International Conference “Marketing – from information to decision” 2nd Edition 2009

Marketing Research about Customer Retention for

Dental Services

Gheorghe ORZAN
Bucharest Academy of Economic Studies
orzang@ase.ro

Daniel Adrian GÂRDAN

Spiru Haret University
danielgardan@yahoo.com

Iuliana Petronela GEANGU

Spiru Haret University
geangupetronela@yahoo.com

ABSTRACT. Marketing decisions about studying the patients’ needs and requests are rarely taken,
without adequate scientific basis. In order to improve the dentist-patient relationship, the authors
undertook a series of quantitative and qualitative marketing researches, to identify the main modalities for
attracting and retaining customers for dental services. Thus, two focus-group-type qualitative researches
were conducted on two different groups of persons in Bucharest. The theme perception technique was
used in the first focus group and the brainstorming technique was used in the second. The focus groups
had the purpose of exploratory research, in order to identify the variables which influence the patients
when they decide to choose a particular dental office, as well as the factors which induce them to
maintain the relationship with the same office. Contents analysis was used as a method for data analysis.
A survey-type quantitative research was then conducted among the Bucharest population in order to
accomplish the objective of the research and to validate the variables identified through qualitative
research. The conclusions of the article are a starting point for further investigations regarding the dentist-
patient relationship – conducted in the Romanian medical marketing environment.

1. Introduction

The marketing of dental services represents a field that has been explored only tangentially,
particularly as far as the Romanian specialized literature is concerned.

Nonetheless, the interest for carrying out research in this particular field is aroused by the
increase in the necessity to implement marketing principles to the dental services, due to the
market liberalization and autonomization of the institutions providing dental care services.

With the Law no. 463, dated 04/11/2004, that stipulates that the graduates of the faculties of
Dental Medicine and Pharmacy are automatically granted the right of free practice, and with the
Law no 236/09.06.2006 concerning the possibility to buy surgeries, the only surgeries under the
control of the Public Health and Family Ministry in Romania are surgeries in schools and
surgeries of Emergency Hospitals, that provide only emergency assistance services. Dental
emergencies (caries, dental abcesses etc.) are free of charge according to the law no 145/1997
concerning social health insurance. Except for these dental emergency services, dental surgeries
can be privately owned. Unlike the majority of medical services, dental care services do not
enjoy a dominant position any longer.

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The main characteristics that define and make the distinction between the marketing process in
relation to dental services and the health care services in general, on the Romanian market, are
the following:
• A clearer specification of the demand and the offer (the patient defines himself/herself
easier in terms of a “consumer”)
• The expansion of the range of needs associated with dental services that take the form of
different categories of needs – aesthetic purposes, social status etc.
• A greater repetitivity over time of the consumption act
• A more pronounced sensitivity of the consumers to the doctor’s personality or to the public
image of the dental care institution (the affective load associated with the doctor-patient
relationship)
• The possibility of an easier attainment of a level of communication characteristic to the
“medical education”
• It is the only field of health care services in Romania in which medical prescriptions play a
minor role (compared to other health care services where the patient follows the prescription
of the family doctor)
• In the process of creation and delivery of the service, the provider is totally dependent on a
category of (dental) materials providers – the dental technicians – from the qualitative as
well as the temporal perspective/capacity of adjusting to the client requirements.

As far as health care services (and dental care services in particular) are concerned, the buyers
are not mainly driven by economic reasons, but by emotional (affective) reasons. However, to
the difference of the other health care services where the costs are deducted from the health
insurance and the consumers may get compensated medication, (the patient does not give the
money directly to the doctor), in the field of dental care services, the patient is billed directly for
the dental service he/she has required, which implicitly motivates the type of service the patient
opts for.

The clients of dental care services differ from the consumers of health care services in general,
in that the former determine their need for dental assistance, they always know the costs, the
cost is rarely supported by a third party, they rarely need a prescription from a specialist (other
than the dentist), they have less limited possibilities as to choosing from various available
options (there are many dentists in all parts of the country), but the dental services cannot be
substituted by any other type of health care service, as it requires significant knowledge of the
dental service characteristics.

