Document Type : Research Article


1 Saveetha Dental College and Hospitals, Saveetha Institute of Medical and Technical Sciences, Saveetha University, Chennai, India

2 Senior Lecturer, Department of Pedodontics, Saveetha Dental College and Hospitals, Saveetha Institute of Medical and Technical Sciences, Saveetha University, Chennai, India

3 Associate Professor, Department of Public Health Dentistry, Saveetha Dental College and Hospitals, Saveetha Institute of Medical and Technical Sciences, Saveetha University, Chennai, India


Widespread use of fluoride has been a major factor towards the decline in both the prevalence and severity of dental caries in economically developed countries. Fluorides prevent tooth decay by promoting remineralization and inhibiting demineralization of enamel. It is recommended as part of a comprehensive tooth decay prevention program. The growing number of parents who refuse topical fluoride in clinical practice warrants attention from dental professionals and the scientific community. The goal of this research is to know the level of acceptance of fluoride treatment. The aim of this study was to evaluate the acceptance of topical fluoride application among pediatric dental patients.A retrospective study was conducted using the patient records from Saveetha Dental College, Chennai from June 2019 - April 2020. The study population included pediatric patients with dental caries, selected by non-probability purposive sampling. Data was collected and then subjected to statistical analysis. Microsoft Excel 2016 (Microsoft office 10) data spreadsheet was used to collect data and later exported to SPSS IBM (version 20.0). Descriptive statistics and chi square test were employed with a level of significance set at p<0.05. It has been concluded that the overall acceptance of fluoride application was 20.72%, among which 80.34% of the patients preferred fluoride gel and 19.66% preferred fluoride varnish. Children between 6-13 years of age and children with higher dental caries, especially males, had a more favourable level of acceptance.Thus the most parental acceptance was noticed only after progression of decay in children. There is a paramount need to educate the parents and caregivers about the importance of topical fluoride application as a preventive measure in preventing caries and progression of decay in children.


Main Subjects

  1. Adams, S. H. et al. (2012) ‘Caregiver acceptability and preferences for preventive dental treatments for young African-American children’, Journal of Public Health Dentistry, pp. 252–260. doi: 10.1111/j.1752-7325.2012.00332.x.
  2. Al-Malik, M. I. and Rehbini, Y. A. (2006) ‘Prevalence of Dental Caries, Severity, and Pattern in Age 6 to 7-Year-old Children in a Selected Community in Saudi Arabia’, The Journal of Contemporary Dental Practice, pp. 46–54. doi: 10.5005/jcdp-7-2-46.
  3. Al-Omiri, M. K., Al-Wahadni, A. M. and Saeed, K. N. (2006) ‘Oral health attitudes, knowledge, and behavior among school children in North Jordan’, Journal of dental education, 70(2), pp. 179–187.
  4. Arends, J., Lodding, A. and Petersson, L. G. (1980) ‘Fluoride uptake in enamel. In vitro comparison of topical agents’, Caries research, 14(6), pp. 403–413.
  5. Autio-Gold, J. T. and Courts, F. (2001) ‘Assessing the effect of fluoride varnish on early enamel carious lesions in the primary dentition’, The Journal of the American Dental Association, pp. 1247–1253. doi: 10.14219/jada.archive.2001.0367.
  6. Chen, S.-F. and Lin, H.-C. (2009) ‘Dental service utilization and costs before and after introduction of fluoride gel application for preschool children in Taiwan’, Health Policy, pp. 94–101. doi: 10.1016/j.healthpol.2008.12.007.
  7. Chhabra, N. and Chhabra, A. (2012) ‘Parental knowledge, attitudes and cultural beliefs regarding oral health and dental care of preschool children in an Indian population: a quantitative study’, European archives of paediatric dentistry: official journal of the European Academy of Paediatric Dentistry, 13(2), pp. 76–82.
  8. Chi, D. L. (2014) ‘Caregivers Who Refuse Preventive Care for Their Children: The Relationship Between Immunization and Topical Fluoride Refusal’, American Journal of Public Health, pp. 1327–1333. doi: 10.2105/ajph.2014.301927.
