Parental preference for fluoride varnish: a new concept in a rapidly developing nation

A Comparison Between Parents with Different Attitudes Towards Topical Fluoride Application for Their Children: A Cross-Sectional Study

PURPOSE

Although fluoride is known to be effective and safe, an increasing number of parents refuse to allow fluoride applications for their children. This study aimed to compare the parents who accepted and rejected fluoride application for their children in terms of their attitudes toward fluoride and vaccinations, sociodemographic characteristics, and source of knowledge.

MATERIALS AND METHODS

In this cross-sectional study, a previously validated questionnaire was administered to 85 parents who did not consent to have topical fluoride applied to their children's teeth (AF group) and the 143 parents who consented to have it applied (F group) in a pediatric dentistry clinic. Data were analysed using the independent t-test and chi-squared test.

RESULTS

In the F group, the number of those who disagreed with the statement that fluoride causes intellectual disability, autism, and damages the pineal gland was statistically significantly higher than in the AF group (p 0.05). The most common source of information for the AF group was the internet/social media (67.06%), while for the F group, it was dentists/medical doctors (62.24%). More parents in the F group stated that childhood and Covid-19 vaccinations must be performed; this was a statistically significant difference (p 0.05).

CONCLUSION

No relationship was found between fluoride hesitancy and the educational level of the parents. Most parents in the AF group have doubts and concerns about fluoride rather than being strongly opposed to it. Therefore, educational programs given to parents are likely to have a positive effect on their acquisition of correct information.

Fluoride hesitancy: A mixed methods study on decision-making about forms of fluoride

OBJECTIVES

To investigate whether professionally applied topical fluoride-hesitant caregivers are also hesitant about other forms of fluoride for their child.

METHODS

This was a mixed methods study of 56 caregivers hesitant about professionally applied topical fluoride for their child recruited from the University of Washington Center for Paediatric Dentistry and Seattle Children's Hospital's Odessa Brown Children's Dental Clinic. A 32-item semi-structured interview script was piloted and finalized. One-time interviews with caregivers were conducted by phone in 2019. Associations between hesitancy of topical fluoride, fluoridated water and toothpaste were assessed quantitatively via two-tailed chi-squared tests. Qualitative data were coded using an inductive approach and content analytic methods to investigate reasons for hesitancy.

RESULTS

There were significant associations between hesitancy in all three pairwise comparisons of fluoride form (p < .01). Similar proportions of caregivers strongly or somewhat opposed fluoridated water compared with toothpaste (75% and 65%, respectively), but four times as many caregivers strongly or somewhat favoured fluoridated toothpaste compared to water for their child (25% and 7%, respectively). Concerns about harm were the most common reason caregivers opposed both fluoridated water and toothpaste. However, fluoride-hesitant caregivers reported being more comfortable with fluoridated toothpaste because amount and frequency can be controlled, and ingestion can be prevented.

CONCLUSIONS

Professionally applied topical fluoride hesitancy is significantly associated with fluoridated water and toothpaste hesitancy, but caregivers who were hesitant about topical fluoride was more comfortable with fluoridated toothpaste than fluoridated water for their child.

Topical fluoride hesitancy among caregivers: Development of a content-valid topical fluoride hesitancy identification item pool

OBJECTIVES

To develop a content-valid set of items to characterize different types of topical fluoride hesitancy among caregivers. We will use this information to develop and test tailor-made interventions directed to caregivers with varied types and levels of topical fluoride hesitancy, to ultimately improve child oral health.

METHODS

Caregivers participated in three study activities, in the following order: (1) semi-structured concept elicitation interviews (n = 56), (2) cognitive interviews (n = 9), and (3) usability interviews (n = 3). Interviews were conducted via telephone and audio-recorded and transcribed for qualitative analysis. Twelve pediatric dental providers and researchers participated in item review. An assessment of reading level of items was made with goal of 6th grade reading level or less.

RESULTS

Based on elicitation interviews, we initially developed 271 items, which the investigative team evaluated for conceptual clarity, specificity to topical fluoride hesitancy, and sensitivity to potential interventions. After four rounds of review and cognitive interviews, we retained 33 items across five previously identified domains. Changes after cognitive interviews included item revision to improve comprehension and item re-ordering to avoid order effects. Changes after usability testing including clarification regarding referent child for families with multiple children. The reading level of the item pool is grade 3.2.

