dental care, although many perceive that they play a passive role in treatment decisions. In some cases, however, some patients (e.g., those who suffer from particularly high anxiety) do show a preference for interaction marked by "communicative dominance" on the practitioner's part, which refers to the extent to which the dentist controls the nature and topics of the encounter.

Another dimension is satisfaction with the results of dental treatment. This dimension is to some extent concentrated in the specialty area of prosthodontics - the sub-field that deals with the restoration and replacement of teeth (e.g., fitting of dentures, implants, and bridges) - although these satisfaction concerns do span other areas of dentistry. This dimension includes basic (improvement in) comfort experienced by the patient as a result of dental work, the functionality of prosthodontic dental work (e.g., in eating or chewing, or phonetics), as well as the overall appearance, or aesthetics, of prosthodontics.

Evidence for Rationale

Allen PF, McMillan AS, Locker D. An assessment of sensitivity to change of the Oral Health Impact Profile in a clinical trial. Community Dent Oral Epidemiol. 2001 Jun;29(3):175-82. PubMed External Web Site Policy

Bader JD, Shugars DA, White BA, Rindal DB. Evaluation of audit-based performance measures for dental care plans. J Public Health Dent. 1999 Summer;59(3):150-7. PubMed External Web Site Policy

CAHPS dental survey: year one final report. To inform the CAHPS dental survey pilot project: a national effort to measure the dental health care experience in the MHS. Rockville (MD): Agency for Healthcare Research and Quality (AHRQ); 2005 Nov 21. 129 p.

Chapple H, Shah S, Caress AL, Kay EJ. Exploring dental patients' preferred roles in treatment decision-making - a novel approach. Br Dent J. 2003 Mar 22;194(6):321-7; discussion 317. PubMed External Web Site Policy

de Bruyn H, Collaert B, Linden U, Bjorn AL. Patient's opinion and treatment outcome of fixed rehabilitation on Branemark implants. A 3-year follow-up study in private dental practices. Clin Oral Implants Res. 1997 Aug;8(4):265-71. PubMed External Web Site Policy

Hakestam U, Karlsson T, Soderfeldt B, Ryden O, Glantz PO. Does the quality of advanced prosthetic dentistry determine patient satisfaction. Acta Odontol Scand. 1997 Dec;55(6):365-71. PubMed External Web Site Policy

Hegarty AM, McGrath C, Hodgson TA, Porter SR. Patient-centred outcome measures in oral medicine: are they valid and reliable. Int J Oral Maxillofac Surg. 2002 Dec;31(6):670-4. PubMed External Web Site Policy

Leitch JA, Sutcliffe N, Kenny GN. Patient-maintained sedation for oral surgery using a target-controlled infusion of propofol - a pilot study. Br Dent J. 2003 Jan 11;194(1):43-5. PubMed External Web Site Policy

Lundgren S, Rosenquist JB. Comparison of sedation, amnesia, and patient comfort produced by intravenous and rectal diazepam. J Oral Maxillofac Surg. 1984 Oct;42(10):646-50. PubMed External Web Site Policy

Malmstrom HS, Chaves Y, Moss ME. Patient preference: conventional rotary handpieces or air abrasion for cavity preparation. Oper Dent. 2003 Nov-Dec;28(6):667-71. PubMed External Web Site Policy

Newton J, Brenneman D. Communication in Dental Settings Scale (CDSS): Preliminary development of a measure to assess communication in dental settings. Br J Health Psychol. 1999;4:277-84.

Pau AK, Croucher R, Marcenes W. Perceived inability to cope and care-seeking in patients with toothache: a qualitative study. Br Dent J. 2000 Nov 11;189(9):503-6. PubMed External Web Site Policy

Rankin JA, Harris MB. Patients' preferences for dentists' behaviors. J Am Dent Assoc. 1985 Mar;110(3):323-7. PubMed External Web Site Policy

Riley JL 3rd, Myers CD, Robinson ME, Bulcourf B, Gremillion HA. Factors predicting orofacial pain patient satisfaction with improvement. J Orofac Pain. 2001 Winter;15(1):29-35. PubMed External Web Site Policy

Schropp L, Isidor F, Kostopoulos L, Wenzel A. Patient experience of, and satisfaction with, delayed-immediate vs. delayed single-tooth implant placement. Clin Oral Implants Res. 2004 Aug;15(4):498-503. PubMed External Web Site Policy

Sloan JA, Tolman DE, Anderson JD, Sugar AW, Wolfaardt JF, Novotny P. Patients with reconstruction of craniofacial or intraoral defects: development of instruments to measure quality of life. Int J Oral Maxillofac Implants. 2001 Mar-Apr;16(2):225-45. PubMed External Web Site Policy

Smith TA, Thompson JA, Lee WE. Assessing patient pain during dental laser treatment. J Am Dent Assoc. 1993 Feb;124(2):90-5. PubMed External Web Site Policy

Stahlnacke K, Soderfeldt B, Unell L, Halling A, Axtelius B. Perceived oral health: changes over 5 years in one Swedish age-cohort. Community Dent Oral Epidemiol. 2003 Aug;31(4):292-9. PubMed External Web Site Policy

Street RL. Patients' satisfaction with dentists' communicative style. Health Commun. 1989;1(3):137-54.

Weinstein M, Schuchman J, Lieberman J, Rosen P. Age and denture experience as determinants in patient denture satisfaction. J Prosthet Dent. 1988 Mar;59(3):327-9. PubMed External Web Site Policy

Zimmerman RS. The dental appointment and patient behavior. Differences in patient and practitioner preferences, patient satisfaction, and adherence. Med Care. 1988 Apr;26(4):403-14. PubMed External Web Site Policy

Primary Health Components

Adult dental care; patients' satisfaction with their dental plan

Denominator Description

Dental plan patients age 18 years and older who answered the "Overall Ratings - Dental Plan" question on the CAHPS Dental Plan Survey

Numerator Description

Patients' ratings of their dental plan on a scale from 0 to 10, where 0 is the worst dental plan possible and 10 is the best dental plan possible.

