Citation Information :
Shin Y, Lopez E, Bullock A, Chirachevin P, Oyoyo U, Burtch P, Tian A, Il Kim B, Kwon SR, Li Y. Dental and Dental Hygiene Students’ Knowledge and Perception on Fluoride Use in Dentistry. J Contemp Dent Pract 2021; 22 (1):4-8.
Aim: The 75th anniversary of community water fluoridation in the United States was celebrated in 2020. However, there are studies that stimulate polarized discussion over the use of fluoride in dentistry. The purpose of this study was to evaluate dental and dental hygiene students’ knowledge and perception of fluoride use in dentistry. Materials and methods: A survey was conducted to gauge participant\'s knowledge and perception of fluoride and their opinion on the need for developing viable alternatives to fluoride. An Institutional Review Board (IRB# 5190496) application was filed and approved. A hard copy survey was distributed to all student classes at Loma Linda University School of Dentistry (U.S.) between January 13, 2020, and February 5, 2020. Descriptive data were compiled and analyzed. Knowledge-based questions were compared using Kruskal–Wallis procedure to evaluate correct percentage among different classes. Perception questions were analyzed using a Likert scale and also a Chi-squared test. All tests were two-sided with α at 0.05. Results: Out of 482 students, 282 students responded (58.5%). The mean of correct responses for knowledge ranged from 49 to 69%. There was a statistically significant difference among the classes. Overall the perception of the use of fluoride in dentistry was positive, and it changed with exposure to lectures on fluoride over the years. Conclusion: There was a correlation between knowledge and the perception of the use of fluoride in dentistry, indicating the importance of adequate delivery of didactic teaching on knowledge of fluoride to dental and dental hygiene students. Clinical significance: The oral healthcare provider plays a pivotal role in communicating pertinent information on the benefits of fluoride in preventing dental caries to the general public, prompting adequate delivery of didactic teaching on this topic in dental education.
Marinho VC, Higgins JP, Logan S, et al. Systematic review of controlled trials on the effectiveness of fluoride gels for the prevention of dental caries in children. J Dent Educ 2003:67(4):448–458.
Herschfeld JJ. Frederick S. Mckay and the “Colorado brown stain”. Bull Hist Dent 1978:26(2):118–126.
Smith MC, Lantz EM, Smith HV. The cause of mottled enamel. Science 1931:74(1914):244. DOI: 10.1126/science.74.1914.244.
McDonagh MS, Whiting PF, Wilson PM, et al. Systematic review of water fluoridation. BMJ 2000:321(7265):855–859. DOI: 10.1136/bmj.321.7265.855.
American Dental Association. Fluoridation facts 2018. http://www.ada.org/~/media/ADA/Files/Fluoridation_Facts.pdf?la=en/ last accessed Feb 8, 2021.
Centers for Disease Control and Prevention. Ten great public health achievements—United States, 1900–1999. JAMA 1999:281(16):1481. DOI: 10.1001/jama.281.16.1481.
Aravind A, Dhanya RS, Narayan A, et al. Effect of fluoridated water on intelligence in 10–12-year-old school children. J Int Soc Prev Community Dent 2016:6(Suppl 3):S237–S242. DOI: 10.4103/2231-0762.197204.
Valdez-Jimenez L, Soria Fregozo C, Miranda Beltran ML, et al. Effects of the fluoride on the central nervous system. Neurologia 2011:26(5):297–300. DOI: 10.1016/j.nrl.2010.10.008.
McPherson CA, Zhang G, Gilliam R, et al. An evaluation of neurotoxicity following fluoride exposure from gestational through adult ages in Long–Evans hooded rats. Neurotox Res 2018:34(4):781–798. DOI: 10.1007/s12640-018-9870-x.
Yu X, Chen J, Li Y, et al. Threshold effects of moderately excessive fluoride exposure on children's health: a potential association between dental fluorosis and loss of excellent intelligence. Environ Int 2018:118:116–124. DOI: 10.1016/j.envint.2018.05.042.
