Periodontal disease, also known as gum disease, is a chronic inflammatory condition that affects the supporting structures of the teeth, including the gums, periodontal ligament, and alveolar bone (1). The impact of periodontal disease extends beyond individual oral health presenting significant implications for public health on a global scale (2). It’s high prevalence and associated health and economic burdens underscore the importance of effective prevention and treatment strategies (3, 4).

In China, a national survey revealed that periodontal disease among adults aged 55–74 was characterized by high prevalence rates of bleeding, probing depths ≥4 mm, and attachment loss >3 mm, underlining the need for targeted public health interventions (5). It is widely recognized that the progression of periodontal disease is influenced by multiple of factors, including microbial pathogens, immune response, tobacco use, and systemic illnesses. In conjunction with the aforementioned biopathological factors, inadequate oral hygiene is a particularly prominent risk element for the initiation of periodontitis. However, it is frequently underappreciated (6, 7). Several studies have demonstrated that periodontal disease patients’ knowledge and attitude toward disease management are potentially important factors affecting their oral health behavior. A cross-sectional study with a sample of 250 adult users of primary health care services in Brazil demonstrated that primary health care users with low oral health literacy exhibited more severe periodontal diseases (8). Similarly, a study on inequities in periodontal disease prevalence, prevention, and management concluded that the frequency of dental visits, oral hygiene, and risk behaviors of patients which impact an individual’s oral health status (9). However, comprehensive study encompassing these facets is conspicuously absent.

Knowledge, attitudes and practices (KAP) studies have been widely used in clinical research (10–12). This provides insights into the determinants that influence decisions and actions, rendering it valuable for crafting precise interventions. Moreover, it contributes to attaining a comprehensive comprehension of the intricate interplay among KAP. Globally, most prior KAP studies on periodontal disease have focused on healthcare professionals (13), pregnant women (14), or other population groups (15), primarily addressing diagnosis, treatment, or prevention, with few studies specifically examining KAP among patients with periodontal disease concerning self-management. Only one study conducted in China reported satisfactory levels of knowledge and attitudes but highlighted gaps in self-management practices related to dental plaque control among these patients (16). Therefore, this study aimed to investigate the KAP among patients with periodontal disease toward disease management.

A total of 514 questionnaires were collected. Among the patients, 313 (60.89%) were female, 309 (60.12%) resided in urban and 130 (25.29%) reported having severe periodontal disease. The mean score of knowledge, attitudes and practices were 3.05 ± 2.03 (possible range: 0–8), 18.71 ± 3.64 (possible range: 6–30), and 14.85 ± 3.63 (possible range: 6–30), respectively (Table 1).

The three knowledge items with the highest correctness rates were as follows: “Periodontal disease is closely associated with systemic diseases such as diabetes mellitus and cardiovascular disorders” (K3) with a correctness rate of 60.70%, and “Daily oral hygiene maintenance is an important way to maintain periodontal health” (K7), with a correctness rate of 40.66%. On the other hand, the three items with the lowest correctness rates were “Periodontal disease is divided into two main categories: gingivitis and periodontitis” (K1) with a correctness rate of 36.96%, “Regular oral check-ups with a dental specialist and appropriate therapy are necessary to maintain oral and periodontal health” (K8) with a correctness rate of 37.16%, and “Periodontal disease is a mild disease that can be treated with medication regardless of its severity” (K9) with a correctness rate of 37.74% (Table 2).

In this study, 46.11% of the participants strongly agreed/agreed that paying close attention to bleeding and painful gums is important in their daily lives (A2). Similarly, 43.78% strongly agreed/agreed that following doctor’s instructions and regular follow-up appointments was essential for achieving a good therapeutic effect (A6). Moreover, a considerable portion (12.65%) of patients indicated a preference for self-managed measures over seeking medical help (A5) (Table 3).