In this context, the development of the marketing research specific to the domain under question
- research that is meant to identify the complex mechanisms that define the patient-dental
services providers interaction patterns - represents a goal that is compulsory for the evolution of
the dental care services institutions towards a viable model.

The present article represents a first attempt to explore the urban dental services consumers’
consumption and perception universe, so as to be able to identify the factors that determine the
choice of a dental surgery, as well as the reasons that determine the consumers’ loyalty toward a
specific dental surgery.

2. Literature review

The development of marketing in the field of health care services has known a sinuous
evolution, characterized by a more accelerated dynamics in the last 20 years. Beginning with the
end of the 1970s, the interest in the marketing of health care services has started being
correlated with the marketing implementation process in the development strategy of health care

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institutions. (Thomas K. Richard, 2008). While marketing principles were far from being
enthusiastically accepted, there could be found reasons for including marketing among the
functions of the health care institution. Thus, a series of reasons for sustaining marketing efforts
have been identified in this period: the consumers became more and more informed even as far
as health care services were concerned, the health services providers’ desire to better inform the
consumers and increase their visibility by improving their public image, the involvement of the
organizations in the effort of increasing their prestige and attracting medical personnel and
employees, as well as in the counteracting of the marketing of the competitors on the market.

The accepting of marketing by the health care specialists in the USA, in the 1980s, represented
the starting point for the perception of marketing as an authentic function within health care
institutions. Thus, funds have been allotted to specific marketing activities, new departments
and jobs have been set up within health care organizations, a series of methods and concepts
have been borrowed from other fields of activity, and there has been a shift from product
orientation to consumer orientation.

Currently, the implementation of marketing principles has greatly expanded compared to the
1980s, becoming more of a science than an art and finding ways to prove its efficiency even to
its more vehement critics. Despite this progress, the whole potential of marketing principles
application is not always attained, since many representatives of the health care system continue
to believe in myths about marketing.

The interest in the marketing of health care services in general has recently increased, starting
from some instances of relevant marketing research. Thus, the written media devoted to the
marketing of health care services published a series of articles and books that depict the social
dimension of health care services, the health care institution-patient relationship, some factors
related to the patients’ satisfaction and the controversial issue of obeying the ethical principles
in the application of marketing techniques in the field of health care services.

In this context, one can mention international authors (Ram Misra et al., 2008) that present the
importance of setting up sites and discussion forums by health care services providers. In an
article (Eric W. Hayden, 2009) it is also presented a model of a retail type of health care clinic,
the model representing a consistent improving in the classical distribution of health care
services to the population.

The research conducted by specialists in the well-known consulting firm McKinsey Quarterly
Company (Kurt D. Grote et al., 2007), has revealed a series of unexpected aspects related to the
defining attributes of consumers’ satisfaction, to their decision to change the health care
institution (hospital) they turned to for getting health care services at a given time. Thus, it has
been found out that there are two extremely important attributes in this process, namely, on the
one hand, the capacity of the institution to provide their patients complete, extensive and
available information about the services provided during/after the hospitalization and, on the
other hand, the reduction of the waiting time and the careful following of the appointments for
the various services.

Surprisingly, in the wider context of the consumption decision, these aspects related to the non-
clinical valences of the health care services bear greater importance compared to the purely
clinical aspect of the quality of the services provided. In other words, even with the patients that
hold insurance in the private system, the decision is influenced to a greater extent by these
collateral aspects of the clinical medical services. The inquiry of the doctors’ opinion (generalist
as well as specialist doctors) regarding the hospitalization recommendations they make, has
revealed the same position – the doctors are likely to recommend the hospitals with a good

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information policy, that follow and make appointments currently, that easily register patients, to
the detriment of hospitals with a solid material basis.

The cross-results of the research conducted on a sample population of 2000 patients and 100
doctors, representative for the whole range of hospitals in the USA, have revealed aspects that
one cannot possibly ignore in the elaboration of a viable marketing strategy for the respective
health care institutions. In the context in which the promotion expenses have risen by
approximately 13% between 2002–2006 per total number of health care institutions on the
American market, choosing communication objectives doubled by a services provision policy
that is effectively able to meet the consumers’ necessities becomes a compulsory goal in
acquiring competitive advantages.

