During their session at this November's Oral Health Summit in Edinburgh, Shauna Culshaw and Louise O'Dowd will be sharing patients' perspectives on their journey with periodontal disease.

figure 1

©RuslanDashinsky/E+/Getty Images Plus

Introduction

Shauna Culshaw and Louise O'Dowd's session will explore the central role of patients as active partners in securing and maintaining their periodontal health. Through hearing directly from patients, Shauna and Louise will examine how the experience of living with periodontal disease - and undergoing its management - affects their wellbeing, quality of life, and engagement with treatment. Participants will gain insight into what patients truly want and need from their dental professionals, and how integrating these perspectives can help achieve effective partnerships and optimal clinical outcomes.

In this exclusive preview in BDJ Team, Shauna and Louise will provide insights into their upcoming session.

Q&A

Why do you think now is the right time to talk about patient beliefs in periodontal care?

SC and LO: There is a growing body of academic evidence demonstrating the link between periodontal health and quality of life outcomes, and this message needs to be widely shared with practitioners. Who better to convey this than patients themselves? As healthcare professionals, we must learn to see through the patient's lens in order to engage in meaningful dialogue, supporting them to understand and participate in evidence-based care. This is especially important in the current climate, where patients have ready access to a wide range of health information of varying reliability.

What kinds of beliefs or misconceptions do patients often have about periodontal disease and its treatment?

  • That nothing can be done so what's the point?

  • That it will be cured - like a filling or an extraction

  • That it's ‘their fault' and ‘shameful'

  • That everybody's gums bleed

  • That it is a normal part of ageing.

How do those beliefs shape the decisions patients make about their care or their willingness to follow through with treatment?

This very much depends on the nature of the misconception and is highly patient-specific. It is important to recognise that, as in all aspects of life and healthcare, people are individuals. Therefore, our approach to treatment - and the way in which we engage patients - must be tailored to the individual and viewed as a process rather than a one-off event.

For example, two people may share the belief that ‘nothing can be done, so what is the point?' Both may initially appear disengaged, despondent, and feel that treatment is a waste of time. However, one individual may respond positively to input from dental professionals at the time they present, particularly if the professional has taken time to understand their beliefs and treatment goals. By contrast, another patient may remain unresponsive despite a similar approach.

Importantly, health beliefs can be successfully changed, particularly when patients begin to see tangible evidence of improvement for themselves.

It is not uncommon for patients to believe that bleeding gums are normal, affect everyone, and that nothing can be done about it. This belief is often held even by those with advanced disease. In order to achieve optimal periodontal outcomes, such beliefs must first be identified, explored, and then sensitively challenged. How this is approached depends very much on the individual patient - their presenting concerns, treatment goals, and personal circumstances.

Importantly, health beliefs can be successfully changed, particularly when patients begin to see tangible evidence of improvement for themselves. One of the most rewarding aspects of practice is when patients return with demonstrable engagement, reflected in reduced plaque and bleeding scores, alongside genuine enthusiasm for the process. Negative health beliefs can be turned around, and many of these patients go on to become advocates for periodontal health within their own families and communities.

How can understanding a patient's beliefs help when planning treatment?

Understanding a patient's beliefs about periodontal health is fundamental to planning care and making decisions together. Patients often present with misconceptions, for example believing that bleeding gums are normal or that nothing can be done. Unless these beliefs are identified and addressed, engagement with treatment may be limited. By exploring the patient's perspective, we can tailor communication, build trust and align treatment with their personal goals while also taking into account treatment costs. This approach not only helps motivate behaviour change, set realistic expectations and improve adherence but also makes care more collaborative and rewarding, leading to better long-term outcomes.

By being aware of patient sensitivity around blame and shame in relation to their condition, practitioners can more effectively relate to patients and build trust.

What role does communication play here?