Regarding practices, 18.29% of patients indicated undergoing annual visits to dental clinics or hospital dentistry for oral examinations, while 24.51% exhibited a more rigorous approach with biannual or more frequent visits (P1). Concerning basic periodontal scaling, 21.21% of respondents frequently sought dental intervention, 19.07% adhered to at least an annual schedule, while 16.93% extended their visit gap beyond 5 years (P2). Additionally, a notable trend encompassed the acquisition of knowledge on periodontal disease prevention and treatment, with 22.57% frequently seeking such information and 15.18% consistently engaging in this pursuit (P3). Notably, 25.10% of patients intermittently prioritized the observation of bleeding or swollen gums as a pivotal facet of their oral care regimen (P4) (Table 4).

Pearson’s analysis showed that knowledge and attitudes (r = 0.312, p < 0.001) were positively correlated as well as knowledge and practices (r = 0.230, p < 0.001). Additionally, there was a positive correlation between attitudes and practices (r = 0.171, p < 0.001) (Table 5).

The multivariate logistic regression analysis showed that urban residence (OR = 1.84, 95% CI: 1.11–3.05, p = 0.018), freelance employment (OR = 0.34, 95% CI: 0.14–0.84, p = 0.020), unemployed (OR = 0.25, 95% CI: 0.10–0.63, p = 0.003), severe periodontal disease (OR = 0.27, 95% CI: 0.14–0.55, p < 0.001) and smoking <10 cigarettes per day (OR = 0.25, 95% CI: 0.14–0.45, p < 0.001), smoking ≥10 cigarettes per day (OR = 0.32, 95% CI: 0.17–0.57, p < 0.001), alcohol consumption (OR = 0.51, 95% CI: 0.31–0.84, p = 0.008), brushing teeth 3 times a day (OR = 0.41, 95% CI: 0.19–0.89, p = 0.022) were independently associated with knowledge (Table 6).

Knowledge (OR = 1.16, 95% CI: 1.02–1.32, p = 0.021), unemployed (OR = 0.28, 95% CI: 0.12–0.65, p = 0.003), housewife/househusband (OR = 0.40, 95% CI: 0.17–0.93, p = 0.033), student (OR = 0.47, 95% CI: 0.30–0.97, p = 0.040) and smoking <10 cigarettes per day (OR = 0.50, 95% CI: 0.29–0.86, p = 0.012) and smoking ≥10 cigarettes per day (OR = 0.57, 95% CI: 0.33–0.98, p = 0.041) were independently associated with attitudes (Table 7).

Knowledge (OR = 1.30, 95% CI: 1.14–1.49, p < 0.001), aged ≥33 years old (OR = 0.33, 95% CI: 0.18–0.62, p = 0.001), housewife/househusband (OR = 0.41, 95% CI: 0.17–0.95, p = 0.037) and student (OR = 0.43, 95% CI: 0.20–0.92, p = 0.029) were independently associated with practices (Table 8).

In this study, patients with periodontal disease demonstrated insufficient knowledge, negative attitudes, and passive practices. Suggested recommendations to improve clinical practice include in-hospital training, tailored communication, targeted interventions for specific groups, smoking cessation counseling, and public health campaigns.

The participants demonstrated relatively good understanding of the association between periodontal disease and systemic conditions such as diabetes mellitus and cardiovascular disorders. However, this study identified conspicuous gaps in understanding regarding the consequences of periodontal disease on speech articulation and facial appearance, along with the effectiveness of medical interventions, regardless of the severity of the disease. Beyond their role in the masticatory process, teeth substantially contribute to the articulation of sounds, aesthetic presentation, and the growth of the craniofacial complex (21). A targeted educational approach that addresses these relatively underexplored dimensions has the potential to enhance overall levels of awareness, thus fostering improved outcomes within the domain of oral health (22). Moreover, demographic differences in KAP outcomes were observed, with higher education levels and urban residents showing better knowledge and more proactive practices. Additionally, female patients generally demonstrated higher knowledge scores compared to males, aligning with previous findings that gender differences may influence health-related knowledge acquisition (23). These differences highlight the need for tailored educational interventions that consider socioeconomic and demographic characteristics.