  9. Christabel, S. L. and Linda Christabel, S. (2015) ‘Prevalence of Type of Frenal Attachment and Morphology of Frenum in Children, Chennai, Tamil Nadu’, World Journal of Dentistry, pp. 203–207. doi: 10.5005/jp-journals-10015-1343.
  10. Chu, C., Fung, D. and Lo, E. (1999) ‘Dental caries status of preschool children in Hong Kong’, British Dental Journal, pp. 616–620. doi: 10.1038/sj.bdj.4800347a.
  11. Clarkson, J. E. and Worthington, H. V. (1993) ‘Association between untreated caries and age, gender and dental attendance in adults’, Community dentistry and oral epidemiology, 21(3), pp. 126–128.
  12. Deogade, S., Gupta, P. and Ariga, P. (2018) ‘Effect of monopoly-coating agent on the surface roughness of a tissue conditioner subjected to cleansing and disinfection: A Contact Profilometric In vitro study’, Contemporary Clinical Dentistry, p. 122. doi: 10.4103/ccd.ccd_112_18.
  13. D’Hoore, W. and Van Nieuwenhuysen, J.-P. (1992) ‘Benefits and risks of fluoride supplementation: Caries prevention versus dental fluorosis’, European Journal of Pediatrics, pp. 613–616. doi: 10.1007/bf01957733.
  14. Dohnke-Hohrmann, S. and Zimmer, S. (2004) ‘Change in Caries Prevalence after Implementation of a Fluoride Varnish Program’, Journal of Public Health Dentistry, pp. 96–100. doi: 10.1111/j.1752-7325.2004.tb02734.x.
  15. Dua, K. et al. (2019) ‘The potential of siRNA based drug delivery in respiratory disorders: Recent advances and progress’, Drug development research, 80(6), pp. 714–730.
  16. Duraisamy, R. et al. (2019) ‘Compatibility of Nonoriginal Abutments With Implants: Evaluation of Microgap at the Implant-Abutment Interface, With Original and Nonoriginal Abutments’, Implant dentistry, 28(3), pp. 289–295.
  17. Ersin, N. K. et al. (2008) ‘Effectiveness of 2-year application of schoolbased chlorhexidine varnish, sodium fluoride gel, and dental health edu’, Quintessence international, 39(2). Available at:
  18. Ezhilarasan, D. (2018) ‘Oxidative stress is bane in chronic liver diseases: Clinical and experimental perspective’, Arab journal of gastroenterology: the official publication of the Pan-Arab Association of Gastroenterology, 19(2), pp. 56–64.
  19. Ezhilarasan, D., Apoorva, V. S. and Ashok Vardhan, N. (2019) ‘Syzygium cumini extract induced reactive oxygen species-mediated apoptosis in human oral squamous carcinoma cells’, Journal of oral pathology & medicine: official publication of the International Association of Oral Pathologists and the American Academy of Oral Pathology, 48(2), pp. 115–121.
  20. Ezhilarasan, D., Sokal, E. and Najimi, M. (2018) ‘Hepatic fibrosis: It is time to go with hepatic stellate cell-specific therapeutic targets’, Hepatobiliary & pancreatic diseases international: HBPD INT, 17(3), pp. 192–197.
  21. Featherstone, J. D. B. (1999) ‘Prevention and reversal of dental caries: role of low level fluoride’, Community Dentistry and Oral Epidemiology, pp. 31–40. doi: 10.1111/j.1600-0528.1999.tb01989.x.
  22. ‘Fluoride, Fluoridated Toothpaste Efficacy And Its Safety In Children - Review’ (2018) International Journal of Pharmaceutical Research, 10(04). doi: 10.31838/ijpr/2018.10.04.017.
  23. Gheena, S. and Ezhilarasan, D. (2019) ‘Syringic acid triggers reactive oxygen species-mediated cytotoxicity in HepG2 cells’, Human & experimental toxicology, 38(6), pp. 694–702.
  24. Gomathi, A. C. et al. (2020) ‘Anticancer activity of silver nanoparticles synthesized using aqueous fruit shell extract of Tamarindus indica on MCF-7 human breast cancer cell line’, Journal of Drug Delivery Science and Technology, p. 101376. doi: 10.1016/j.jddst.2019.101376.
