Abstract
Original abstract online at
https://journals.sagepub.com/doi/10.1177/00220345261428043
Fluoride is widely regarded within dentistry and public health as a safe and effective measure for preventing dental caries. Public ambivalence toward fluoride has intensified in recent years, reflected in ongoing disputes over water fluoridation. This scoping review synthesizes qualitative evidence on how fluoride hesitancy is constructed and expressed across social and clinical contexts. Qualitative studies examining perceptions, beliefs, and decision-making related to fluoride use were identified through searches of PubMed, Scopus, Embase, and CINAHL to April 2025. Twelve studies met the inclusion criteria. Data were extracted using a standardized charting approach and synthesized through an inductive, grounded theory–informed thematic analysis supported by constant comparison and reflexive memoing. Five interconnected domains of hesitancy were identified: (1) perceptions of fluoride as harmful or toxic; (2) uncertainty about benefits or necessity; (3) mistrust of scientific, professional, or governmental institutions; (4) ethical concerns regarding autonomy, consent, and environmental integrity; and (5) discomfort with specific delivery modalities paired with preferences for alternatives. Hesitancy was shaped not only by information but also by emotional responses, lived experience, parenting norms, online discourse, and interpretations of institutional credibility. Across studies, decisions about fluoride reflected broader efforts to navigate uncertainty, protect children, and maintain control over health choices. Fluoride hesitancy is a multifaceted interpretive process rather than a simple knowledge deficit. Addressing it requires approaches that pair clear scientific communication with attention to trust, autonomy, and the social contexts in which preventive recommendations are received. Strategies that acknowledge experiential perspectives and increase transparency around policy decisions may enhance the credibility and uptake of fluoride guidance, but some degree of hesitancy is likely to persist given wider environments of uneven trust and contested information.
Data availability statementThe data supporting the findings of this study are provided in the Appendix. Detailed descriptions of the literature-screening process, calibration procedures, and interrater reliability are provided in the Appendix Methods. The complete search strategies and database counts are in Appendix Table 1, the list of full?text exclusions with reasons is in Appendix Table 2, the reported funding sources and conflict of interest statements from included studies are in Appendix Table 3, the qualitative critical appraisal outcomes for included studies are in Appendix Table 4, and the thematic synthesis mapping of studies to themes and subthemes is in Appendix Table 5. As this review synthesized published qualitative studies, no original interview transcripts were generated; illustrative quotes were drawn from the included publications and cited in the text.
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