Topical fluoride hesitancy and opposition are significantly and positively associated: A cross-sectional study

The goal of this study was to evaluate the associations between topical fluoride hesitancy and opposition to determine if hesitancy is a potential precursor to opposition. We administered an 85-item survey (11/2020-09/2021) to 1,135 caregivers that included the 20-item, 5-domain Fluoride Hesitancy Identification Tool (FHIT), from which we created five domain-specific scores of topical fluoride hesitancy (none/moderate/high for each domain); a score reflecting any topical fluoride hesitancy (moderate/high on any of the five domains); and a topical fluoride hesitancy severity score (total number of moderate/high responses to the five domains; range 0-5). The survey measured degree of topical fluoride opposition (0-10 with no = 0 and yes ≥ 1). We ran confounder-adjusted logistic regression models to evaluate associations between topical fluoride hesitancy scores and opposition. The analyses included 1,042 caregivers; mean age was 42.0 years (SD: 8.3), 78.7% were woman, and 58.3% were white. General hesitancy was reported by 82.9% of surveyed caregivers. Domain-specific hesitancy prevalence (moderate/high) was 81.3% for the necessity domain, 31.3% for chemicals, 19.5% for harm, 30.1% for uncertainty, and 25.2% for distrust. For severity, 14.7% of caregivers reported moderate/high hesitancy for all 5 domains, 7.7% for 4, 6.8% for 3, 9.3% for 2, and 43.9% for 1 domain. Opposition was reported by 39.1%. In the regression models, every hesitancy measure had a statistically significant (p < 0.01), positive association with opposition. In conclusion, topical fluoride hesitancy and opposition are positively associated but not identical. Additional work should elucidate the relationship between the two to inform strategies to address topical fluoride hesitancy and opposition.