Understanding the feelings and experiences of patients with periodontal disease: a qualitative meta-synthesis

Search results

A total of 567 articles were initially searched and two additional articles were acquired while full-text level screening. Of these, 362 were excluded after reading titles and abstracts. A total of 11 records were assessed by reading full texts. At last, eight articles were included and analyzed for meta-synthesis. The retrieval searching process of the review is shown in Fig. 1.

Fig. 1figure 1

Prisma flow chart depicting the search strategy of the studies included in the meta-synthesis

Study characteristics and quality appraisal

All of the included studies (Table 1) were qualitative studies. They were conducted in Europe (n = 4; 3 in Sweden and 1 in the UK), Asia (n = 3; 1 in Korea, 1 in Indonesia, and 1 in Singapore), and Oceania (n = 1, New Zealand), published between 2008 and 2021. A total of 131 participants (Men = 56, Women = 75) were comprised in the studies. Interviews were used in all included studies, and dairies were used in one study additionally. Thematic analysis and the constant comparative method were used most frequently (n = 6, 75%). Other studies (n = 2, 25%) did not specify which analytical method was used, but they described the detailed analytical steps.

Table 1 Characteristics of the included studies

We only used the JBI Critical Appraisal Tool because there was no mix-method study. The methodological quality of all included articles was scored 7–9, which means at least seven out of ten items were “yes” (Additional file 1: Appendix Table S2). All studies reported in detail the research questions, objectives, data collection, data analysis, interpretation of results, characteristics of the study population, ethical issues, and conclusions. However, five studies failed to state philosophical perspective clearly and only reported the study was qualitative or used qualitative methodology [19,20,21,22,23]. Additionally, all included studies except two [20, 22], failed to discuss the role of the researchers and their influence on the research.

Meta-synthesis

We identified three analytical and nine descriptive themes from the analysis of eight eligible papers (Fig. 2). The main themes are entitled “pressure,” “coping and adaptation,” and “reflection and evaluation.” For patients with PD, these three themes interact with each other. “Pressure” is caused by the disease and its treatments, “coping and adaptation” is a response to pressure and self-reflection; the process of “reflection and evaluation” is activated from the moment the symptoms appear. Combining all these themes, we can explain the feelings, experiences, and perceptions of patients with PD.

Fig. 2figure 2

Thematic diagram framework

Theme 1: pressure

This analytical theme depicts the various impacts of PD on patients through three descriptive themes: “physical,” “psychosocial,” and “financial.”

Physical

Owing to physiological changes, patients with PD experienced a variety of symptoms, most of which was masticatory discomfort. For example, patients reported inability to masticate, tooth sensitivity, toothache, etc. [19, 20, 22] As a result, some of them had to change their eating habits and avoid masticating which they used to eat, as one patient expressed “I cannot bite into an apple and eat it that way, I have got to chop it up...”[19] (P2) Some patients started masticating unilaterally [22], which may have an impact on their appearances. Moreover, the consequences of periodontitis, such as the destruction of periodontal support tissue and tooth loss subsequently, can further affect the appearance [22]. Some patients were quite concerned about their bad breath and feel embarrassed [19, 22]. Especially when they were in a relationship, halitosis can make them very upset, “The wife mentioned something like ‘Your breath smells’, I feel a bit self-conscious.” [19] (P7).

Psychosocial

With these symptoms, patients usually experienced a range of negative feelings. When they were diagnosed with periodontitis, the patients expressed the feeling as “a shock,” even though they had already had the problem for a long time. Then, they perceived that there was too much to fear. Some patients worry about tooth loss, “I was so afraid that my teeth would fall out there,” [22] (P9) and some fear that the situation is a sign of faint, “I didn’t feel dizzy, but I felt I could faint because too much blood came out [from her gums].”[22] (P4) In some cases, patients considered it a stigma. One patient reported, “I’ve always felt there was like a stigma about it [PD].”[19] (P13) Therefore, some reported the disease had affected their self-confidence a lot [22]. When they communicated with others, they were extremely uncomfortable, and some unconsciously covered their mouths [21, 22], Moreover, as some cases reported, PD have limited patients’ daily life in many ways [21, 22, 24, 25], “All of my activities were interrupted, I couldn’t do anything.” [22] (P16).

Financial

In studies from Sweden [24, 26] and Korea [21], some patients expressed the financial burden of periodontal treatment. They expressed their frustration with the health insurance system and their sadness over the high costs, “The cost is too high. I thought it was 2.5 million won as a total, but if the pillar (implant fixture) takes 1 million won, then it would cost me another pretty penny for visiting back and forth.” [21] (P1).

