How Patients Define Quality in Dental Care: A Qualitative Systematic Review

Abstract

Patient-centered care is central to high-quality health care, yet systems-level understanding of how patients themselves define dental care quality remains limited. This systematic review synthesized qualitative evidence using the Donabedian framework to examine patients' perceptions of dental care and to identify core elements of quality as defined by the patients themselves. A comprehensive search of 6 databases was conducted up to July 2025. Qualitative and mixed-methods studies examining patients' views, experiences, and values related to dental care delivery were included. Study quality was appraised using the Joanna Briggs Institute Critical Appraisal tool, and data were synthesized using thematic synthesis. Thirty-six studies spanning diverse populations and dental care contexts were included. Four analytical themes characterized how patients define quality dental care: (1) organizational and structural conditions shaping confidence in dental care; (2) feeling safe in experienced hands, reflecting perceived clinical competence; (3) interpersonal care as the foundation of perceived quality, encompassing respect, empathy, communication, and shared decision-making; and (4) relational continuity as a patient-relevant outcome over time. Patients interpret relational, emotional, and systemic features of care as symbolic indicators of health system orientation, particularly in contexts in which technical competence is difficult to assess. These indicators accumulate across encounters, shaping expectations of future care and influencing engagement, particularly among populations at greater risk of disengagement, highlighting the centrality of relational and organizational dimensions in patient-defined dental care quality.