  25. Govindaraju, L. and Gurunathan, D. (2017) ‘Effectiveness of Chewable Tooth Brush in Children-A Prospective Clinical Study’, Journal of clinical and diagnostic research: JCDR, 11(3), pp. ZC31–ZC34.
  26. Govindaraju, L., Jeevanandan, G. and Subramanian, E. (2017) ‘Clinical Evaluation of Quality of Obturation and Instrumentation Time using Two Modified Rotary File Systems with Manual Instrumentation in Primary Teeth’, Journal of clinical and diagnostic research: JCDR, 11(9), pp. ZC55–ZC58.
  27. Govindaraju, L., Jeevanandan, G. and Subramanian, E. M. G. (2017a) ‘Comparison of quality of obturation and instrumentation time using hand files and two rotary file systems in primary molars: A single-blinded randomized controlled trial’, European journal of dentistry, 11(3), pp. 376–379.
  28. Govindaraju, L., Jeevanandan, G. and Subramanian, E. M. G. (2017b) ‘Knowledge and practice of rotary instrumentation in primary teeth among indian dentists: A questionnaire survey’, Journal of International Oral Health, 9(2), p. 45.
  29. Gurunathan, D. and Shanmugaavel, A. K. (2016) ‘Dental neglect among children in Chennai’, Journal of the Indian Society of Pedodontics and Preventive Dentistry, 34(4), pp. 364–369.
  30. Helfenstein, U. and Steiner, M. (1994) ‘Fluoride varnishes (Duraphat): A meta-analysis’, Community Dentistry and Oral Epidemiology, pp. 1–5. doi: 10.1111/j.1600-0528.1994.tb01559.x.
  31. Hsu, C.-L. et al. (2018) ‘The effect of professional fluoride application program for preschool children in Taiwan: An analysis using the National Health Insurance Research Database (NHIRD)’, Journal of Dental Sciences, pp. 248–255. doi: 10.1016/j.jds.2018.04.001.
  32. Humphris, G. M. and Zhou, Y. (2014) ‘Prediction of nursery school-aged children who refuse fluoride varnish administration in a community setting: a Childsmile investigation’, International Journal of Paediatric Dentistry, pp. 245–251. doi: 10.1111/ipd.12068.
  33. Hu, S. et al. (2020) ‘Parental acceptance of silver diammine fluoride in children with autism spectrum disorder’, International journal of paediatric dentistry / the British Paedodontic Society [and] the International Association of Dentistry for Children. doi: 10.1111/ipd.12624.
  34. Hyde, S. et al. (2009) ‘Developing an Acceptability Assessment of Preventive Dental Treatments’, Journal of Public Health Dentistry, pp. 18–23. doi: 10.1111/j.1752-7325.2008.00088.x.
  35. Jeevanandan, G. (2017) ‘Kedo-S Paediatric Rotary Files for Root Canal Preparation in Primary Teeth - Case Report’, Journal of clinical and diagnostic research: JCDR, 11(3), pp. ZR03–ZR05.
  36. Jeevanandan, G. and Govindaraju, L. (2018) ‘Clinical comparison of Kedo-S paediatric rotary files vs manual instrumentation for root canal preparation in primary molars: a double blinded randomised clinical trial’, European Archives of Paediatric Dentistry, pp. 273–278. doi: 10.1007/s40368-018-0356-6.
  37. J, P. C. et al. (2018) ‘Prevalence and measurement of anterior loop of the mandibular canal using CBCT: A cross sectional study’, Clinical implant dentistry and related research, 20(4), pp. 531–534.
  38. Kumar, A. et al. (2019) ‘A survey of caregiver acculturation and acceptance of silver diamine fluoride treatment for childhood caries’, BMC oral health, 19(1), p. 228.
  39. Malli Sureshbabu, N. et al. (2019) ‘Concentrated Growth Factors as an Ingenious Biomaterial in Regeneration of Bony Defects after Periapical Surgery: A Report of Two Cases’, Case reports in dentistry, 2019, p. 7046203.