CONCLUSIONS

The resulting 33-item fluoride hesitancy item pool is content valid and will address an important need for identifying and addressing topical fluoride hesitancy in the context of dental research and clinical practice. Next steps include psychometric evaluation to assess scale and test-retest reliability and construct validity.

Association between caregiver opposition to topical fluoride and COVID-19 vaccines

PURPOSE

Caregivers who oppose topical fluoride in dental settings may be opposed to other preventive health treatments, including COVID-19 vaccines. The study objective was to examine the association between caregiver opposition to topical fluoride and COVID-19 vaccines.

METHODS

The study took place at the University of Washington in Seattle, WA. English-speaking caregivers of children aged < 18 years were eligible to participate. An 85-item REDCap survey was administered from February to September 2021. The predictor variable was topical fluoride opposition (no/yes). The outcome was COVID-19 vaccine opposition (no/yes). The models included the following covariates: child and caregiver age; caregiver race and ethnicity, education level, dental insurance type, parenting style, political ideology, and religiosity; and household income. Logistic regression models generated odds ratios (OR) and 95 % confidence intervals (α = 0.05).

RESULTS

Six-hundred-fifty-one caregivers participated, and 403 caregivers with complete data were included in the final regression model. Mean child age was 8.5 years (SD 4.2), mean caregiver age was 42.1 years (SD 9.1), 53.0 % of caregivers were female, 57.3 % self-reported as white, and 65.5 % were insured by Medicaid. There was a significant positive association between topical fluoride and COVID-19 vaccine opposition (OR = 3.13; 95 % CI: 1.87, 5.25; p < 0.001). Other factors associated with COVID-19 vaccine opposition included conservative political views (OR = 2.77; 95 % CI: 1.26, 6.08; p < 0.011) and lower education (OR = 3.47; 95 % CI: 1.44, 8.38; p < 0.006).

CONCLUSIONS

Caregivers opposed to topical fluoride in dental settings were significantly more likely to oppose COVID-19 vaccines for their child. Future research should identify ways to address both topical fluoride and vaccine opposition to prevent diseases in children.

Is It Mum or the Dad? Parental Factors That Influence the Use and Acceptance of Fluoride Varnish among Parents in Eastern Saudi Arabia

Objective

To investigate parental factors that influence knowledge, use, and acceptance of fluoride varnish (FLV) application.

Methods

This cross-sectional study was conducted during December 2021. A multistage sampling technique was used to recruit parents with children aged 3 to 6 years and residing in Eastern Saudi Arabia, excluding those working in the dental field. The questionnaire consisted of four parts: demographics, knowledge, previous experience, and acceptance of FLV and was pilot-tested and distributed online using social media.

Results

A total of 623 parents responded to the survey. Only 36.9% of parents had good FLV knowledge with dentists being the main source of information. Gender, educational level, family income, being in the medical field, and source of knowledge were factors that significantly (P < 0.05) influenced parental knowledge. Only 24.6% of the parents applied fluoride varnish to their children before, of whom only 29% were satisfied with the experience. Parent's FLV knowledge, view of dental visits, satisfaction with previous experience, perception of children's oral health, and willingness to reapply FLV were factors that significantly (P < 0.05) influenced FLV use. Working in the medical field, perception of dental visits, and the source of knowledge were factors that significantly (P < 0.05) influenced the parent's acceptance to apply FLV. While lack of knowledge about fluoride benefits (15%) was the main reason for parental refusal to apply FLV.

Conclusions

The current study highlights the lack of knowledge and application of FLV among parents. There were more factors influencing mothers' acceptance of FLV application compared to fathers. Age, educational level, working in the medical field, perception, and patterns of dental visits were some of the identified factors. Dentists played a major role in parental knowledge and FLV acceptance. In a country with high caries prevalence, preventive programs such as FLV education and application are crucial.

Parental Knowledge and Awareness of Fluoride Varnish Application on Their Children - A Cross-Sectional Study

Introduction

Fluoride varnishes are forms of topical fluoride that are applied on the surfaces of teeth to prevent from dental caries. It contains sodium fluoride, which is the active ingredient in the varnish and the concentration is about 22,600 ppm. Fluoride can promote enamel remineralization which protect against dental caries and it can be professionally applied by dentists and physicians for infants and young children.

Methods

In this, cross-sectional study, a close-ended survey containing 14 items was given to 399 randomly assigned parents in Jeddah, Saudi Arabia. The questionnaire included demographic data and items to assess the general knowledge about fluoride and fluoride varnish. The responses were coded and statistical analysis was performed.

