The life experiences of 19 participants with periodontal disease were reconstructed through the use of in-depth interviews. A total of 899 key results were obtained, and each semantic unit was categorized into one of four upper categories: “Interfering Elements for Dental Care,” “Declined Quality of Life caused by Dental Disease,” “Satisfaction Elements after Treatment of Dental Disease,” “Improvements for Voluntary Dental Care.” Details are shown in Table 2.
1. Interfering Element for Dental Care
1) Regrets of Previous Dental Treatment
Most participants had been to other dentists before visiting the current university hospital. The participants have had gingiva pain for numerous years and have visited the dentist for the purpose of treatment. Unfortunately, the dentists at the previous clinics and hospitals did not offer sufficient explanations about their gingiva condition and they made unconditional recommendations for tooth extraction. In addition, the previous dentists only provided medicine when the participants had toothaches and did not educate them on gingiva care. As a result, the participants did not experience any improvement in gingiva pain even after the extraction and medication consumption. Thus, they decided to receive treatment from their current dentists at the periodontal department of the university hospital voluntarily or upon the recommendation of an acquaintance.
“It’s painful… When I went to a general hospital, they said they (would) have to pull it out. (Your tooth?) Yeah, like they have to pull it out.” (Participant 4)
“There was pus coming out of my gums. I didn’t get a precise answer when I went to that dentist, not even from another dentist.” (Participant 13)
“If you go to a clinic, they only give you meds when you tell them you are in pain, no treatment like this, but just give you antibiotics and meds when you tell them it aches. So, after taking the meds, it doesn’t get better and it still wobbles… So they said I should just pull it out… Pull this one out and do (dental) implant, pull that one out and (dental) implant …” (Participant 2)
2) Lack of Dental-Related Knowledge
Some participants were exposed to an environment where little to no attention was given to dental care for reasons such as living in an impoverished era of war or challenging living conditions. Nevertheless, they had never been educated on proper tooth-brushing techniques, even though they had visited a dentist since their living conditions have improved. Their lack of knowledge meant that they were unable to actively manage the periodontal disease symptoms, such as pus, swelling, and bleeding, and, as patients, they unconditionally obeyed the doctors' orders for tooth extraction.
“I left home to live by myself when I went to high school, so that’s when I started to brush my teeth… I mean, I didn’t know that I had to brush my teeth after breakfast; I was just busy eating my meal and went (to school) … I used to live in (the) countryside, so I didn’t do any dental care at all… There was (also) no concept of brushing.” (Participant 3)
“When I brushed my teeth, there was a bit of blood quite often and (I) felt the swelling, but it didn’t really bother me too much, so I brushed it off.” (Participant 17)
“At the first hospital, it was so bad that they simply told me they had to pull all my teeth out in a few years, (there was) nothing (said) about they will do such and such in order to deal with this or that in what way.” (Participant 17)
3) Obstacles to Dentistry
The unique environment of the dentist was an obstacle that delayed the participants’ dentistry despite their experiencing symptoms of periodontal disease. They also stated that medical staff from different hospitals gave dissimilar treatment directions for the same dental condition and displayed a considerable variation in the requested bills, which decreased the credibility of professionalism.
“It’s scary after all, and the atmosphere, I guess? That sound and you have to like, open your mouth like this and show everything; How scary these things are (is) the biggest (reason). (Participant 16)
“I am so afraid of the anesthesia, I have a phobia (about that), so I insisted that I will get it (the treatment) from a university hospital … because of the horror and fear, I couldn’t go (to the dentist) and I was under a situation where I couldn’t get an act of courage as well because I am a type that doesn’t get anesthetized that well.” (Participant 6)
“I think the biggest thing is distrust. Because (you worry) if you go (to the dentist) and they might scam you when you got nothing or anything (wrong with your teeth) … You get scared when you go to a hospital because you are sick and they say “If you don’t do this or that, you will get into big trouble,” instead of saying something like “Your condition is blah blah blah and this should be treated in this particular way.” When I hear stories (about hospital visits), it’s all different from every hospital … Frankly, I am (a) bit skeptical a lot of times.” (Participant 17)
2. Declined Quality of Life caused by Dental Disease
1) Difficulties in Daily Life
The symptoms of periodontal disease that participants experienced were primarily presence of pus, swelling of the gingiva, tooth wobbling, bleeding, halitosis, and toothache in which the gingiva felt like a sponge. These symptoms were exacerbated when they suffered from sleep deprivation or stress. They claimed that it interrupted the daily routine and one participant said that they even felt a threat to their life.
