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Understanding Fluoride Hesitancy: A Qualitative Scoping Review.

S M S Chen¹, Y J Ong¹, L Y Soh²

¹Department of Restorative Dentistry, National Dental Centre Singapore, Singapore.

Journal of Dental Research

|March 18, 2026

Summary

Fluoride hesitancy stems from concerns about toxicity, mistrust in institutions, and ethical issues, not just a lack of knowledge. Addressing it requires building trust and understanding social contexts, not just providing scientific information.

Keywords:

dental caries pediatric dentistry preventive dentistry qualitative research topical fluorides treatment refusal

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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.