Results

About 65.3% of males and 47.4% females were not sure if fluoride application was safe for their children, however, 67.2% of the population revealed that tooth pastes were one among the fluoride sources for their children. Pearson’s correlation test showed high statistical significance between the parents’ educational background and awareness level of fluoride varnish was of with p-value-0.000 and correlation coefficient (r-value-0.427).

Conclusion

The lack of awareness among parents on an important caries-control measure warrants the implementation of special awareness programs on fluorides and its benefits in young children.

Topical Fluoride Applications Related Posts Analysis on Twitter Using Natural Language Processing

PURPOSE

Social media is today a comprehensive source of data that can serve as a guide to professionals in issues related to public health. The purpose of this paper is to investigate the content of topical fluoride-related Twitter posts made over a 3-year period in order to improve our understanding of Twitter users' perceptions and treatment experiences.

MATERIALS AND METHODS

A continuous cross-sectional sample of Tweets on the subject of 'approaches to the topical fluoride treatment of tooth decay' was collected from the Twitter social networking platform between 1 January 2017 and 1 January 2020 using a software application developed for this research that makes use of the Twitter advanced search API. The words and phrases used for the identification of related Tweets were determined through a screening of the topical fluoride keywords of previous studies, and a search was conducted in the English language. To better arrange the collected Tweets and to make the data more meaningful, firstly one of the natural language process techniques - Tokenization - was applied, after which the Tweets were converted into a set of meaningful words and regular expressions. The Tweets were then compared with each other, word-by-word, with the help of a word-based Levenshtein distance algorithm, after which two experts in the computational social science domain labelled each Tweet.

RESULTS

A total of 132,358 Tweeter posts referencing topical fluoride applications were collected, of which 110,847 were eliminated through the use of a word-based Levenshtein distance algorithm, and the remaining corpus of 21,511 posts was analysed and evaluated for specific content. Within the garnered data, 48.5% (n = 10,428) of the Tweeter posts concerned topical fluoride treatments, and 7% (n = 1,507) reported experiences with topical fluoride treatment. Negative Tweeter posts about topical fluoride treatment (5,679, 26.4%) vastly outnumbered those that were positive (3,897, 18.1%).

CONCLUSION

The current study achieved its main objectives of analysing topical fluoride application-related posts made on social media. From the garnered Twitter data, it can be understood that Twitter users regularly share their concerns and negative sentiments about the side effects of topical fluoride treatments on the platform. Future explorations of social media may aid public health and dental professionals in the development of strategies to educate the public and to raise awareness of the importance of topical fluoride applications.

<p>Parental Perception of a Dental Home for Children with Special Needs</p>

Background and Objectives

There is a major gap in the literature that addresses parental perception of acquiring a dental home for children with special healthcare needs (CSHCN). The objectives of this study are to assess parental perceptions and challenges in acquiring a dental home for their CSHCN.

Methods

Cross-sectional prospective study using a questionnaire.

Results

A total of 302 questionnaires were completed by caregivers. More than 70% of children had developmental delay, 20% had musculoskeletal disabilities, and the rest had respiratory compromise on non-invasive ventilation, learning disability, and visual and hearing disabilities; 75% of the caregivers do not believe pediatricians are qualified to contribute in oral hygiene. Moreover, 70% of children had not had a routine dentist visit in the 12 months preceding the interview. The reasons given for the lack of such visits included the long time of appointments (25%), difficulty in child’s mobility (17%), the perception that dental care is expensive (9%), and a lack of dentist experience in dealing with children with special needs (5%). When asked what factors would encourage caregivers to choose a dental home for their children, 63% mentioned quick appointments, followed by dentists specialized in children with special needs (51%), child friendly atmosphere (21%), low cost (26.6%), close to home (20%), and others (6%). Interestingly, the majority of parents (75%) believed that the primary pediatrician of the child should initiate the dental home process.

Conclusion

Despite proper resources, children with special healthcare needs lack proper oral healthcare. This could be attributed to the lack of a dental home. A pediatrician’s role is crucial in initiating the process of acquiring a dental home for this special population.

The role of Polish school nurses in the oral health promotion for 7-19 year-old children and adolescents

Purpose

The assessment of the role of school nurses in the oral health education and counselling of children and adolescents aged 7–19 years.

Methods

A self-administered questionnaire was used to evaluate nurses’ practice in oral health education, previous training in caries prevention, collaboration with a dentist and self-assessment of knowledge. Data were analysed with the Chi square test.