  40. Mathew, M. G. et al. (2020) ‘Evaluation of adhesion of Streptococcus mutans, plaque accumulation on zirconia and stainless steel crowns, and surrounding gingival inflammation in primary …’, Clinical oral investigations. Available at:
  41. Mehta, M. et al. (2019) ‘Oligonucleotide therapy: An emerging focus area for drug delivery in chronic inflammatory respiratory diseases’, Chemico-biological interactions, 308, pp. 206–215.
  42. Menon, S. et al. (2018) ‘Selenium nanoparticles: A potent chemotherapeutic agent and an elucidation of its mechanism’, Colloids and Surfaces B: Biointerfaces, pp. 280–292. doi: 10.1016/j.colsurfb.2018.06.006.
  43. Nair, M. et al. (2018) ‘Comparative evaluation of post-operative pain after pulpectomy with k-files, kedo-s files and mtwo files in deciduous molars -a randomized clinical trial’, Brazilian Dental Science, 21(4), pp. 411–417.
  44. Nowak, A. J. (1997) ‘Rationale for the timing of the first oral evaluation’, Pediatric dentistry, 19(1), pp. 8–11.
  45. Packiri, S., Gurunathan, D. and Selvarasu, K. (2017) ‘Management of Paediatric Oral Ranula: A Systematic Review’, Journal of clinical and diagnostic research: JCDR, 11(9), pp. ZE06–ZE09.
  46. Panchal, V. et al. (2019) ‘Comparison of instrumentation time and obturation quality between hand K-file, H-files, and rotary Kedo-S in root canal treatment of primary teeth: A randomized controlled trial’, Journal of the Indian Society of Pedodontics and Preventive Dentistry, 37(1), p. 75.
  47. Panchal, V., Jeevanandan, G. and Subramanian, E. M. G. (2019) ‘Comparison of post-operative pain after root canal instrumentation with hand K-files, H-files and rotary Kedo-S files in primary teeth: a randomised clinical trial’, European archives of paediatric dentistry: official journal of the European Academy of Paediatric Dentistry, 20(5), pp. 467–472.
  48. Pc, J., Marimuthu, T. and Devadoss, P. (2018) ‘Prevalence and measurement of anterior loop of the mandibular canal using CBCT: A cross sectional study’, Clinical implant dentistry and related research. Available at:
  49. Petersen, P. E. and Lennon, M. A. (2004) ‘Effective use of fluorides for the prevention of dental caries in the 21st century: the WHO approach’, Community Dentistry and Oral Epidemiology, pp. 319–321. doi: 10.1111/j.1600-0528.2004.00175.x.
  50. Prabakar, J. et al. (2018) ‘Comparative Evaluation of Retention, Cariostatic Effect and Discoloration of Conventional and Hydrophilic Sealants - A Single Blinded Randomized Split Mouth Clinical Trial’, Contemporary clinical dentistry, 9(Suppl 2), pp. S233–S239.
  51. Rajendran, R. et al. (2019) ‘Comparative Evaluation of Remineralizing Potential of a Paste Containing Bioactive Glass and a Topical Cream Containing Casein Phosphopeptide-Amorphous Calcium Phosphate: An in Vitro Study’, Pesquisa Brasileira em Odontopediatria e Clínica Integrada, pp. 1–10. doi: 10.4034/pboci.2019.191.61.
  52. Rajeshkumar, S. et al. (2018) ‘Biosynthesis of zinc oxide nanoparticles usingMangifera indica leaves and evaluation of their antioxidant and cytotoxic properties in lung cancer (A549) cells’, Enzyme and microbial technology, 117, pp. 91–95.
  53. Rajeshkumar, S. et al. (2019) ‘Antibacterial and antioxidant potential of biosynthesized copper nanoparticles mediated through Cissus arnotiana plant extract’, Journal of photochemistry and photobiology. B, Biology, 197, p. 111531.
  54. Rajesh, R., Sunitha, M. and Joshi, N. (2005) ‘Prevalence of dental caries among school children in Kulasekharam village: A correlated prevalence survey’, Journal of Indian Society of Pedodontics and Preventive Dentistry, p. 138. doi: 10.4103/0970-4388.16887.
  55. Ramadurai, N. et al. (2019) ‘Effectiveness of 2% Articaine as an anesthetic agent in children: randomized controlled trial’, Clinical oral investigations, 23(9), pp. 3543–3550.
