Periodontal disease – patient awareness levels low


Periodontal disease (PDDs) is very common and a significant cause of tooth loss globally. Severe periodontal disease is the 6th most common disease worldwide and mild to moderate periodontal disease affects most adults. Prevention is key to periodontal health but low awareness of the disease and its consequences impacts on effective management.

The aim of this review was to identify the most relevant gaps of knowledge about PDDs among the general public and to disclose whether they are culturally consistent.


Searches were conducted in the Embase, Medline and SciELo databases. Cross-sectional and community based studies conducted in adults and reporting on knowledge of PDDs published in English, German, French, Italian, Portuguese, or Spanish languages were considered. Study selection, data abstraction and study quality assessment was carried out independently by a number of reviewers. Study quality was assessed using a criteria based system.


  • 6 papers involving a total of 7945 patients were included.
  • Sample sizes varied form 500-3088.
  • Only 1 study was considered to be at high risk of bias.
  • Raw data were grouped into nine dimensions of periodontal knowledge: 1) awareness; 2) aetiology; 3) associated risks; 4) signs and symptoms; 5) risk factors; 6) treatment; 7) general knowledge; 8) prevention; and 9) attitudes.
  • The highest estimated knowledge gaps was seen for ‘awareness’
  No. of Studies Estimated knowledge gap
Awareness 5 80.0%
Aetiology 5 75.0%
Associated risks 7 71.4%
Signs and symptoms 8 50.0%
Risk factors 8 50.0%
Treatment 4 50.0%
General knowledge 8 37.5%
Prevention 19 36.8%
Attitudes 11 36.4%


The authors concluded

The number of available community-based investigations on periodontal knowledge is scarce and restricted to areas with a very high level of human development. These studies identify gaps of knowledge in every geographic area, with the most relevant being low awareness, poor knowledge about the etiology of PDDs, and their relation with systemic disorders.


A broad search in multiple databases and languages has been conducted to identify relevant studies for this review. The included studies have been assessed for quality to criteria based on a paper by Bennet et al. This paper is  an analysis of reporting guidelines for survey research that present a wide range of criteria rather than a single clear list so there is a lack of clarity regarding the way these have been applied in the main paper.

The authors also note that they have followed the presumption that, ‘each research group has designed their questions according to their sociocultural environment and the health literacy level they anticipate to be adequate for their particular setting’.  This may not have been the case, in addition the questions between the surveys vary and it is also unclear whether the individual questions have been validated.  The review authors have assigned the individual questions to their 9 dimensions and whether the weighting process uses is appropriate could be questionable.  Overall this review raises important questions about knowledge of periodontal disease, which is generally low , so it will interesting if the recent European Gum health Awareness Day launched on 12th May will have a positive impact.


Primary paper

Varela-Centelles P, Diz-Iglesias P, Estany-Gestal A, Seoane-Romero JM, Bugarín-González R, Seoane J. Periodontitis Awareness Amongst the General Public: A Critical Systematic Review to Identify Gaps of Knowledge. J Periodontol. 2016 Apr;87(4):403-15. doi: 10.1902/jop.2015.150458. Epub 2015 Nov 6. PubMed PMID: 26545044.

Other references

Original review protocol on PROSPERO database

Bennett C, Khangura S, Brehaut JC, Graham ID, Moher D, Potter BK, Grimshaw JM. Reporting guidelines for survey research: an analysis of published guidance and reporting practices. PLoS Med. 2010 Aug;8(8):e1001069. doi: 10.1371/journal.pmed.1001069. Epub 2011 Aug 2. PubMed PMID: 21829330; PubMed Central PMCID: PMC3149080

European Periodontology Day – 12th May 2016

Dental Elf – 25th Apr 2016

Periodontal disease and quality of life

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Derek Richards

Derek Richards is a specialist in dental public health, Director of the Centre for Evidence-Based Dentistry and Specialist Advisor to the Scottish Dental Clinical Effectiveness Programme (SDCEP) Development Team. A former editor of the Evidence-Based Dentistry Journal and chief blogger for the Dental Elf website until December 2023. Derek has been involved with a wide range of evidence-based initiatives both nationally and internationally since 1994. Derek retired from the NHS in 2019 remaining as a part-time senior lecturer at Dundee Dental School until the end of 2023.

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