While a significant portion of the patients exhibited an inclination toward highlighting the significance of adhering to medical directives and participating in scheduled post-treatment sessions, certain misconceptions endured among a subset of participants who regarded periodontal disease with reduced gravity. Dispelling these misconceptions and educating patients about the potential consequences of untreated periodontal disease can foster more informed and proactive attitudes toward oral health (24). To address the misconceptions about the severity of periodontal disease, a more nuanced educational strategy is needed. This could involve tailored communication campaigns that emphasize the potential long-term consequences of untreated periodontal disease, such as bone loss, systemic health risks, and impacts on overall well-being. In addition, implementing in-hospital training modules that use real-life cases, visual aids, and interactive workshops could help bridge these knowledge gaps. Providing targeted education to high-risk groups, integrating oral health information into community outreach programs, and utilizing digital tools like mobile health apps may also prove effective in enhancing awareness and promoting timely treatment (25, 26). Dental practitioners ought to actively participate in patient-centered dialogs, aimed at dispelling misconceptions and underscoring the gravity of periodontal ailment. Motivating patients to adhere to dentists’ directives and to consistently attend scheduled follow-up consultations holds the potential to bolster constructive dispositions regarding both preventive measures and therapeutic interventions (27, 28).

Regarding practices, although the majority of participants reported adhering to routine dental visits, a substantial proportion acknowledged never having undergone fundamental periodontal scaling procedures. Additionally, differences were observed in the inclination to seek information concerning periodontal disease, and discrepancies emerged in the frequency of self-monitoring practices in this study. Encouragement of regular dental check-ups and consistent self-monitoring regimens can significantly aid in the early identification of periodontal anomalies and the cultivation of proactive oral health behaviors (29, 30). Dental practitioners assume a pivotal role in educating patients about effective self-monitoring strategies for gum health, encompassing regular assessments for indicators such as gum bleeding or inflammation (31, 32). This emphasis on self-awareness and prompt identification of oral health issues empowers patients to adopt a proactive stance toward their oral care, thereby contributing to enhanced oral health outcomes and holistic well-being.

It is imperative to acknowledge the variability in dental attendance frequency exhibited among the participants, wherein a notable proportion reported having their last visit more than 5 years ago. To enhance the rates of dental attendance, the implementation of diverse strategies emerges as a pivotal consideration. Reminiscent of effective tactics encompassing reminder systems, outreach initiatives, and community-oriented oral health endeavors, these approaches can play a pivotal role in bolstering early detection and intervention for cases of periodontal disease (33–35).

This study had limitations. Primarily, it was conducted at a single center and followed an observational approach. Moreover, it is crucial to acknowledge that the utilization of self-reported data concerning attitudes and practices might render it susceptible to diverse biases, encompassing the likes of social desirability bias or recall bias (36). These biases could potentially lead to overreporting of positive behaviors or underreporting of negative ones, thus affecting the accuracy of the findings. Additionally, the study did not account for all possible factors that might influence KAP, which may limit the depth of the analysis. This limitation has been acknowledged as it is impossible to collect all relevant variables. Future research could mitigate these biases by incorporating objective measures, such as clinical assessments or validated behavior tracking tools, to complement self-reported data. This study presents noteworthy strengths and holds significant clinical implications. In a clinical context, understanding the knowledge gaps, attitudes, and practices of patients with periodontal disease has direct relevance for healthcare practitioners.

In conclusion, patients with periodontal disease showed insufficient knowledge, negative attitudes, and passive practices toward disease management. Based on the results, clinical practice can be improved by implementing in-hospital training programs to educate patients on periodontal disease prevention and treatment. Targeted interventions should focus on improving practices among specific groups, and smoking cessation counseling should be integrated into patient care protocols.