Results

The study group consisted of 140 Polish school nurses. Respondents declared the following activities: dietary counselling (99.2%), oral hygiene education (92.8%), NHS-funded supervised fluoride prophylaxis (82.8%), and caries screenings (4.3%). 47.1% participated in training on caries prevention, 25.7% had a collaboration with a dentist. Nurses from schools located in towns less frequently provided oral hygiene education (p < 0.005) and dietary counselling, but more often had a collaboration with a dentist (p < 0.05). The youngest nurses were more confident about their knowledge (p < 0.05). There was an association between participation in training on caries prevention and positive opinion on a school-based fluoride prophylaxis (p < 0.01). Nurses who did not include dental topics in their practice worked mainly with pupils older than 15 years, had shorter experience (p < 0.05), secondary education, worked in urban areas and had no training on dental problems (p < 0.01).

Conclusion

Polish school nurses have potentially crucial roles in improving the oral health status in pupils through oral hygiene education, dietary counselling and fluoride prophylaxis included in their duties.

Polish School Nurses' Opinion and Knowledge towards Topical Fluoride Treatment

Aim

The aim of this study was to evaluate the Polish school nurses’ opinion on the topical fluoride treatment and their knowledge about fluoride safety.

Methods

A cross-sectional study with the use of a self-administered questionnaire was conducted on 164 school nurses. The questionnaire concerned previous training in caries prevention, action taken at schools with regard to caries prevention, cooperation with dentists, opinion on the topical fluoride application program and nurses’ knowledge about fluoride safety.

Results

93.9% of nurses included oral health in their duties and 81.7% accomplished the topical fluoride treatment. 52.1% never attended any training concerning dental issues. Nurses from cities and villages more often than those from towns provided lectures on caries prevention and fluoride topical applications (respectively p= 0.033 and p=0.021, chi2 test). The nurses had a positive opinion on the effectiveness and safety of topical fluoride application. Only a half of respondents knew the fluoride probable toxic dose and one fifth of them did not know the concentration of fluoride in gel. The knowledge was statistically dependent on the level of nurses’ education (p=0.019, Kruskal-Wallis test). Nurses with a low level of knowledge were not aware of a potential harm effect of fluoride and they had negative opinion about the effectiveness of fluoride program at school.

Conclusion

Polish school nurses had a positive opinion on topical fluoride treatment. However, there are gaps in their knowledge and the institutional training is needed.

Parental attitudes about acquiring a dental home for preschool children: a new concept in the Arab state of Qatar

OBJECTIVE

The purpose of the study was to assess parental perceptions and acceptability of a dental home for their preschool children, a new concept in the state of Qatar.

METHODS

A cross-sectional prospective study was conducted at Hamad Medical Corporation, in the state of Qatar. Parents of infants and children <5 years of age were offered an interview survey.

RESULTS

A total of 309 questionnaires were completed (response rate =98%). More than 90% of the participants believed that oral health and dentition affected total-body well-being. Only 18% of parents stated that their children had excellent oral health. Interestingly, more than two-thirds of children had not had a routine dentist visit in the 12 months preceding the interview. Reasons for not having such visits included long appointment times (17.4%), the perception that dental care was expensive (15.5%), the notion that deciduous teeth did not need care (9%), the impression that insurance did not cover dental procedures (8%), unawareness of location of dental centers (4%), the child did not want to go (4%), the notion that children are difficult to handle during a dental procedure (3%), a combination of these factors (33.5%), and other factors (5%). When asked what factors would encourage them to enrol a dental home for their children, almost 20% mentioned speedy appointments followed by dentists specialized in pediatrics (14.3%), child-friendly atmosphere (12%), low cost (12%), close to home (5.7%), none (2.7%), others (2%), and all of the above (32.3%).

CONCLUSION

Counseling by primary-care physicians can increase dental home acceptability in the state of Qatar, especially that access to health care is easy in our community.

Parent Refusal of Topical Fluoride for Their Children: Clinical Strategies and Future Research Priorities to Improve Evidence-Based Pediatric Dental Practice

A growing number of parents are refusing topical fluoride for their children during preventive dental and medical visits. This nascent clinical and public health problem warrants attention from dental professionals and the scientific community. Clinical and community-based strategies are available to improve fluoride-related communications with parents and the public. In terms of future research priorities, there is a need to develop screening tools to identify parents who are likely to refuse topical fluoride and diagnostic instruments to uncover the reasons for topical fluoride refusal. This knowledge will lead to evidence-based strategies that can be widely disseminated into clinical practice.