Ullah R, Zafar MS, Shahani N. Potential fluoride toxicity from oral medicaments: a review. Iran J Basic Med Sci 2017:20(8):841–848. DOI: 10.22038/IJBMS.2017.9104.
Roberts AJ. Role of models in assessing new agents for caries prevention—non-fluoride systems. Adv Dent Res 1995:9(3):304–311. DOI: 10.1177/08959374950090031601.
Narendran S, Chan JT, Turner SD, et al. Fluoride knowledge and prescription practices among dentists. J Dent Educ 2006:70(9): 956–964.
Bansal R, Bolin KA, Abdellatif HM, et al. Knowledge, attitude and use of fluorides among dentists in Texas. J Contemp Dent Pract 2012:13(3):371–375. DOI: 10.5005/jp-journals-10024-1153.
Sabti MY, Al-Yahya H, Al-Sumait N, et al. Dental and medical practitioners’ perception of community water fluoridation as a caries preventive measure. Eur Arch Paediatr Dent 2019:20(1):53–61. DOI: 10.1007/s40368-018-0385-1.
Akbar AA, Al-Sumait N, Al-Yahya H, et al. Knowledge, attitude, and barriers to fluoride application as a preventive measure among oral health care providers. Inter J Dent 2018:2018:8908924. DOI: 10.1155/2018/8908924.
Horowitz HS. The 2001 CDC recommendations for using fluoride to prevent and control dental caries in the United States. J Public Health Dent 2003:63(1):3–8. DOI: 10.1111/j.1752-7325.2003.tb03467.x.
Baka A, Figgou L, Triga V. ‘Neither agree, nor disagree’: a critical analysis of the middle answer category in voting advice applications. Int J Electron Gov 2012;5(3/4):244–263. DOI: 10.1504/IJEG.2012. 051306.
Buzalaf MAR, Pessan JP, Honório HM, et al. Mechanisms of action of fluoride for caries control. Monogr Oral Sci 2011;22:97–114. DOI: 10.1159/000325151.
Lambrou D, Larsen MJ, Fejerskov O, et al. The effect of fluoride in saliva on remineralization of dental enamel in humans. Caries Res 1981;15(5):341–345. DOI: 10.1159/000260536.
O'Mullane DM, Baez RJ, Jones S, et al. Fluoride and oral health. Community Dent Health 2016;33(2):69–99.
Rozier RG, Adair S, Graham F, et al. Evidence-based clinical recommendations on the prescription of dietary fluoride supplements for caries prevention: a report of the American Dental Association Council on Scientific Affairs. J Am Dent Assoc 2010;141(12):1480–1489. DOI: 10.14219/jada.archive.2010.0111.
Community water fluoridation exposure: a review of neurological and cognitive effects [Internet]. Ottawa (ON): Canadian Agency for Drugs and Technologies in Health; 2019.
Lalumandier JA, Rozier RG. The prevalence and risk factors of fluorosis among patients in a pediatric dental practice. Pediatr Dent 1995;17(1):19–25.
Beltrán-Aguilar ED, Barker L, Dye BA. Prevalence and severity of dental fluorosis in the United States, 1999–2004. NCHS Data Brief 2010;(53):1–8. Hyattsville, MD: National Center for Health Statistics. 2010. Abstract at: https://www.ncbi.nlm.nih.gov/pubmed/21211168. Available at: https://www.cdc.gov/nchs/data/databriefs/db53.pdf. Accessed August 28, 2017.
Shruthi MN, Anil NS. A comparative study of dental fluorosis and non-skeletal manifestations of fluorosis in areas with different water fluoride concentrations in rural Kolar. J Family Med Prim Care 2018;7(6):1222–1228. DOI: 10.4103/jfmpc.jfmpc_72_18.
Liu G, Ye Q, Chen W, et al. Study of the relationship between the lifestyle of residents residing in fluorosis endemic areas and adult skeletal fluorosis. Environ Toxicol Pharmacol 2015;40(1):326–332. DOI: 10.1016/j.etap.2015.06.022.
