Understanding Fluoride Hesitancy: A Qualitative Scoping Review

Area of Science:

• Public Health
• Dental Research
• Social Science

Background:

• Fluoride is recognized for its effectiveness in preventing dental caries.
• Public skepticism towards fluoride, particularly water fluoridation, has increased.
• Understanding the roots of fluoride hesitancy is crucial for public health initiatives.

Purpose of the Study:

• To synthesize qualitative evidence on the construction and expression of fluoride hesitancy.
• To explore perceptions, beliefs, and decision-making processes related to fluoride use.
• To identify key domains contributing to fluoride hesitancy in various contexts.

Main Methods:

• Scoping review of qualitative studies identified through comprehensive database searches (PubMed, Scopus, Embase, CINAHL).
• Inclusion of studies examining perceptions, beliefs, and decision-making regarding fluoride use up to April 2025.
• Thematic analysis using grounded theory principles, constant comparison, and reflexive memoing.

Main Results:

• Five interconnected domains of hesitancy identified: perceived harm, uncertainty of benefits, institutional mistrust, ethical concerns, and preference for alternatives.
• Hesitancy is influenced by emotions, personal experiences, parenting norms, online discourse, and trust in institutions.
• Decisions regarding fluoride reflect broader efforts to manage uncertainty, protect children, and assert health autonomy.

Conclusions:

• Fluoride hesitancy is a complex interpretive process, not merely a knowledge gap.
• Effective strategies must integrate clear scientific communication with trust-building and consideration of social contexts.
• Acknowledging experiential perspectives and enhancing transparency may improve uptake, though some hesitancy may persist due to trust issues.