Effective communication is a cornerstone of patient-centred, values-based care in long-term oral health management. There is no single communication technique that has demonstrably more evidence for use in periodontal care. Techniques such as open-ended questioning allow clinicians to explore patients' beliefs, concerns and priorities, helping to identify misconceptions and barriers to engagement. Motivational interviewing provides a structured framework that supports patients in reflecting on their habits and articulating their own reasons for change, thereby enhancing intrinsic motivation and adherence. Empathetic and consistent communication fosters trust and partnership, making patients more receptive to evidence-based guidance and active participation in care. By being aware of patient sensitivity around blame and shame in relation to their condition, practitioners can more effectively relate to patients and build trust. Tailoring information and using language appropriate to individual health literacy, prior experiences, and cultural context ensures that advice is meaningful and relevant. Positive reinforcement of measurable progress - such as reduced plaque or bleeding scores - helps consolidate behaviour change and improve long-term outcomes.

How do you personally balance respecting a patient's viewpoint with making sure you deliver evidence-based care?

This is a core aspect of contemporary clinical practice and not something that tends to present a particular challenge. Central to this is the principle of shared decision-making, whereby patients are recognised as active partners in their care. Respecting autonomy requires clinicians to listen to and acknowledge patients' beliefs, values and preferences, even when these differ from professional perspectives. At the same time, practitioners have a duty to provide care that is safe, effective and evidence-based, in line with regulatory and professional guidance.

Achieving this balance depends on effective communication - presenting information in an accessible and meaningful way, linking evidence-based recommendations to the patient's own goals, and supporting them to make informed choices. Importantly, this is best viewed as a process rather than a single event, allowing time for dialogue, reflection, and reinforcement. In doing so, clinicians can respect individuality while ensuring that care remains grounded in the best available evidence, ultimately leading to more sustainable engagement and improved outcomes.

Do these lessons extend beyond periodontology?

This principle applies not only to periodontology but also to other areas of oral and general healthcare. The traditional model, in which the clinician solely decides what is best and the patient plays a secondary role, is increasingly recognised as outdated. Across healthcare, it is widely acknowledged that patients should be at the centre of decision-making. Positive long-term health outcomes are achievable only when care is delivered in partnership with patients, respecting their values, preferences, and lived experiences.

What part does the wider oral healthcare team have to play in this kind of approach?

The dental nurses are the people the patients like the most - they're perceived as an ally - the team can use this to their advantage.

Person-focused care is not the responsibility of the clinician alone but is created through every interaction the patient has within the service. Administrative staff, dental nurses, dental hygienists, and dental therapists all contribute to establishing an environment of trust, respect, and continuity. For example, dental nurses and dental hygienists are often ideally placed to reinforce key preventive messages, provide practical demonstrations of oral hygiene techniques, and support patients as they begin to notice improvements in their own health. These repeated, consistent interactions are important in addressing misconceptions and sustaining behaviour change.

Furthermore, the involvement of the wider oral healthcare team ensures that information is presented in accessible ways, tailored to the patient's level of health literacy and aligned with their personal goals. This collaborative approach reflects the principles of shared decision-making advocated by NICE (2021)1 and the General Dental Council's ‘Standards for the dental team' (2013),2 both of which emphasise respect for patient autonomy and the integration of evidence-based practice. Embedding these values across the whole team not only improves health outcomes but also enhances patient experience and engagement, creating a more rewarding clinical environment for both patients and professionals.

What do you hope participants will take away from your session at the Oral Health Summit?

Understanding that poor periodontal health affects not only the mouth and general health but also patients' overall quality of life is essential. Both the disease itself and its management can have a profound impact on daily living. Recognising and valuing the patient's experience of the disease and its treatment can make the work of the oral healthcare team easier, more rewarding, and ultimately lead to better outcomes for all.

Find out more about the Oral Health Summit, which takes place in Edinburgh on 28 and 29 November 2025, and book your place at https://profile.eventsair.com/oral-health-summit-2025/.