# Developing Topical Fluoride Hesitancy Measures for Causal Modeling and Intervention Research

> **NIH NIH R01** · UNIVERSITY OF WASHINGTON · 2020 · $65,305

## Abstract

Topical fluorides help prevent tooth decay and are a routine part of dental visits for children and adolescents.
However, concerns about the safety, necessity, and effectiveness of fluorides have resulted in fluoride
hesitancy, leading some parents to refuse fluoride treatment for their children. Our data indicate that 13% of
parents refuse topical fluoride during dental or medical visits, which is similar to vaccine refusal rates. Many
more parents may accept fluoride but are hesitant. According to dentists, fluoride hesitancy and refusal are
growing problems, but many dentists do not realize how universal approaches of providing fluoride to all
children regardless of caries risk may have contributed to the problem. To convince hesitant and refusing
parents to accept fluoride, dentists rely on paternalistic educational approaches that are largely ineffective at
changing parents’ beliefs or behaviors. This is because education alone ignores the specific reason(s) why a
parent is hesitant about fluoride. When efforts to change parent behaviors fail, some dentists dismiss these
patients from their practices and most dentists avoid talking about fluoride to hesitant parents at subsequent
visits to avoid conflict. Behavioral risk-based approaches could help dentists to address fluoride hesitancy and
refusal in clinical practice. Validated measures will be needed to assess such approaches, but such measures
currently do not exist. In this measure development study, we will address this critical gap. We will use the
Health Belief Model and the Extended Parallel Process Model to understand fluoride hesitancy and refusal
behaviors and to develop 2 measures for use in research and clinical settings. The Aims are to: (1) Construct
a theoretical model of topical fluoride hesitancy/refusal; (2) Develop and validate 2 measures – a
screening tool to identify fluoride hesitant/refusing parents and a diagnostic instrument to identify the
reason(s) for topical fluoride hesitancy/refusal; and (3) Determine the stability of fluoride
hesitancy/refusal behaviors. After the study is completed, the next step will be to design a behavioral clinical
trial that incorporates a multi-pronged approach that addresses the specific reason(s) a parent is fluoride-
hesitant/refusing and appropriate communication strategies used by health providers that incorporate a child’s
caries risk. Our long-term goal is to improve oral health outcomes in high-risk children and adolescents who
may otherwise not have an opportunity to benefit from fluorides, thereby addressing a growing threat to
reducing dental caries rates and achieving health equity. The proposed study addresses Healthy People
2020’s Oral Health Objectives 1 and 8, and the Centers for Medicare and Medicaid Oral Health Initiative on
Access to Quality Dental Care. By using dentistry as a laboratory, the proposed work is broadly applicable in
understanding and addressing similar issues in public health like vaccine refusal and...

## Key facts

- **NIH application ID:** 9822406
- **Project number:** 3R01DE026741-02S1
- **Recipient organization:** UNIVERSITY OF WASHINGTON
- **Principal Investigator:** Donald Leslie Chi
- **Activity code:** R01 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2020
- **Award amount:** $65,305
- **Award type:** 3
- **Project period:** 2018-09-01 → 2021-04-15

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/9822406

## Citation

> US National Institutes of Health, RePORTER application 9822406, Developing Topical Fluoride Hesitancy Measures for Causal Modeling and Intervention Research (3R01DE026741-02S1). Retrieved via AI Analytics 2026-05-23 from https://api.ai-analytics.org/grant/nih/9822406. Licensed CC0.

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