Sandhu R, Lal H, Kundu ZS, et al. Serum fluoride and sialic acid levels in osteosarcoma. Biol Trace Elem Res 2011;144(1–3):1–5. DOI: 10.1007/s12011-009-8382-1.
Bassin EB, Wypij D, Davis RB, et al. Age-specific fluoride exposure in drinking water and osteosarcoma (United States). Cancer Causes Control 2006;17(4):421–428. DOI: 10.1007/s10552-005-0500-6.
Susheela AK, Bhatnagar M, Vig K, et al. Excess fluoride ingestion and thyroid hormone derangements in children living in Delhi, India. Fluoride 2005;38(2):98–108.
Singh N, Verma KG, Verma P, et al. A comparative study of fluoride ingestion levels, serum thyroid hormone & TSH level derangements, dental fluorosis status among school children from endemic and non-endemic fluorosis areas. Springerplus 2014;3:7. DOI: 10.1186/2193-1801-3-7.
Xiang Q, Liang Y, Chen L, et al. Effect of fluoride in drinking water on children's intelligence. Fluoride 2003;36(2):84–94.
Khan SA, Singh RK, Navit S, et al. Relationship between dental fluorosis and intelligence quotient of school going children in and around Lucknow district: a cross-sectional study. J Clin Diagn Res 2015;9(11):ZC10–ZC15. DOI: 10.7860/JCDR/2015/15518.6726.
Sebastian ST, Sunitha S. A cross-sectional study to assess the intelligence quotient (IQ) of school going children aged 10–12 years in villages of Mysore district, India with different fluoride levels. J Indian Soc Pedod Prev Dent 2015;33(4):307–311. DOI: 10.4103/0970-4388.165682.
Choi AL, Sun G, Zhang Y, et al. Developmental fluoride neurotoxicity: a systematic review and meta-analysis. Environ Health Perspect 2012;120(10):1362–1368. DOI: 10.1289/ehp.1104912.
Green R, Lanphear B, Hornung R, et al. Association between maternal fluoride exposure during pregnancy and IQ scores in offspring in Canada. JAMA Pediatr 2019;173(10):940–948. DOI: 10.1001/jamapediatrics.2019.1729.
Bashash M, Thomas D, Hu H, et al. Prenatal fluoride exposure and cognitive outcomes in children at 4 and 6-12 years of age in Mexico. Environ Health Perspect 2017;125(9):097017. DOI: 10.1289/EHP655.
Pakdaman A, Yarahmadi Z, Kharazifard MJ. Self-reported knowledge and attitude of dentists towards prescription of fluoride. J Dent (Tehran) 2015;12(8):550–556.
Wang Y, Jiang L, Zhao Y. Awareness of the benefits and risks related to using fluoridated toothpaste among doctors: a population-based study. Med Sci Monit 2019;25:6397–6404. DOI: 10.12659/MSM.918197.
Lima VV, de Almeida Carrer FC, Gabriel M, et al. Knowledge of primary care professionals about fluoride topics. Minerva Stomatol 2018;67(5):196–201. DOI: 10.23736/S0026-4970.18.04069-4.
Podgorny PC, McLaren L. Public perceptions and scientific evidence for perceived harms/risks of community water fluoridation: an examination of online comments pertaining to fluoridation cessation in Calgary in 2011. Can J Public Health 2015;106(6):e413–e425. DOI: 10.17269/cjph.106.5031.
Moon H, Paik D, Horowitz AM, et al. National survey of Korean dentists’ knowledge and opinions: dental caries etiology and prevention. J Public Health Dent 1998;58(1):51–56. DOI: 10.1111/j.1752-7325.1998.tb02990.x.
Capobianco DM, Fleming DE, Kleinman DV. Assessing dental hygiene students’ and community caregivers’ knowledge of strategies for caries prevention. J Dent Educ 2019;83(3):351–358. DOI: 10.21815/JDE.019.022.
Petterson EO. Attitudes concerning water fluoridation among graduating Swedish dentists. Community Dent Oral Epidemiol 1979;7(2):69–74. DOI: 10.1111/j.1600-0528.1979.tb01188.x.