Unpacking X (formerly Twitter) discourse on fluoride and related topics during the 2024 US presidential election.

Abstract

Original abstract online at
https://www.sciencedirect.com/science/article/abs/pii/S0002817726001650

Background

Fluoride is a cornerstone of caries prevention, yet public trust in fluoride has become increasingly contested, particularly on social media platforms where health misinformation and political narratives intersect. Understanding how fluoride is discussed online may inform strategies to improve communication and public confidence in oral health interventions.

Methods

The authors analyzed publicly available posts from X (formerly Twitter) (X Corp) during the 2024 US presidential election that referenced fluoride and related topics. Natural language processing techniques were used to classify post sentiment and emotional tone and to identify dominant discussion themes. Comparisons were made between fluoride-related posts and general posts by the same users to assess differences in sentiment distribution and emotional expression.

Results

Fluoride-related discourse was considerably more negative than general discourse on the platform. Negative sentiment toward fluoride was frequently associated with distrust in government and public health institutions, political polarization, and perceived health risks. Positive discourse emphasized caries prevention, dental products, and evidence-based public health benefits. Users expressing negative sentiments toward fluoride were also more likely to express negative sentiments in non–fluoride-related posts.

Conclusions

Online discussions about fluoride during a politically charged period reflected broader sociopolitical beliefs and emotional responses rather than isolated concerns about dental science.

Practical Implications

Dental care professionals should recognize that patient concerns about fluoride may stem from emotionally driven narratives encountered online. Communication strategies that acknowledge concerns while clearly explaining the safety and benefits of fluoride may support effective patient counseling and public engagement.

Section snippets

Study design and data source

In our observational study, we analyzed publicly available posts from X during the 2024 US presidential election. Data were collected using the X Developer Application Programming Interface (X Corp) during 2 discrete periods (November 1-8 and November 9-14, 2024), corresponding to the immediate pre- and postelection timeframe. Due to platform restrictions, access required a paid Application Programming Interface subscription. All data were publicly available and deidentified; therefore, the …

Lexical overview

Figure 1 contains word clouds of fluoride-related posts stratified according to sentiment classification, including frequently occurring bigrams. Prominent terms such as tooth, toothpaste, and decay, alongside terms including vaccine, poison, RFK [Robert F. Kennedy Jr], and Trump, illustrate the coexistence of dental health–related discussions with politically framed or conspiratorial narratives. This visualization provides an overview of the lexical landscape surrounding fluoride discourse …

Discussion

Our study results provide a timely analysis of public sentiment surrounding fluoride by means of examining discourse on X during the 2024 US presidential election. Using natural language processing techniques, including sentiment analysis, emotion classification, and topic modeling, we identified pervasive negative sentiment, emotionally charged language, and the embedding of fluoride-related discussions within broader narratives of institutional distrust, conspiracy, and politicization. For …

Conclusions

Although fluoride remains a scientifically validated cornerstone of caries prevention, its meaning in the digital public sphere is increasingly contested. This shift has direct implications for patient communication, public trust, and the sustainability of preventive programs. Efforts to promote fluoride must therefore extend beyond traditional health education to engage with the emotional, ideological, and technological contexts in which public opinion is formed. Future research should examine …

Declaration of AI and AI-Assisted Technologies in the Writing Process

During the preparation of this work the authors used DistilRoBERTa (Hugging Face) and ChatGPT-4o (OpenAI) to aid in sentiment, emotion, and topic classification of social media posts. After using DistilRoBERTa and ChatGPT-4o, the authors reviewed and edited the content as needed and take full responsibility for the content of the publication.

Disclosure

None of the authors reported any disclosures.

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NOTES:
This research was supported by K08 award K08DE027720 from the National Institute of Dental and Craniofacial Research, National Institutes of Health, awarded to principal investigator Dr. Astha Singhal.

All data sets analyzed in this study are publicly available through the project’s GitHub repository at: https://github.com/shupasneaky/Fluoride-Sentiment-Emotion-2024-Election. This repository contains the processed tweet data, sentiment and emotion annotations, and topic modeling outputs used in the analyses described in the article.