Note: Higher ratings indicate better quality.

Type of Evidence Supporting the Criterion of Quality for the Measure

  • A formal consensus procedure, involving experts in relevant clinical, methodological, public health and organizational sciences
  • Focus groups
  • One or more research studies published in a National Library of Medicine (NLM) indexed, peer-reviewed journal

Additional Information Supporting Need for the Measure


Extent of Measure Testing

The design and testing of this tool were informed by the Consumer Assessment of Healthcare Providers and Systems (CAHPS) initiative. CAHPS is a public-private initiative begun in 1994 and continuing through 2012 to develop a standard set of surveys of health care quality as experienced and reported by patients. Widespread adoption of these surveys by providers and/or systems is facilitated by the quality of the methods used to develop, test and disseminate them. These methods include rigorous scientific peer review of results, the involvement of key stakeholders in the design and testing of the surveys, and the distribution of surveys and supporting material free of charge at the Agency for Healthcare Research and Quality (AHRQ) Web site.

Evidence for Extent of Measure Testing

Keller S, Col Martin GC, Evensen CT, Capt Mitton RH. The development and testing of a survey instrument for benchmarking dental plan performance: using insured patients' experiences as a gauge of dental care quality. J Am Dent Assoc. 2009 Feb;140(2):229-37. PubMed External Web Site Policy

State of Use

Current routine use

Current Use


Decision-making by businesses about health plan purchasing

Decision-making by consumers about health plan/provider choice

External oversight/State government program

External oversight/Veterans Health Administration

Internal quality improvement

Quality of care research

Measurement Setting

Managed Care Plans

Professionals Involved in Delivery of Health Services

Does not apply to this measure (e.g., measure is not provider specific)

Least Aggregated Level of Services Delivery Addressed

Single Health Care Delivery or Public Health Organizations

Statement of Acceptable Minimum Sample Size


Target Population Age

Age greater than or equal to 18 years

Target Population Gender

Either male or female

National Quality Strategy Aim

Better Care

National Quality Strategy Priority

Health and Well-being of Communities
Person- and Family-centered Care

IOM Care Need

Getting Better

Staying Healthy

IOM Domain


Case Finding Period


Denominator Sampling Frame

Enrollees or beneficiaries

Denominator (Index) Event or Characteristic


Patient/Individual (Consumer) Characteristic

Denominator Time Window

Does not apply to this measure

Denominator Inclusions/Exclusions

Dental plan patients age 18 years and older who answered the "Overall Ratings - Dental Plan" question on the CAHPS Dental Plan Survey



Does not apply to this measure

Numerator Inclusions/Exclusions

Patients' ratings of their dental plan on a scale from 0 to 10, where 0 is the worst dental plan possible and 10 is the best dental plan possible.

Note: Higher ratings indicate better quality.


Numerator Search Strategy

Fixed time period or point in time

Data Source

Patient/Individual survey

Type of Health State

Does not apply to this measure

Instruments Used and/or Associated with the Measure

CAHPS Dental Plan Survey

Measure Specifies Disaggregation

Does not apply to this measure



Interpretation of Score

Desired value is a higher score

Allowance for Patient or Population Factors

Case-mix adjustment

Description of Allowance for Patient or Population Factors

To fairly compare your dental plan's results to those of other dental plans, we adjusted the results for differences in respondent characteristics across dental plans. These are characteristics that could change the way a patient responds to the survey regardless of their care experience; in this case: patients' age, education, and self-reported health. For example, individuals in better health and older individuals have tended to rate their care and the setting in which they receive their care higher than individuals who are younger and in poorer health. The adjusted results are those we would expect for each dental plan, if they had similar patients. For this report, the results were case-mix adjusted by respondents' age, education, and overall health status following standard CAHPS methods that have been subject to rigorous development and testing.

Standard of Comparison

External comparison at a point in, or interval of, time

External comparison of time trends

Internal time comparison

Original Title

Overall ratings - dental plan.

Measure Collection Name

CAHPS Dental Plan Survey


Agency for Healthcare Research and Quality - Federal Government Agency [U.S.]


Agency for Healthcare Research and Quality - Federal Government Agency [U.S.]

CAHPS Consortium - Health Care Quality Collaboration

Funding Source(s)

TRICARE Management Authority

Composition of the Group that Developed the Measure


Financial Disclosures/Other Potential Conflicts of Interest



This measure was not adapted from another source.

Date of Most Current Version in NQMC

2009 Feb

Measure Maintenance


Date of Next Anticipated Revision


Measure Status

This is the current release of the measure.

The measure developer reaffirmed the currency of this measure in May 2016.


CAHPS Dental Plan Survey. Rockville (MD): Agency for Healthcare Research and Quality (AHRQ); 2009 Feb 10. 9 p.

Items in the reporting composites and overall ratings for the CAHPS Dental Plan survey. Rockville (MD): Agency for Healthcare Research and Quality (AHRQ); 2009 Feb. 2 p.

Measure Availability

CAHPS Dental Plan Survey available from the CAHPS Web site External Web Site Policy.

For more information, contact CAHPS Technical Assistance.

NQMC Status

This NQMC summary was completed by ECRI Institute on February 11, 2010. The information was verified by the measure developer on April 8, 2010.

This NQMC summary was retrofitted into the new template on April 21, 2011.

The information was reaffirmed by the measure developer on May 5, 2016.

Copyright Statement

No copyright restrictions apply.

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