Specialists draw a clear-cut distinction between the various types of entities from the point of
view of health care services demand. Thus, one can distinguish: the clients, the patients, the
registered patients, the prescribers, the final users (Richard K. Thomas, 2008), all these
categories being in a continuous interaction whose dynamics determines the implementation of
a marketing strategy that can improve the flow of health care services provisions according to
each category’s role in the process of consumption.

As far as written works are concerned, the field of the marketing applied to the dental care
services has known a more considerable development after 2000, through the publication of a
number of specialist works, doctoral theses (Clouse Bradley Alan, 2002); (Jonathan Paul
Suzuki, 1999), or articles.

Making use of the multi-linear discriminant method, it has been attempted the identification of
the differences between the various dental care services market segments, the customers being
differentiated on the basis of the various attributes that prompted them into choosing a particular
dentist. (Zhengyuan Wang et al., 1996)

Most of the articles about the field of the marketing of dental services have as a starting point
research studies concerning the factors that determine dental services consumers’ satisfaction.
(Alessandra Mazzei et al., 2009).

Studies have been elaborated with the purpose of analyzing the effects that the evaluation of the
quality of the services has (through the questions provided by the SERVQUAL model) for three
types of services: banking services, hair services and dental care services respectively. (Carol
W. DeMoranville & Carol C. Bienstock, 2003). The study has revealed that the questions hold
equally valid for improving the quality of services for all three types of services under analysis.

In Romania the field of the marketing applied to health care services is relatively poorly
explored, as far as the volume of published works as well as the scope and complexity of
approaches are concerned.

The first approaches to the field are to be found in some works on sanitary management
(Enăchescu D. & Marcu M.G., 1998), (Amariei C, 1998), (Mihai Luchian, 2005), the issue of
health care marketing being tangentially tackled and considered as a managerial function at the
level of the organization of health care institutions.

Subsequently, the specificities of marketing application to the field of health care services are
revealed, (Violeta Rădulescu et al., 2008), these specificities being shaped by the characteristics
of the market, of the organizations, of the products, of the personnel and of the consumers. As
far as the market is concerned, the authors consider that the existence of a real market,
economically speaking, in the field of health care services, is arguable, since the way in which

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the law od offer and demand works out is quite different compared to other markets; even if the
offer for health care services is increasing, generally, this does not lead to a diminishing of
prices, and, on the other hand, even if the level of demand is increasing, this does not mean
raising prices; in other words, in most of the cases, price modifications are not subject to any
influence. The offer depends on government policies and on various limitations, whereas the
level of demand varies with the level of insurances, the availability of resources and the activity
of family doctors and less with the sickening degree of the population. Moreover, the existence
of a real market would entail strictly economic reasons and activities of health care services
providers and third parties, which does not represent a characteristic of the behavior of the
health care organizations.

On a real market, health care services providers compete with their competitors for the
consumers’ resources, whereas the competition on the market determines the price of goods and
services, which does not hold valid to health care services. Moreover, many organizations hold
the monopoly for a specific service. Consequently, there will emerge a specific market. The
oligopoly is particularly visible, as sometimes the consumers do not have many options in their
choice of the medical personnel or the health services which are provided.

In an article about the quality of dental services and the dental services users’ satisfaction in the
county of Bihor, (Bodog Simona et al., 2008) it has been revealed that despite the presence of
dental surgeries in the countryside as well, it has been reported that a great number of patients
(54%) coming from the countryside have made appointments at dental surgeries in the city of
Oradea. The explanation resides in the fact that the general opinion of the patients is that the
quality of dental services provided through dental surgeries in the cities is highly superior to that
of the same services provided by dental surgeries located in the countryside. Also, there has
been remarked increased confidence in the professional training of the dentist that practise their
jobs in dental surgeries located in the cities compared to those in the countryside. The patients’
attitude regarding their expectations or the evaluation of the dental services provided is
influenced by the information about the rural or urban origin of the dentist, as well as by their
age and studies.

From the point of view of the fidelisation of customers and establishment of a long-term
relationship with them, there are written works that explore the reasons that lead to the
formation of specific buying and consumption behavior (Cărăuşu E.M., 1999), as well as the
analysis of the typology of fidelisation programmes implemented in pharmacies. (Stancu M.M.,
2007).

