Parents' attitudes towards topical fluoride and vaccines for children: Are these distinct or overlapping phenomena?

Despite attention paid to parental refusal of child vaccines, the phenomenon of topical fluoride refusal is poorly understood. We examine the extent to which parent attitudes and Internet use regarding topical fluoride treatment and vaccines may overlap and, in turn, uniquely or distinctly correlate with fluoride and vaccine refusal for the child. In 2017, we analyzed data collected from 2011 to 12 for 361 children from three Washington state dental clinics. The instrument included analogous measures of topical fluoride and vaccine safety concerns, perceived severity of preventable cavities/disease, and Internet use for fluoride/vaccine information; and measures of non-fluoridated toothpaste use, attitudes towards dental x-rays and amalgam and composite fillings. We assessed dental chart-based topical fluoride refusal occurring in 2009 or 2010 and parent-reported vaccine refusal. All analogous fluoride and vaccine items were substantively correlated. However, in a series of adjusted models, none of these items were significantly associated with fluoride refusal. Multiple fluoride and vaccine items were associated with vaccine refusal in unadjusted models; but only vaccine safety concerns, perceived severity of a preventable cavity, and Internet use for vaccine information remained significant in adjusted models. Although there is concordance between the two refusal behaviors as well as analogous attitudes and Internet use, these findings challenge the idea that fluoride refusal should be addressed with interventions focusing on vaccine refusal. Further research is required on the factors underlying refusal of preventive dental care.