Missed Dental Appointments in Primary Care: Evidence from the Jeddah First Health Cluster.

Introduction: This study examined patient-reported reasons for missed dental appointments, factors associated with acknowledgment behavior, and patient preferences for system responses in primary care dental clinics within the Jeddah First Health Cluster. It also introduces the Patient-Induced Service Loss (PISL) framework as a conceptual model to guide future estimation of preventable service loss associated with missed appointments. Methods: A cross-sectional survey of patients recorded as dental no-shows was conducted over five consecutive working days in November 2024. Virtual interviews were administered to patients identified through the appointment management system across all primary care dental clinics (n = 381). Descriptive statistics and chi-square tests were used to examine associations between patient characteristics and acknowledgment behavior. Multivariable logistic regression was performed to identify independent predictors of acknowledgment of the missed appointment. Results: Most participants (76.4%) acknowledged missing their appointment. Among those who acknowledged the missed visit, transportation difficulties (24.9%), forgetting the appointment (13.4%), and time conflicts (9.2%) were the most frequently reported reasons. In the multivariable analysis, lower education levels were associated with higher odds of acknowledgment compared with university-level participants (elementary or middle school: OR = 2.95, 95% CI = 1.26–6.91; high school: OR = 1.74, 95% CI = 1.004–3.02). Urban residence and preference for reminders delivered 24 hours before the appointment were also independently associated with acknowledgment (OR = 2.12, 95% CI = 1.14–3.96 and OR = 2.53, 95% CI = 1.45–4.43, respectively). Nearly half of participants reported previous experience cancelling appointments. When asked about appropriate system responses, most participants favored corrective rather than punitive measures, with 68.6% recommending placement on a waiting list. Conclusion: Missed dental appointments reflect a complex interaction between patient behavior and system design. Transportation barriers and reminder timing were important factors associated with non-attendance and acknowledgment patterns. The proposed PISL framework provides a conceptual direction for future evaluation of the operational and economic consequences of missed appointments. System-level improvements, including optimized digital reminders, clearer communication of cancellation policies, flexible scheduling, and real-time release of cancelled appointment slots, may help strengthen patient engagement and reduce preventable service loss in primary dental care.