3. Research methodology

The present article has as an objective an incursion into the complex and dynamic domain of
dental services consumer’s behavior on the one hand, and into the domain of relationship
marketing and fidelisation strategies on the other hand.

This approach has materialized in the elaboration of two distinct researches, one based on
qualitative analysis and the other on quantitative analysis. The research goal has been attained
by making use of the methods characteristic to qualitative research, as the authors have
considered that, from the perspective of the nature of the issues approached, the quantitative
analysis couldn’t have been efficiently carried out in the absence of an initial exploratory
qualitative research.

Qualitative research offers the opportunity to explore some aspects that are specific to the
affective and conative levels of the answer that the consumer’s psychic produces to the external
stimuli at a given moment. The syntagm “qualitative research” was forged toward the end of the

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1960s in the Anglo-Saxon area, to designate a distinctly shaped modality of psychological and
sociological research.

Even if certain attempts of conceptual clarification were signaled in the first half of the 20th
century, it was not until the last decades of it – in the 1980s-1990’s that one can find a vast
number of specialized works, in the domains of psychology and sociology – as traditional
domains of applicability, as well as in the domain of marketing.

From the beginning, the issue of qualitative research has been approached by relating it to
quantitative research, which was largely accepted, after being successfully applied to a wide
range of domains. (including the field of marketing).

The advantages that the use of qualitative research entails must be quantified from the
perspective of their complementarity with qualitative researches, which the present article
attempts to highlight as well. Thus, qualitative research provides access to a wider range of
information that concerns directly consumers’ psychological resorts, and it presupposes the
researcher’s active involvement, it offers the possibility of carefully selecting the working
samples, the ruling out of the elements than could impede upon the application of analysis
techniques based on projections, mental constructs, games etc. that go beyond the respondents’
expression and communication barriers, as they involve the quantification of results that is more
accurate than in other methods of research.

The qualitative research that the authors have conducted under the form of two focus-group
sessions had as an objective the identification of variables that influence the consumers’ choice
of a dental surgery as well as the gathering of qualitative information about the factors that lead
to consumers’ fidelisation toward the dental surgery they opted for.

The research has made extensive use of the focus-group method, organized in two working
sessions of 12 respondents each; the Thematic Apperception Test as well as the brain-storming
technique were widely used within the group-discussion. The sample of respondents was
selected on the basis of a micro questionnaire; thus, there were selected Bucharest residents,
aged above 18, not working in the health care/dental care/marketing domain. The authors have
tried to make a uniform distribution on the basis of gender and age, to the purpose of accurately
depicting the real consumption behavior of the respondents.

Data analysis was carried out on the basis of the content analysis of the transcriptions of the
audio-video recordings and of the moderators’ notes.

Chronologically speaking, the qualitative information obtained on the basis of the qualitative
research have been used in the elaboration of the second research, the quantitative research, that
was conducted under the form of the direct field investigation – a survey conducted on a sample
of 120 respondents, Bucharest residents, aged above 18, not working in the health care/dental
care/marketing domain.

The purpose of this research is improving the dentist-patient relationship through the
identification of the main ways of attracting and retaining dental services customers, as well as
of the dimensions that characterize the consumers’ decision and consumption behavior.

Unlike the qualitative research, the quantitative research offers the representativity of the
information obtained for the statistical population of Bucharest, as well as the possibility of
using the identified variables in order to segment and characterize the urban dental services
consumers. The corroborated results of both types of research represent a starting point for

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further investigations, as they can be successfully integrated in the process of elaboration of a

relationship marketing strategy for the dental surgeries located in the cities.

4. The analysis of the qualitative research

The qualitative research has been organized under the form of two working sessions – focus-
group, of 12 participants each. The structure of each group was 50% women, 50% men, aged
from 21 to 48, evenly distributed.
The discussions were divided on 10 topics of discussion, ranging from the general to the
particular, and 6 collateral topics that were spontaneously approached during the discussions, in
order to ensure the natural and easier transition between the main topics.

