Will your patients see their gum problems in the same way you do?

Date: May 2021

Author: Louise Sinclair


As dental students, you understand how periodontal diseases manifest and progress in our patients. However, patients often have a very different perception and experience of periodontal disease symptoms. Here, we discuss the findings of a recent Patient Experience Program (PEP), and what they can tell us about communicating with and educating patients.

The key findings

The PEP used a questionnaire distributed via dental professionals in France, obtaining valid responses from 1,200 dental patients with existing gingival problems. Occasional bleeding was the most commonly reported sign among participants (79%), but it was very rarely considered the most annoying or embarrassing. Only 3% reported it as such, with 21% claiming that bleeding didn’t trouble them at all. Redness (18%), sore gums (13%) and inflammation (10%) were considered to be the most annoying/embarrassing signs and symptoms, despite a much lower occurrence in participants (36%, 34% and 27%, respectively). A small number of participants – 5%, 3% and 5%, respectively -- reported that they were not at all bothered by these.

What does this mean for dental students?

We can take two key insights from these findings:

  1. Patients tend not to see occasional bleeding as a cause for concern, suggesting a lack of awareness about the manifestation and progression of periodontal diseases.
  2. Patients are most concerned by pain and appearance, and are therefore likely to be more motivated to act when these two factors are involved.

The first step, then, is to educate patients on the clinical relevance of gingival bleeding. Many mistakenly believe that occasional bleeding is normal and happens to everyone, but we know that it is an early and reliable indicator of periodontal disease. It’s important that we make sure that patients know that, too.

Using non-technical terms (e.g., “gums” instead of “gingiva”), it's important to describe the progression of periodontal disease to patients, explaining what is happening to the periodontal tissues at each stage and how that might appear to the patient. It may help to share educational resources, like this detailed but very accessible gum health guide from the European Federation of Periodontology (EFP).

In explaining the symptoms of gingivitis and periodontitis, you can take the opportunity to dispel some common misconceptions about gingival bleeding. Be sure to point out that:

  • Healthy gums do not bleed during brushing or flossing (unless too much force is being used).
  • In the early stages of periodontal disease, bleeding can appear on its own without any other obvious signs or symptoms.
  • While lots of people do experience bleeding gums, it indicates that periodontal (gum) disease is more common than people realize, not that gingival bleeding is normal.

Patients are clearly very motivated by pain and an unsightly appearance, so the second step is to explain how addressing gingival bleeding can help them avoid both.

Emphasize that only the first stage of periodontal disease – gingivitis – is reversible, after which the loss of periodontal tissue is permanent. Patients should be informed that bleeding is an early warning sign, and that by acting upon it painful and unsightly consequences such gingival recession, exposed roots, loose teeth, and even tooth loss, can be prevented.

Dental students and dental professionals see the consequences of periodontal diseases every day, and gingival bleeding takes on a certain urgency that we want to impress upon patients. However, by recognizing that patients view signs and symptoms of periodontal disease from an entirely different perspective, and appealing to their own priorities and motivations, they can be more effectively guided them towards positive oral health outcomes.

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