“My teeth came up like this and when I chewed something on top (of my teeth), they suddenly slid down like chewing a sponge and then came back up. So, I looked at my gum, and (there was) pus, and the inflammation, it came out when you squeeze it; That’s why I went to the hospital … When I brushed my teeth, I felt pus coming out and there was also a lot of bleeding when I did the brushing.” (Participant 3)
“I think sleep and gum (health) (are) very closely connected. On days when I can't sleep and felt tired, my gums start to bleed immediately and the blood gushes out the next day.” (Participant 12)
“It was almost to the point where I immediately went into convulsion when I hear D of the dentist. Because I had really really bad teeth or gums. I went through extreme suffering that the meaning of life, I mean I couldn’t find the meaning of it … Since I couldn’t chew on it, so I thought about death too.” (Participant 5)
2) Difficulties in Social Life
Working life and interpersonal relationships are exceptionally significant in the 21st century. Some participants were unable to properly manage their teeth while working and often abandoned their careers due to neglected dental care caused by frequent after-work drinking sessions. Likewise, in terms of interpersonal relations, halitosis or changes in teeth appearance affected by periodontal disease were a factor that intimidated them.
“I didn't want to go to work. You know, when your teeth are like that, it’s hard to work… I can’t keep brushing my teeth … During work, around 10 A.M., I get a coffee break and eat some sweets, but I can’t brush my teeth right then; I can brush my teeth after lunch, but it’s hard to do it thoroughly.” (Participant 1)
“Since people have been pointed out (my teeth), I automatically cover my mouth with my hands whenever I meet someone … some people said harsh things like I look fine with my closed mouth, but I look like a monster when I open my mouth.” (Participant 6)
3) Economic Difficulties
As one participant said, “I spent money, enough to buy a luxury car, to treat periodontal disease,” it is clear that dental treatment costs were overwhelming for them. However, some were not under this financial pressure, as they were satisfied with the cost-effectiveness of the treatment results. Most participants, however, were distressed by the large medical expenses of dental treatment. Notably, one participant shared their experience of receiving illegal dental treatment from a non-medical professional as they had failed to receive tooth scaling due to monetary difficulty.
“Just for the sake of the smooth sailing of my treatment … I was happy. Happy, and I had faith (in the treatment).” (Participant 5)
“More than 10 million won for (the treatment of) today also. I'm getting one again this time. I am getting it done again because the previous ones were really bad, and this costs about 5 million won, so you feel extreme economic stress.” (Participant 7)
“The cost of expense 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.” (Participant 1)
3. Satisfaction Elements after Treatment of Dental Disease
1) Positive Change in Daily Life
The participants who went through the periodontal disease treatment experienced various changes in their daily lives. The most significant change was the improvement of QOL resulting from the relief of the periodontal disease symptoms. Specifically, they were able to eat the food they wanted, taste the flavor of food, preserve their teeth without extraction, and sleep soundly due to toothache relief.
“It (the pain) suddenly decreased, (it did) not just simply decrease, but it got one in a million times smaller … If before if it was 100 points, now it rapidly decreased to 1 to 5 points.” (Participant 10)
“I couldn't have eaten well before; Now I eat well … Eating almonds was something that I couldn't imagine, but now I can. Just as an example, I can even eat almonds.” (Participant 3)
“The pain is gone, so I became 100% confident. Say, for the longest time, what would be a better hope than that we, as human beings, could all have our own teeth for the rest of our lives—it is a blessing. It is the ultimate choice to have your own teeth preserved the most for a long time. That’s why I made sure to keep this tooth. Now I live without any feeling of pain at all.” (Participant 12)
2) Positive Change in Relationship
The participants who felt much discomfort in their interpersonal relationships due to periodontal disease symptoms said their halitosis and aching were reduced when they were treated for periodontal disease. As a result, they stated that the sharpness of pain disappeared, and they were happy to meet and interact with people. One participant used to cover their mouth with their hands all the time due to halitosis, and when the symptoms improved, they mentioned that they were happy to be able to be interviewed and to have a big smile.