Based on the content analysis of the audio-video transcriptions, there can be drawn a series of
edifying conclusions for the results of each focus-group. As a first remark, we have noticed that
the degree of interaction and the general motivation were sufficiently high, which denoted a real
preoccupation of the participants for the issues tackled – “dental surgery and dental services –
the doctor-patient relationship”. The spontaneously raised interest for the topics of discussion –
irrespective of age or gender criteria – was the same, although, the young participants proved to
be somewhat reluctant in expressing loudly their individual opinions.

The general theme – concerns about dental care and day-to-day communication related to dental
care has revealed a slightly nuanced attitude that presupposes usual communication at the work
place, with family members, and occasional communication with friends and acquaintances.

Most of the respondents do not talk about aspects of dental care in general, but about specific
dental affections. We cannot talk about a daily behavior, about the habit of quantifying the
impact of eating habits on dental hygiene. Eating habits are not very well internalized; we can
talk about minimal knowledge about the chemical composition of food, their pH level, the color
of the food and drinks. The aesthetic aspect of teeth is important, but not to an utmost degree (if
we consider the structure of the micro sample – ordinary people, this is only natural).

The respondents do not make consistent efforts to stick to a certain food regime adapted to their
dental problems. One can still identify the willingness to follow a regime though no consistent
efforts are made toward this.

The concerns related to the prophylaxis are modest as well. The respondents invoked limitations
imposed by time factors, their jobs, the seriousness of the dental affection.

Ways of getting informed are not well crystalized either, there is not concern for getting
information regarding the novelties in the domain constantly, from official sources. The
respondents get informed by talking to their dentist, if they are under treatment, or by
spontaneous discussions with the friends and/or family.

Women manifested the willingness to try persuading the men and/or children of the utility of the
instruments of dental hygiene (tooth brushing, toothbrush) or of the necessity of treating dental
affections (such as paradonthosis).

As for the topic of discussion related to the internalization of the seriousness of the dental
affection, most of the respondents react depending on the pain intensity, the visibility, waiting
the confirmation from a doctor. Once the affection has been confirmed, the young show
availability to getting better informed (especially by searching on the Internet), to complement
the dentist’s clarifications.

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Analyzing the decision making process of choosing the services, it has been noticed that most
people tended to be brave initially – going alone to the office, later on, in particular in the case
of the marrieds, especially the men, the tendency is to go accompanied by their wife.

Also, the mothers have expressed their complete willingness to accompany their children to the
dentist office, having an educational motivation.

The frequency of visiting the dental surgery is relatively high, being more noticeable for women
(reasons – esthetic, pain prophylaxis), with occurrence frequencies such as: twice a year, 7 times
per year, annually). An important factor that can influence the frequency of visiting the dental
surgery is the trust in the close persons that recommends it, offers details, while the opinion of a
generalist (family doctor) is almost irrelevant for the responders. The ideal dentist’s surgery,
from satisfaction point of view, after a brainstorming session of the focus group, must have a
series of top attributes. The respondents indicated, in this order: location, the surgery hygiene,
advanced technical equipment, the manner of service, auxiliary personnel, the communication
with the dentist, the servicing (scheduling, waiting time etc).

In choosing the dentist’s surgery, from the information point of view, it was noticed that for the
older people, the need for information is more complex, accompanied by recommendations
(they feel the need for more and diverse information, not just information referring to the prices
or quality; i.e. information about everything that the operation in itself comprises). Also, for the
same consumer segment, they create expectations based on the quality of the people that give
the recommendation towards a certain dentist’s surgery. A gradation of the need for information
can be noticed, based on different age categories, as already mentioned, the young people,
feeling the need for extra information that confirms a certain diagnostic, while the older people
have the same tendency but later, strictly related to the actual surgery choice and the operation
itself.

The trust invested in the dentist is equivalent to a condition for satisfaction, his professional
status, granted by his professional experience, being a guaranty in that matter. In the same time,
after many discussions, the conclusion was that there is no individualized perception about
dentists, in the general context of medical specialties. Nevertheless is was noted that the
experience is, often times, associated with the biological age, accompanied by a number of
expectation related to the dentist being able to explain before performing an intervention.

Married men have shown a natural tendency of trusting their wife’s recommendations.

