17 April 2023

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Why do some parents reject fluoride for their kids? Study has answers

By UW School of Dentistry News

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Why are some parents reluctant to let their child receive fluoride treatments from a dental provider? A new study, led by Dr. Donald Chi of the Department of Oral Health Sciences at the University of Washington, has some answers.

Dr. Chi’s team of researchers, who interviewed 56 fluoride-hesitant parents, grouped fluoride hesitancy into six main areas:

• Thinking topical fluoride is unnecessary
• Wanting to keep chemicals out of their child’s body
• Thinking fluoride is harmful
• Thinking there is too much uncertainty about fluoride
• Feeling pressured to get topical fluoride, and
• Feeling fluoride should be a choice.

The central theme of the parents’ response, according to the study, was “wanting to protect and not mess up their child.” The study was published March 23 in PLOS ONE.

“The underlying assumption sometimes is that fluoride-hesitant parents don’t care about their children, don’t love their children, and that they’re making these bad decisions for them,” said Chi, associate dean for research at the School of Dentistry. “However, our data show that parents are trying to make decisions that protect their children. I think that’s the main force behind these drivers.”

Chi rarely encountered fluoride hesitancy early in his career as a pediatric dentist. But as time progressed and the internet became more accessible, parents started walking into the dental office equipped with more questions.

“There is a general backlash happening now with preventive care among some parents. It affects us with fluoride just like it affects physicians with vaccines,” he said.

In another study Chi helped publish, it was determined that parents who opposed topical fluoride in dental settings were significantly more likely to oppose COVID-19 vaccines for their child.

“A lot of parents don’t think it’s necessary. In the case of fluoride, it might be that ‘Oh, my child gets other sources of fluoride,’ whereas with vaccines it may be ‘Natural immunity is more important.’ Therefore they feel vaccines are not necessary,” said Chi.

With rising skepticism of medical practices, creating conceptual models, like the one Chi and his team have made for topical fluoride, is becoming increasingly important. Healthcare providers must be familiar with the different reasons why a parent may be hesitant so they can offer a nuanced response.

“If a provider doesn’t understand what is driving a parent’s decision, or assumes that they know what’s driving it, they can end up making a hard conversation even more difficult,” said Chi.

The team plans to further their current conceptual model by establishing chair-side decision trees that outline ways of managing each of the six drivers. Such approaches will require training on communication strategies. That way, dental providers can be far better prepared to handle fluoride hesitancy.

“I need to know where parents are coming from so I can tailor my communication approach,” said Chi. “You can’t treat all your patients the same way and assume that all parents refuse fluoride for the same reasons.”