This study was conducted in accordance with the Helsinki Declaration as revised in 2013. The study protocol was approved by the Stomatology Research Ethics Committee of the Affiliated Stomatology Hospital (No. 2021-122R-X1) of Zhejiang University School of Medicine. Informed consent was obtained from all participants.

Study population

A total of 80 patients were enrolled in this study and were randomly divided into control and intervention groups using the Excel spreadsheet method, with 40 patients in each group (Fig. 1).The study subjects were patients with chronic periodontitis who visited the department of Periodontics at Stomatology Hospital affiliated to Zhejiang University in China between December 2021 to January 2023. Socio-demographic data were collected including age, gender, employment and education level. Inclusion criteria: (1) chronic periodontitis was determined according to the recent update to the International Symposium on the Classification of Periodontal Diseases [16]; (2) received nonsurgical treatment for periodontitis; (3) aged between 20 and 70 years, with no gender restriction; (4) clear consciousness, without cognitive or behavioral dysfunction; (5) proficient in using smart mobile devices.

Fig. 1

Exclusion criteria: (1) severe heart, lung, or kidney dysfunction; (2) acute critical illness; (3) coagulation dysfunction; (4) severe infection or metabolic disease; (5) concomitant mental disorders; (6) inability or unwillingness to cooperate with the researchers. (7) smoking.

Study designControl group

The control group received routine health care, including: (1) demonstrating the correct BASS tooth brushing method and providing oral hygiene guidance for patients during the hospital visit; (2) implementing oral health education after the treatment by traditional patient leaflets. Patients were instructed on key points from the leaflets to gain specific and detailed oral health knowledge, strengthen their oral health awareness, and guide them in the correct use of dental floss or interdental brushes.

Intervention group

In addition to routine health care, the intervention group implemented a health intervention model based on internet, which included: (1) establishing a WeChat group for patients and sending them information about their oral hygiene twice a day and answering patients’ any questions about oral health; (2) displaying videos about the BASS tooth brushing method, dental floss, and interdental brushes on screens in the waiting area for patients to watch and learn while waiting; for patients with severe cases, nurses would accompany or remind them to watch the videos and answer any questions; (3) registering patients’ contact information and providing telephone follow-ups during their revisit periods, supervising and guiding their oral hygiene behavior, and using phone reminders and WeChat group messages to encourage timely visits; for particularly severe cases, increasing the frequency of follow-ups to improve patients’ understanding of periodontal disease; (4) providing one-on-one psychological counseling for patients, communicating with them in a timely manner, patiently answering their questions, and establishing a good doctor-patient relationship while emphasizing the importance of regular periodontal maintenance and encouraging patients to revisit and actively cooperate with treatment, relieving their psychological stress and guiding them in maintaining good personal oral hygiene; (5) generating QR codes for post-treatment health education content, tooth brushing, interdental brush, and dental floss usage, allowing patients to take photos and save them for easy access to educational materials and videos.

Establishing an internet-based nursing intervention team

The team consisted of 2 periodontal specialists, 1 head nurse of stomatology and 2 nurses. The periodontal specialists and the head nurse of stomatology served as team leaders and give the guidance and advice to other team members. All team members received unified training and were qualified for periodontal examination and providing oral hygiene instructions for the patients with periodontitis. The periodontal probes were positioned parallel to the long axis of the tooth and were always in contact with the tooth using approximately 20–25 g of force. During the clinical data collection process, one of the two periodontal specialists was responsible for chair-side clinical examination. The other was responsible for chair-side supervision and data recording. All nurses received training of unified the speaking skills and the way of using oral hygiene tools (tooth brush, interdental brush, and dental floss) to ensure that patients in the intervention group received the same information.

Outcome measurements

The evaluation indicators of both groups are measured at four time points: initial visit, 6–8 weeks follow-up, 3 months follow-up, and 6 months follow-up.

Periodontal pocket probing depth

Periodontal pocket depth is the distance from the gingival margin to the pocket bottom. Healthy gingival sulcus probing depth does not exceed 2-3 mm. Probing method: (1) hold the probe (UNC15) with a modified pen grip; (2) use the labial surface of the adjacent tooth or the proximal edge as a fulcrum, or use an extraoral fulcrum; (3) apply light probing force, about 20-25 g; (4) the probe should be parallel to the tooth’s long axis when inserted. The probe should be close to the tooth surface, avoiding entry into soft tissue, bypassing calculus, and reaching the pocket bottom until slight resistance is felt at the sulcus bottom; (5) move the probe with a lifting and inserting motion, sequentially probing the periodontal pocket depth of the six points on the labial (buccal) and lingual (palatal) sides of each tooth, taking the average value.

Bleeding on probing (BOP)

Use a blunt-tipped periodontal probe (UNC15) to gently probe the pocket bottom or sulcus bottom from the buccal, lingual, proximal, and distal sides. After removing the probe, observe for 10–15 s for bleeding, and record the results. The ratio of bleeding points to all points is the BOP%.

Self-efficacy scale for self-care (SESS) score

Self-efficacy level of patients with chronic periodontitis was assessed using the SESS [17]. The scale consists of 15 items, including self-efficacy for regular dental visits, proper tooth brushing, and balanced diet. It uses a Likert 5-point scale, scoring 1–5 points from “completely unconfident” to “very confident.”

Satisfaction

Patients’ satisfaction with nursing care was assessed by filling out a designed questionnaire. The questionnaire evaluated the clinic environment, waiting area cleanliness, nursing staff service attitude, health education content, nursing staff answering questions, respecting privacy, service instructions, waiting time, and professional ethics of medical staff. The results divided into three categories that included satisfied, general, and need improvement, with scores of 3 − 1 points, respectively. The questionnaire also asked about whether willing to introduce other patients to the hospital. is scored as or, with the values ranging from 2 (willing) to 1 (unwilling). The total evaluation score ranges from 10 to 29 points, with higher scores indicating higher patient satisfaction.

Statistical analysis

SPSS 26.0 software was used for statistical analysis. Count data are described using frequency and rate, and comparisons between groups are made using the χ2 test. Measurement data are tested for normality using the Shapiro-Wilk test. Normally distributed data are described using mean ± standard deviation. Comparisons between groups for baseline data are made using independent-sample T-tests, and outcome data comparisons are made using analysis of covariance. Skewed data are described using median and quartiles, and comparisons between groups are made using the Mann-Whitney U test. Repeated measures data at multiple time points within groups are compared using the Friedman M test. The test level is α = 0.05.