Referring to the discussion theme that frequently dissatisfied the respondents; the emphasis was
on false information about the final cost of the service, breach of schedule, too little time during
treatment (lack of tact on the doctor’s part).

Respondents were asked to describe the most pleasant experience in a dental surgery. At this
point, most have described a situation where communication was personalized and the preparing
for the operation - anesthesia was executed perfectly. In fact there was a situation where, due to
the involvement and professionalism of the dentist – the cases where usually there is a fear of
treatment or pain were surpassed.

The discussion theme that focused on the concept of loyalty in general in the respondent’s
current activities, has led to identifying a small number of attributes, that in their opinion
characterize the status of “being loyal”: high satisfaction degree, performance, the ratio between
price and quality, the product “represents themselves”.

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The consumer’s opinion regarding loyalty is shallow and confused, only a few older people
being able to clearly state that they are loyal to certain products or a dental surgery.

Thus, talking about being loyal – the idea was associated with trust in the brand, product, with
the consequences that the product can have when used by the consumer.

None of the respondents thinks usually, spontaneously of their own loyalty to a product, most of
them feeling pressured by time in choosing the products. Even though they become fond of a
product, the respondents have also expressed the need of trying new products. At the non verbal
level, the mimics and the gestures have confirmed a special emotional state associated with this
response – which shows that the need for varying the products represents a something that
characterizes that natural consumption behavior of the respondents. An argument in this sense is
given by the opinion that according to it, the product’s quality changes throughout time
(compared to the moment of its launching on the market) and implicitly causes the temptation to
try new products (loyalty is also given by maintaining the quality throughout time). Other
conclusions have established that their own taste changes according to their income – with its
decrease the customs change gradually, by identifying other products that will replace the initial
ones; also the taste will change with age changing.

A few of the respondents felt that product loyalty is given by the product’s quality but also by
the appurtenance to a certain class, consumer group. Regarding some examples of Romanian
brands that made efforts for rendering their clients loyalty, they were vary vague, only 3 brands
being mentioned - Vodafone, Cosmote and Tuborg, their loyalty programs weren’t known, not
having elements that were remembered by the respondents.

From the point of view of loyalty to a certain dentist’s surgery, it was expressed not only by the
habit of calling the same service provider, but also from the patient’s capacity of following the
doctor’s advice, the developed trust and their relation on a long term.

The last debate revealed a number of key aspects, considered important by the respondents, in
the case of the efforts of a dentist’s surgery to ensure an effective loyalty of its patients. By
using, within the second focus group meeting, the test of thematic apperception – built on the
case where a dentist’s surgery wants to gain the loyalty of an acquaintance of the respondent,
who is a new client, the following essential attributes have been identified, which in the
respondent’ opinion could lead to gaining his loyalty.

Thus, the specific attributes of loyalty gaining strategy, towards a dental surgery can be grouped
into the following topics:

a) The practitioner’s profile

• personalized constant communication of the doctor (availability to answer phone any time)
• doctor’s ability to empathize and his sociability (approach and other topics of discussion
during treatment, sincerity, concerned for the patient as an individual outside of the doctor –
patient relationship)
• maintaining the active interest towards the patient and his needs
• maintaining the quality of the services from all points of view (quality of the services, of the
materials, staff-patient communication) throughout the development of a personalized
communication
• communication should not become a plethora of familiarity (developing a trust towards the
doctor should not be forced, the use of a sober and professional language, patients can be
subjected to regular marketing studies but without intimate questions)
• professional qualification of the practitioner

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b) Discounts and bonuses

• adapting the prices to the consumption frequency and to the consumer type – pyramid
discounts
• offering certain discounts for the dental products or pharmacies
• differentiation from competition, maintaining a good selectivity from the patient point of
view

c) Management of the services

• the thorough observance of the programming and reduced waiting time
• maintaining the surgery location
• instrumentation quality, impeccable hygiene condition in the undertaken services

5. Analysis of the quantitative research

The research has been carried out via on line questionnaire during on week all those who
responded being from Bucharest. Number of respondents was 120. Most of the respondents,
(89% of them) have declared themselves much and very much interested in dental hygiene.
Regarding the people with whom respondents discuss about dental problems most of them
discuss with the dentist (36%), with family members (31%), friends (20%), with fellow workers
(6%), with their physicians (3%), neighbours (2%) and pharmacists (2%).

