Tracking the Debate: Geo-Temporal Sentiment Analysis of Community Water Fluoridation on 'X' (Formerly Twitter) With...

This study examined country-level geo-temporal sentiment trends in community water fluoridation (CWF) discussions on 'X' from 2014 to 2023 and generated a five-year forecast to anticipate future shifts.

Sentiment analysis was conducted using the VADER 'SentimentIntensityAnalyzer', with polarity thresholds defined as negative (< -0.05), neutral (-0.05 to +0.05) and positive (> +0.05). Data were collected via the 'X' API and examined for sentiment distribution, country-level geo-temporal patterns based on user location information, and engagement metrics (likes, retweets, replies). Ethical approval was obtained, and only publicly available data were analysed in compliance with the platform's terms of service. Limitations include restriction to English-language tweets and the non-representativeness and demographic biases of 'X' users compared with national populations.

Of 72 309 original tweets analysed, 37.4% were negative, 34.4% positive and 28.2% neutral. Countries with low tweet volumes (e.g., Venezuela, Cyprus, Croatia, Pakistan, Vietnam) showed predominantly positive sentiment. In contrast, high-volume countries (the US, Canada, Australia, Brazil and the United Kingdom) displayed mixed sentiment without a clear majority. Predictive modelling indicated a modest shift toward less positive sentiment polarity over the next 5 years, with average polarity projected to decrease from 0.43 in 2024 to 0.38 in 2028. Supplementary analysis of more recent tweets (Jan 2024-Aug 2025) provided further insight into emerging patterns, broadly consistent with the projected trends.

CWF discourse on 'X' is polarised and varies across countries and time. The expected decline in positivity underscores the need for tailored country-specific public health communication strategies to strengthen engagement and counter misinformation.