A conceptual model on caregivers' hesitancy of topical fluoride for their children.

BACKGROUND: Topical fluoride hesitancy is a well-documented and growing public health problem. Despite extensive evidence that topical fluoride is safe and prevents tooth decay, an increasing number of caregivers are hesitant about their children receiving topical fluoride, leading to challenges in clinical settings where caregivers refuse preventive care. PURPOSE: To explore the determinants of topical fluoride hesitancy for caregivers with dependent children. METHODS: In this qualitative study, we interviewed 56 fluoride-hesitant caregivers to develop an inductive conceptual model of reasons why caregivers are hesitant. RESULTS: The core construct of the conceptual model of topical fluoride hesitancy centered on caregivers "wanting to protect and not mess up their child". Six domains comprised this core construct: thinking topical fluoride is unnecessary, wanting to keep chemicals out of my child's body, thinking fluoride is harmful, thinking there is too much uncertainty about fluoride, feeling pressured to get topical fluoride, and feeling fluoride should be a choice. CONCLUSIONS: Topical fluoride hesitancy is complex and multifactorial. Study findings provide insight for future efforts to understand and optimize caregivers' preventive care decision making.

Association between caregiver opposition to topical fluoride and COVID-19 vaccines.

PURPOSE: Caregivers who oppose topical fluoride in dental settings may be opposed to other preventive health treatments, including COVID-19 vaccines. The study objective was to examine the association between caregiver opposition to topical fluoride and COVID-19 vaccines. METHODS: The study took place at the University of Washington in Seattle, WA. English-speaking caregivers of children aged < 18 years were eligible to participate. An 85-item REDCap survey was administered from February to September 2021. The predictor variable was topical fluoride opposition (no/yes). The outcome was COVID-19 vaccine opposition (no/yes). The models included the following covariates: child and caregiver age; caregiver race and ethnicity, education level, dental insurance type, parenting style, political ideology, and religiosity; and household income. Logistic regression models generated odds ratios (OR) and 95 % confidence intervals (α = 0.05). RESULTS: Six-hundred-fifty-one caregivers participated, and 403 caregivers with complete data were included in the final regression model. Mean child age was 8.5 years (SD 4.2), mean caregiver age was 42.1 years (SD 9.1), 53.0 % of caregivers were female, 57.3 % self-reported as white, and 65.5 % were insured by Medicaid. There was a significant positive association between topical fluoride and COVID-19 vaccine opposition (OR = 3.13; 95 % CI: 1.87, 5.25; p < 0.001). Other factors associated with COVID-19 vaccine opposition included conservative political views (OR = 2.77; 95 % CI: 1.26, 6.08; p < 0.011) and lower education (OR = 3.47; 95 % CI: 1.44, 8.38; p < 0.006). CONCLUSIONS: Caregivers opposed to topical fluoride in dental settings were significantly more likely to oppose COVID-19 vaccines for their child. Future research should identify ways to address both topical fluoride and vaccine opposition to prevent diseases in children.

Variation in Current Guidelines for Fluoride Varnish Application for Young Children in Medical Settings in the United States.

Background: The United States Preventive Services Task Force recommends that medical providers apply fluoride varnish (FV) to the teeth of all children under 6 years of age, but fewer than 10% of eligible children receive FV as recommended. Prior studies suggest that variation in clinical guidelines is associated with low uptake of other evidence-based health-related interventions, but consistency of national guidelines for the delivery of FV in medical settings is unknown. Methods: Eligible guidelines for application of FV in medical settings for children under 6 years of age were published in the past 10 years by national pediatric or dental professional organizations or by national public health entities. Guidelines were identified using the search terms fluoride varnish + [application; guidelines, or recommendations; children or pediatric; American Academy of Pediatrics (AAP); American Academy of Pediatric Dentistry] and a search of Guideline Central. Details of the guidelines were extracted and compared. Results: Ten guidelines met inclusion criteria. Guidelines differed in terms of periodicity recommendations and whether FV was indicated for children with a dental home or level of risk of dental caries. Conclusion: Numerous recommendations about FV delivery in medical settings are available to pediatric medical providers. Further study is warranted to determine whether the variation across current guidelines detected in this study may contribute to low FV application rates in medical settings.

Can silver diamine fluoride be an alternative to aerosol-based dentistry during the COVID scenario? A retrospective analysis.

BACKGROUND: Restrictions on routine dental procedures involving aerosols during COVID-19 have resulted in a significant increase in the suffering of pediatric patients. AIM: The study reported the alternative measures followed in our department using SDF during the COVID era when routine elective dental procedures were prohibited. MATERIALS AND METHODS: The retrospective data of patients aged 2-13 years with carious molar teeth who were treated with silver diamine fluoride without (Group 1) or with (Group 2) caries excavation were collected. RESULTS: One thousand and seventy-two patients (646 males and 426 females) with 2459 carious molar were treated. On follow-up assessment at 3 months, 28 teeth in Group 1 and 21 teeth in Group 2 showed progression of carious lesion using International Caries Detection and Assessment System (ICDAS II criteria). Out of these failure cases, 32 (1.8%) teeth were primary and 17 (2.5%) were permanent. Complete relief in sensitivity/pain on stimulation was reported in 2381 teeth (96.83%), whereas in 78 (3.17%) teeth, mild sensitivity/pain on stimulation was reported. The average time consumed during treatment per tooth in Group 1 was 5.04 min and in Group 2 was 5.78 min. CONCLUSION: SDF application can be carried out as a nonaerosol-generating procedure and is a simple technique for children and clinicians.

Laboratory evaluation of the potential masking of color changes produced by silver diamine fluoride in primary molars.

BACKGROUND: The importance of Silver diamine fluoride (SDF) as a minimally invasive and nonaerosolizing management during COVID-19 pandemic has highly increased. SDF is a caries-arresting agent that causes staining of tooth structure. Managing this discoloration will increase its acceptance in treating primary teeth. The main aim of this study was to quantify the color change associated with the application of SDF on extracted carious primary molars, the potential masking of this color change by potassium iodide (KI), composite (CMP) and glass ionomer cement (GI) and the effect of aging on this color masking effect. METHODS: An in-vitro study in which 52 carious primary molars were collected, prepared, and distributed randomly into four groups equally as follows: Group A: SDF 38%; Group B: SDF 38% + KI; Group C: SDF 38% + CMP; Group D: SDF 38% + GI. Color changes were recorded for each sample at baseline, and after application of the tested materials. Moreover, all samples had undergone Suntest aging followed by a third color reading. CIELAB values L*, a*, b*, ΔL, Δa, and Δb were measured, ΔE was calculated, and data were analyzed using multivariate analysis of variance (MANOVA) and post-Hoc Scheffé test (p < 0.05). RESULTS: MANOVA revealed the significant influence of the factor 'material'. SDF caused an obvious color change compared to the color of carious dentin. Regarding ΔL, the color change of groups C and D was not significant directly after application of the tested materials. After aging, it was significant among all groups, including groups C and D. In Δa there was a difference between SDF and groups B and C after application of the tested materials, and aging produced the same results. The color shifts of Δb of all tested groups varied significantly from one another. After aging, there was no difference between group D and either group A or B. CONCLUSIONS: Treatment with SDF caused obvious discoloration of carious dentin. Directly after SDF application, all tested materials could effectively mask the color change associated with the application of SDF. CMP was the only material whose color masking effect was not completely reversed by aging.