Theme 2: coping and adaptation

This analytical theme is built on the theme of “pressure” and emphasizes the dynamic and balanced process of the disease and its treatment. It can be interpreted by three descriptive themes: “avoidance of the status quo,” “trying to understand it,” and “taking responsibility for their own.”

Avoidance of the status quo

Some deliberately avoided discussing their oral conditions because of the perceived stigma [19, 20, 24]. They felt embarrassed to be diagnosed with PD; some would rather say “my bone’s crumbling” rather than “I’ve got gum disease.” [19] (P13) “I’m reluctant to talk about it. Only very close people really know about it,” [20] (P11) a patient stated. On the other hand, facing various embarrassing symptoms such as halitosis, some disguised it by chewing gum [20].

Trying to understand it

Others took positive approaches to cope with the disease. They got knowledge from various media (internet, TV, radio, etc.) and learned from their interactions with doctors [23]. During their treatment, some of them tried everything to understand how their disease developed with the presentations of radiographs, photographs, and brochures. “The participants had obtained immediate feedback regarding this matter and, if needed, complementary information and instructions,” as the author stated [26].

Taking responsibility for their own

Most patients gradually realized their own responsibility in their struggle against the disease, therefore, they devoted a lot of time, money and energy consciously to regain their health [20, 21, 25, 26]. As one stated, “They have done the hard work and scraping, so it’s up to me now to continue and keep the hygiene side of it up.” [20] (P14) They gradually developed healthy oral hygiene habits, as they reported that they became more careful in brushing their teeth [21] (P10).

Theme 3: reflection and evaluation

This analytical theme can draw a picture of how patients understand their disease and treatment. This process runs throughout the disease and treatment. Three descriptive themes can help illuminate the process, namely “exploring the causes,” “personal control,” and “calling for better dental care.”

Exploring the causes

Their perceived causes of the disease were multiple. Most patients felt that previous unhealthy behavior (e.g. smoking, irregular checkups, etc.) should account for their current condition [19, 20, 24]. Some patients had visited the dentist before, but they felt those doctors failed to inform them of their oral condition adequately and oral health maintenance properly. As a result, their oral condition got worse [21, 24]. Two studies [21, 23] reported subjective obstacles to get dental care; one patient stated that he was fear of anesthesia and thus couldn’t go to the dentist[21] (P6). One study from Korea[21] reported that lack of dental-related knowledge was a cause, which could account for their poor dental care behaviors; one living in the countryside complained that he had no concept of brushing until high school [21] (P3).

Personal control

Personal control emphasizes the degree of confidence one has in controlling the progression of the disease, including the perception of whether the disease can be cured or treated [27]. We found that patients’ personal control over the disease varied among stages and patients [20, 21, 23,24,25,26]. Some patients knew little about the disease when they first learned of their diagnosis and needed some time to understand it [24, 25]. In their primary opinion, PD was a natural process related to aging. Moreover, they were unaware that PD was the main cause of tooth loss [25]. However, when they learned more about the disease, they gradually realized their own responsibility in oral health, so their sense of control increased to some extent [26]. Furthermore, they found harmonious doctor-patient relationships increased their confidence in controlling the disease [20] (P14).

Their sense of control over the treatment was different. On the one hand, some patients reported they lacked a sense of control over the disease after experiencing treatments from different dentists. Therefore, they felt frustrated and had to rely on authority [24]. Besides, a minority were disappointed when they found the treatment was not as effective as they expected, namely it had just slowed the progression in their view. As one patient stated, “I had hoped that the treatment would help more, but it’s just slowed it down a little.” [26] On the other hand, however, the majority had positive attitudes towards the treatment. They felt the treatment gave them a better sense of control over the disease [21, 23,24,25,26]. As one patient stated, “After that (the treatment), my world changed upside down.” [21] (P13).

Calling for better dental care

Reflecting on the whole process from the patient's perspective, we can make some improvements. Some patients would like more public education about the disease, so they can give attention to oral health and take action earlier [21]. Some patients stated it was necessary to train professionals in communication to provide effective health education [25, 26]. “They have to learn to hold a serious dialog…they should learn a little more about dealing with people.” [26] They wanted to be treated with respect and encouraged, rather than leaving them in shame and humiliation while communicating with their dentists; one patient expressed that they were already aware that they had made mistakes, so wished there was no more blame [26]. Further, physical and mental pain during the treatment was another thing to consider [20, 25]. One patient stated the feeling, “Stuck in the chair with the lights… the bite block… the noise… the scraping and the pain.” [20] (P9) Some patients perceived the impact of PD on their quality of life and felt it was necessary to develop a disease-specific quality of life instrument [23]. “It helps the dentist know me better,” one patient stated in a recent study [23] (P9).

留言 (0)

沒有登入
gif