40% 36%
31% Fellow workers
30% Family members
20% Friends
20% Physicians
Neighbours
10% 6%
3% 2%
Pharmacists
2%
Dentist
0%

Fig 1. Categories of people with whom respondents discuss about dental hygiene problems

Discussions regarding dental hygiene mostly refer to the respondents dental diseases when
interviewing respondents (51%), as well as to oral hygiene techniques in general (28%) and to
various dental diseases that a family member is affected by (21%).

When asked if they have influenced another person in choosing a dental surgery, 27% have not
consciously influenced anyone, 24% believe they have influenced at least one friend, 15% have
influenced at least one work colleague, 14% have influenced their parents and 9% their children,
7% their husband, and only 4% have influenced someone else (a neighbors, acquaintance).

Most of the respondents said that they usually go to a dental surgery alone (65%), (14%) go
together with a friend, (12%) go with their spouse, (9%) go with their parents or children. No
respondent checked on the option of going with a work colleague. It may be noted that although
the respondents influence their work colleagues in their choice of a dental surgery, they do not
personally go with them.

The attention to dental hygiene is perceived by 31% of the respondents as a frequently

conducted dental check up (done at least twice a year), 30% perceive it as the regular brushing

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(after each meal),19% believe it is all about using all aids and means for oral hygiene
(mouthwash, dental floss , etc..), 9% perceive it as an increased attention to dietary habits (types
of foods and beverages consumed - the chemical composition of food, their pH level, food or
beverages color), 6% see it as a preoccupation for acquiring information on updates in this area
(from the Internet, magazines, etc.), 5% perceive it as frequent discussions with friends,
acquaintances, family members about oral care.

The respondents stated that they only call on a dentist’s services in case of emergency (63%),
for prevention (regularly at least every 6 months) (33%), and very few call on a specialist for
aesthetic purposes (to have very white teeth or for applying rhinestones which are very
fashionable, etc) (4%).

Regarding the order of importance of the factors that influences the respondents in choosing a
dental surgery, most of them put first the hygiene of the dental cabinet (22%), followed by
quality of medical services (18%), dental surgery location ( proximity to work or home) (13%),
availability of extended working hours and experience the dental practitioner (with 8%), prices
(price-quality ratio) (7%), and ,in a smaller percentages, communication with the dentist
(detailed explanations about the treatment, proper hygiene, etc.) and the organizational benefits
(programming, waiting time etc.), the interior design of the cabinet, including waiting rooms,
price transparency, advanced technical equipment of the dental surgery (materials and
equipment), variety of services provided (radiology, implantology, surgery, perhaps ENT), the
advice of friends/relatives they trust, the staff’s attitude, the practitioner’s charisma (his
joviality).

Regarding the informational approach about a dental surgery, most of the respondents trust the
advice of a friend/relative (57%), but are searching info an the Internet and newsletters as well
(16%),(12%) said they trusted the family doctor’s advice, (11%) are not informed at all and they
spontaneously choose cabinet, if in pain, and (4%) get information from different discussion
forums.

Most respondents stated that they are not familiar with forums and/or blogs on the topics of
dental diseases (88%). A percentage of 12% of the respondents are familiar with such
informational approaches.

Fidelity to a dental surgery is perceived by respondents as confidence in the services offered and
in its results, high satisfaction after the accomplishment of the services, return without fear to
checkup, the habit of regularly returning for checkups as shows in the figure below.

high satisfaction after the

40% 36% accomplishment of the
35% services
30% 25%
confidence in the
services offered and in its
25% 20% 19% results
20% return without fear to
15% checkup
10%
5%
the habit of regularly
returning for checkups
0%

Fig 2. Ways to quantify the respondent’s loyalty to a dental service

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The order of importance regarding the factors that determine the respondents to become loyal
customers of a dental surgery is the following: the high quality of the accomplished work,
attention to clothing equipment (such as changing surgical gloves for each patient), modern
equipment and high quality materials, the variety of services (with all related services
radiography, surgery, etc.), a correct balanced between price and quality, availability of medical
practitioner to offer assistance at any time, discounts for loyal customer, staff’s
communicability (willingness to provide information about treatments), development of a
personalized doctor-patient relationship and promoting a climate of trust, the location of the
surgery closer to work or home, experience (both for the doctor and the support staff),
transparency of prices and pricing method, a waiting time as low as possible and conformity to
appointments, extended hours (weekend and evening), communication and offer presentation on
the Internet.

