Introduction

The Graduate Studies System (SEP) at the University of Costa Rica is dedicated to the mission of contributing to the training of researchers, educators, and professionals with a commitment to academic excellence, a humanistic perspective, and social responsibility, not only in disciplinary fields but also across inter, multi, and transdisciplinary domains (¹). With more than 19,000 graduates and a portfolio of more than 300 curricula, the SEP not only represents the largest and most robust system in the country but also stands as a distinguished institution in the Central Ameri- can region. It effectively coordinates and manages graduate programs in practically all academic disciplines with the university (²). Currently, in the field of dentistry, specifically within the pediatric dentistry and prosthodontic programs, active academic pursuits persist.

The Postgraduate Program in Pediatric Dentistry, established in 1990, holds the distinction of being the first postgraduate initiative affiliated with the Faculty of Dentistry and the SEP. This program offers a comprehensive humanistic approach, emphasizing academic excellence while considering the university’s three substantial axes of teaching, social action, and research. Clinical activities, including oral health promotion, disease prevention, and minor and restorative surgeries, are performed within the Faculty of Dentistry, catering to infants, children, and adolescents, both with and without disabilities. To date, this postgraduate program has conferred degrees on approximately seventy professionals hailing from various countries (³).

The Postgraduate Program in Prosthodontics has a distinguished history of sixteen years of active engagement, during which it has continually adapted to changes and new global trends in the areas of dental materials and treatments. In early 2019, the program underwent an important trans- formation towards the use of digital technology in the creation of oral restorations. Today, digital treatments are widely accepted and poised to shape the future of dental care. It is the students of this Master's Degree program who are well- prepared to harness the potential of these technologies, equipped with extensive experience in their application. To date, the postgraduate program has graduated more than forty prosthodontists. Much like the postgraduate course in pediatric dentistry, this program benefits from the expertise of both national and international dentists who lead the courses at their respective universities (⁴).

Even though these postgraduate courses have been in existence for more than two decades, no data has been published regarding patient satisfaction with dental treatments, which are consistently administered year after year. In the context of health services, user satisfaction is defined as the result of the difference between the patient's perception of the service provided and the expectations he had before receiving it (⁵). These expectations are obtained from previous experiences of the same patient when accessing the health service, from experiences reported by other people and from the commitments that the same system acquires towards the patient (⁶). Satisfaction is considered successful when the perception of the service received is greater than expectations and is considered a failure when expectations are greater than perception (⁵). Patient satisfaction serves as one of the most reliable indicators of healthcare service quality (⁷). Furthermore, it should constitute an inherent and essential objective for any establishment providing healthcare services (⁸).

There are differents questionnaires to measure satisfaction in dental services, some of them are: the Dental Visit Satisfaction Scale, the Satisfaction Scale and the Dental Satisfaction questionnaire (DSQ) (⁹). The DSQ includes five dimensions: quality, accessibility, availability/convenience, pain management, and costs (¹⁰) and has been used in several dental schools (¹¹,¹²,¹³,¹⁴).

The objective of this research was to assess the level of patient satisfaction among those who sought treatment at the postgraduate clinics of the University of Costa Rica during the year 2022, employing the DSQ questionnaire.

Methodology

Results

46 patients or legal guardians of children answered the survey, yielding a response rate of 54.1%. Within the participation group, 23.9% fell within the age range of 30-39 years, with a majority of 65.2% being female. A significant proportion, also at 65.2%, hailed from the province of San José. Approximately 50.0% reported having completed high school, while 63.0% indicated attending the dentist more than once a year. Moreover, 52.2% received dental care at the pediatric clinic (Table 1).

Notably, a substantial 95% of the participants expressed satisfaction or high satisfaction levels with the dental services received at the postgraduate clinic at the Faculty of Dentistry at the University of Costa Rica. The average score on the Dental Satisfaction Index was 81.4. Additionally, when the DSQ domains were converted into a weighting scale, the average scores were 86.6% for quality, 76.2% for pain management, 79.3% for access, 76.3% for availability, and 82.6% for cost.

The questions with the highest ratings were as follows: Question 6 (mean 4.9; standard deviation 0.4), Question 2 (mean 4.7; standard deviation 0.8), and Question 16 (mean 4.7; standard deviation 0.8), all referring to quality aspects. In contrast, the questions with the lowest scores were Question 1 (mean 3.3; standard deviation 01.5), associated with overall satisfaction, and Question 17 (mean 2.7; standard deviation 1.2), relating to quality (Table 2).

The bivariate analysis revealed statistically significant differences between the educational level and pain management (p=0.022) and between the frequency of dental visits and availability (p=0.008). Additionally, a statistically significant difference was observed among postgraduate categories in the domain of quality (p=0.038) (Table 3).

Discussion

The results of this research indicate a high level of patient satisfaction among those receiving treatment in the postgraduate program. The results align with previous studies that have shown consistently high levels of patient satisfaction in all clinics of the School of Dentistry at the University of Costa Rica (¹⁷, ¹⁸).

