Patient Awareness and Recognition of Early Signs of Periodontitis in the Northwestern Romanian Population: A Cross-Sectional Questionnaire-Based Study on 518 Adults.

BACKGROUND/OBJECTIVES: Periodontitis is a chronic inflammatory disease with a high global prevalence and substantial public health burden. Often diagnosed after irreversible damage has occurred, its early detection depends heavily on patient awareness. This study aimed to assess awareness of early periodontal signs, oral hygiene behaviors, and the influence of demographic and behavioral factors among Romanian adults, to inform targeted public health strategies. METHODS: A prospective cross-sectional study was conducted using a structured, 20-item questionnaire adapted from previously published instruments, reviewed by dental specialists, and pretested in a pilot group for clarity. A total of 518 adults participated. Collected data included demographic information, smoking history, oral hygiene habits, and symptom recognition. Descriptive statistics were used to summarize responses, and inferential tests (t-test, Mann-Whitney U, and Cramér's V) were applied to assess associations. A p-value < 0.05 was considered statistically significant. RESULTS: Of the respondents, 58.1% were male and 41.9% female, with a mean age of 36 years; 67.8% resided in urban areas. Although 52.9% reported gingival bleeding, only 47.1% recognized it as abnormal. Gum recession was noticed by 46.1% but seldom interpreted as a health issue. Smoking prevalence was 40.5%, and smoking status showed significant associations with specific awareness items, though not with overall symptom awareness. Manual toothbrush use was common (48%), yet only 24% reported daily flossing. Younger adults showed better hygiene practices, but gaps persisted across all groups. CONCLUSIONS: Romanian adults show limited awareness of early periodontal symptoms and inconsistent oral hygiene behaviors. These findings highlight the urgent need for national oral health education campaigns and the integration of preventive strategies into primary care-particularly targeting rural residents, smokers, and younger populations-to reduce the burden of untreated periodontitis in Eastern Europe.