15
experience (both for the doctor and the support staff)

the high quality of the accomplished work

13
attention to clothing equipment (such as changing
surgical gloves for each patient)
staff’s communicability (willingness to provide
information about treatments)
11 the variety of services (with all related services
radiography, surgery, etc.)
modern equipment and high quality materials
9,379,33
9,33 the location of the office closer to work or home
9 8,53
8,71 7,84
7,94 communication and offer presentation on the Internet
7,72 7,68
7,48
7,11 6,9 a correct balanced between price and quality
7,29
7
6,38 availability of medical practitioner to offer assistance
at any time
transparency of prices and pricing method
6,02
5 extended hours (weekend and evening)

discounts for loyal customer

development of a personalized doctor-patient

3 relationship and promoting a climate of trust
a waiting time as low as possible and conformity to
appointments

Fig 3. Importance of the factors that determines them to become loyal to a certain dental
surgery

When asked about what disappointed them most regarding the dental services that they turned
to over time, the majority said that mostly they are disappointed by the poor quality of work

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(27%), the failure of programming (a long waiting time) (21%), the high prices compared to the
services offered (17%), lack of communication about the real price (a lower initial price than
actually paid in the end) (13%) , the practitioner’s conduct (13%), and the auxiliary staff’s
conduct (9%). Most of the respondents have an monthly income higher than 2500 ron (47%),
(62%) are mostly women, (63%) are unmarried, (63%) and have higher education.

6. Final Considerations

Analyzing the results of the research a profile of dental medical services consumer, from the
urban area, can achieved, profile that can represent the basis for long term relational strategies
and consumer loyalty.

Thus, consumers are people aged between 21 and 50 years, women in a percentage of 62%, with
incomes of over 2500 ron, mostly unmarried people, with a high education. A mediocre level of
medical education can be noted, dental hygiene attention becoming consistent and well
established only after the manifestation of dental disease which involves treatment. The
availability of self-education is minimal, customers requiring additional information, either
immediately after confirmation of a diagnosis, or when choosing a medical service. A better
attention for prevention of dental diseases can be observed in women, their influence on family,
spouses or children in terms of choosing an appropriate dental surgery or usual dental products,
being stronger.

Most consumers go accompanied to the dental surgery at least for the first time and are sensitive
to the degree of price transparency, the surgery location in relation to the workplace or home,
the hygiene and degree of wear of the instruments used. There are also very clearly expressed
requirements regarding the profile of the practitioner, the staff, their availability to develop a
long-term relationships, their empathy and personalized communication.

Urban dental service consumers are characterized by a confused perception regarding their
loyalty towards most consumer goods, well-known loyalty programs that would influence them
in the purchase decisional process, on a long-term, being inexistent. Also, worth mentioning are
the perceptions according to which it is normal to constantly test new products, or for most of
the brands quality does not remain constant over time, compared to the moment of introduction
on the market.

In terms of loyalty to dental services, consumers show a high selectivity based on the perception
of the quality of services, of price transparency and involvement of medical specialist in the
dynamics of current needs.

The Reputation of the dental surgery, recommendations from people emotionally related to the
consumers, may contribute to substantiate the purchase decision, but ultimately this will
materialize according to criteria such as location in relation to prices /quality, the doctor’s
empathy and the materials used.

The establishment of a communication strategy is recommended, which would focus on widely

educating the public, on creating partnerships between the ministry and private dental surgerys
and clinics, in terms of implementing a national campaign on dental hygiene and its influence
on the pathology of other diseases of the digestive system and beyond. Educating consumers
regarding the prophylaxis and aesthetic aspects of dental diseases can also represent a viable
action direction in the context of the services offered on the market in our country.

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