“Tooth (health) is happiness… I have the confidence that I can speak like a normal person without pain, and I can do my job feeling better.” (Participant 5)
“I tend to recommend it (the treatment) to people around me … I get to act in more natural ways. As I forced myself to cover it (my mouth) and unnaturally acted like this in the old days, now I can comfortably face people like this, talk like this, and laugh like this.” (Participant 6)
3) Increased Positive Awareness of Dentistry (Teeth)
Participants who have been receiving dental treatment have considered dental care to be one of the Five Blessings (longevity, wealth, health, love of virtue, and peaceful death), highly essential, and have recommended dental checkups to those around them. In the past, they had vague fears and low confidence in dentists, but they have started to experience high satisfaction and rate dentists as having high credibility because of the improvement of symptoms resulting from meeting their current medical practitioner and gaining understanding of their condition. They were particularly pleased with the departmentalized system and methodical treatment process as they transferred to the university hospital.
“They let me preserve my entire tooth. I felt really appreciative… I could do dozens of interviews like this about teeth. I really went through a lot. But (thanks to) Dr. Lee… After that (the treatment), my world changed upside down. I really went through a lot; because of my teeth…” (Participant 13)
“You know, most people, they tend to have this thought of losing quite a bit with unclarity when you go to a private hospital. … We shouldn't jump to a conclusion, and they are valuable practitioners, but that particular thought can’t escape my head. But since I’ve visited the university hospital, I think the credibility rose to 100%.” (Participant 12)
“I’ve spread the words to the people around me; You can have healthy teeth by visiting the dentist regularly to get dental checkups and care … I should have done this care sooner, but it’s a pity that I couldn’t have done it.” (Participant 14)
4) Improvement of Health Behavior for Dental Care
All participants voluntarily made an effort to alleviate periodontal disease symptoms. Many of them brushed their teeth three times a day by applying proper brushing techniques learned at the hospital, and utilized dental aids such as dental floss and interdental toothbrushes. Also, based on their own periodontal disease experience, they have been actively recommending dental examinations not only for themselves but also for their family members. Moreover, they have tried to stop smoking and abstain from drinking. Lastly, participants who were passive and depressed because of periodontal disease demonstrated positive thoughts and actively participated in the hospital treatment process.
“I used to brush my teeth for less than one minute, and nowadays I'm brushing over three minutes, not just three minutes, meticulously, I mean more meticulously. It takes longer than washing my face and hair.” (Participant 10)
“I like to use an interdental toothbrush more; That debris in that unreachable spot with a toothbrush is removable with an interdental toothbrush.” (Participant 11)
4. Improvements for Voluntary Dental Care
1) The necessity of Publicity for Dental Examination
Despite compulsory routine dental examinations, most participants did not recognize the importance of these examinations. To improve this impression, they mentioned the necessity of active promotion to raise awareness of the need for dental care through the dental examination smartphone application notification service or brochure distribution.
“You can send out a reminder service to the general public so that people can easily look into it. Or distribute an information brochure - like the notification one that you get when you reach a certain age for the free health checkup - so that you can see for yourself and recognize what periodontal disease is like.” (Participant 6)
2) The Necessity for Publicity about the Severity of Periodontal Disease
The participants were not aware of the severity of periodontal disease until their symptoms became severe. In addition, even though the symptoms were acknowledged, they tend to endure pain without treatment. This behavior resulted from ignorance and fear of the severity of periodontal disease, which requires urgent publicity, according to the participants.
“Unless it (symptom) becomes serious like mine, say you’re just a little uncomfortable, then a lot, I mean most of the people don’t go (to the dentist). … (When you publicize it,) I think it will be a good idea for the Health Insurance Corporation to include a simple guidebook to help you learn about the seriousness, such as what is periodontal disease and what other organs will be affected by periodontal disease.” (Participant 6)