Assessments of user satisfaction have yielded diverse outcomes in various universities. For instance, in the postgraduate clinics specializing in pediatric dentistry, operative dentistry, advanced dentistry, endodontics and periodontics at the Faculty of Dentistry of the University of UANL, a noteworthy 83.5% of patients expressed satisfaction with the service they received (¹⁹). Similarly, at the San Martín de Porres University in Peru, 92% of patients who received dental treatment were satisfied (²⁰). However, in the postgraduate Orthodontic program at Babol Dental Faculty, the level of total satisfaction reached 72% (²¹).

This discussion highlights the consistent trend of favorable patient satisfaction across different dental specialties between undergraduate and postgraduate students while also acknowledging some variability in satisfaction levels reported at the same university. In a tertiary health care center, patient satisfaction was notably higher when attended to by postgraduate students compared to undergraduate students (²²). Interestingly, at the University of Costa Rica, previous research indicates that patient satisfaction with undergraduate student care was slightly higher at 98.5% (¹⁷) than what was found in this study.

Upon a closer analysis of the survey questions, one of the most positively rated aspects, achieving a 98% satisfaction rate, was related to whether dental students consistently treated their patients with respect. This high assessment regarding the respect shown by students also occurred in the research carried out in the Specialty of Orthodontics and Orthopedics of the Faculty of Dentistry, Santa María University, where 98.7% of patients reported similar satisfaction (²³). The significance of this aspect lies in the importance of treating their patients with respect, which consists of recognizing the unique qualities, situations, and individual values of each patient, even in situations where there may be differences in thought or perspective (²⁴).

Patient satisfaction with waiting times to be seen was consistently high, with a satisfaction rate of 84%. This figure is notably higher compared to findings from the postgraduate course in orthodontics at San Martín de Porres University, where only 69% of patients were satisfied in this aspect (²⁰). In contrast, satisfaction levels were considerably lower in the Postgraduate Stomatological Clinic of the San Juan Bautista Private University, where only 48.5% of the respondents indicated short waiting times (²⁵).

Some questions achieving intermediate satisfaction levels of 80% included: Are the prices charged by the School of Dentistry at the University of Costa Rica too high? And do the offices of the School of Dentistry at the University of Costa Rica have modern technology? Regarding cost perceptions, the results vary across universities. In one study, in an orthodontic specialty, 92% of patients considered the prices charged to be adequate (²³), while in the postgraduate Stomatological Clinic of the San Juan Bautista Private University, a lower percentage of patients (88.2%) found the treatment costs accessible (²⁵). Surprisingly, satisfaction with the infrastructure was not higher, despite recent renovations in both postgraduate clinics. Other studies carried out in two universities show higher percentages of satisfaction with infrastructure, such as 92.9% in the postgraduate Stomatological Clinic of the San Juan Bautista Private University and 94% in the postgraduate orthodontics of the San Martín de Porres University (²⁰, ²⁵).

There were statistically significant differences between postgraduate courses and with some sociodemographic variables. The users of the postgraduate degree in prosthodontics were those who reported the lowest satisfaction in the quality domain, this can be related to the fact that in this area, patients often require complex restorative treatments such as prostheses or dental implants which may present complications that make patient satisfaction not very high (²⁶, ²⁷). About to educational level, users with more schooling report better pain management, which can be associated with the fact that pain has been related to quality of life and socioeconomic aspects; subjects of low socioeconomic status with restricted access to health services may have greater dental pain (²⁸, ²⁹). Finally, regarding the frequency of visits to the dentist, patients who attended more times were less satisfied with availability, which is understandable since if a patient requires extensive treatments must attend multiple appointments which leads to constantly traveling to the facilities of the UCR.

One of the limitations of the study is that the survey was conducted at a single point in time. Ideally, multiple assessments should be performed to determine changes in satisfaction levels over time. Nevertheless, it is worth noting that this survey represents the first of its kind to evaluate patient satisfaction in the context of postgraduate clinics within the Faculty of Dentistry. By analyzing each of the domains of the survey, it will help to identify areas for improvement to ensure the ongoing quality of the service provided.

Conclusion

The patients who receive care at the postgraduate clinics specializing in prosthodontic and pediatric dentistry at the School of Dentistry at the University of Costa Rica express satisfaction with the care received. While there were no significant differences in overall satisfaction among the participants, there were differences between some domains and sociodemographic variables.

Author contribution statement

Conceptualization and design: N.G.M. Literature review: N.G.M. and A.L.S.

Methodology and validation: N.G.M.

Formal analysis: N.G.M.

Research and data collection: N.G.M. Resources: N.G.M.

Data analysis and interpretation: A.L.S.

Writing and preparation of the original draft: N.G.M. and A.L.S.

Writing: review and editing: N.G.M. and A.L.S.

Supervision: N.G.M.

Project administration: N.G.M.

Acquisition of funds: not applicable.