  56. Ramakrishnan, M., Dhanalakshmi, R. and Subramanian, E. M. G. (2019) ‘Survival rate of different fixed posterior space maintainers used in Paediatric Dentistry - A systematic review’, The Saudi dental journal, 31(2), pp. 165–172.
  57. Ramesh, A. et al. (2018) ‘Comparative estimation of sulfiredoxin levels between chronic periodontitis and healthy patients - A case-control study’, Journal of periodontology, 89(10), pp. 1241–1248.
  58. Ravikumar, D., Jeevanandan, G. and Subramanian, E. M. G. (2017) ‘Evaluation of knowledge among general dentists in treatment of traumatic injuries in primary teeth: A cross-sectional questionnaire study’, European journal of dentistry, 11(2), pp. 232–237.
  59. Samuel, S. R., Acharya, S. and Rao, J. C. (2020) ‘School Interventions-based Prevention of Early-Childhood Caries among 3-5-year-old children from very low socioeconomic status: Two-year randomized trial’, Journal of public health dentistry, 80(1), pp. 51–60.
  60. Schwendicke, F. and Stolpe, M. (2017) ‘In-Office Application of Fluoride Gel or Varnish: Cost-Effectiveness and Expected Value of Perfect Information Analysis’, Caries research, 51(3), pp. 231–239.
  61. Seppä, L., Leppänen, T. and Hausen, H. (1995) ‘Fluoride varnish versus acidulated phosphate fluoride gel: a 3-year clinical trial’, Caries research, 29(5), pp. 327–330.
  62. Sharma, P. et al. (2019) ‘Emerging trends in the novel drug delivery approaches for the treatment of lung cancer’, Chemico-biological interactions, 309, p. 108720.
  63. Slayton, R. L. et al. (2002) ‘Frequency of reported dental visits and professional fluoride applications in a cohort of children followed from birth to age 3 years’, Pediatric dentistry, 24(1), pp. 64–68.
  64. Somasundaram, S. et al. (2015) ‘Fluoride Content of Bottled Drinking Water in Chennai, Tamilnadu’, Journal of clinical and diagnostic research: JCDR, 9(10), pp. ZC32–4.
  65. Sridharan, G. et al. (2019) ‘Evaluation of salivary metabolomics in oral leukoplakia and oral squamous cell carcinoma’, Journal of oral pathology & medicine: official publication of the International Association of Oral Pathologists and the American Academy of Oral Pathology, 48(4), pp. 299–306.
  66. Strohmenger, L. and Brambilla, E. (2001) ‘The use of fluoride varnishes in the prevention of dental caries: a short review’, Oral Diseases, pp. 71–80. doi: 10.1034/j.1601-0825.2001.70202.x.
  67. Subramanyam, D. et al. (2018) ‘Comparative evaluation of salivary malondialdehyde levels as a marker of lipid peroxidation in early childhood caries’, European journal of dentistry, 12(1), pp. 67–70.
  68. Sudha, P. et al. (2006) ‘Dental caries prevalence among preschool children of Hubli: Dharwad city’, Journal of Indian Society of Pedodontics and Preventive Dentistry, p. 19. doi: 10.4103/0970-4388.22829.
  69. Varghese, S. S., Ramesh, A. and Veeraiyan, D. N. (2019) ‘Blended Module-Based Teaching in Biostatistics and Research Methodology: A Retrospective Study with Postgraduate Dental Students’, Journal of dental education, 83(4), pp. 445–450.
  70. Vijayashree Priyadharsini, J. (2019) ‘In silico validation of the non-antibiotic drugs acetaminophen and ibuprofen as antibacterial agents against red complex pathogens’, Journal of periodontology, 90(12), pp. 1441–1448.
  71. Vishnu Prasad, S. et al. (2018) ‘Report on oral health status and treatment needs of 5-15 years old children with sensory deficits in Chennai, India’, Special care in dentistry: official publication of the American Association of Hospital Dentists, the Academy of Dentistry for the Handicapped, and the American Society for Geriatric Dentistry, 38(1), pp. 58–59.
  72. Wahab, P. U. A. et al. (2018) ‘Scalpel Versus Diathermy in Wound Healing After Mucosal Incisions: A Split-Mouth Study’, Journal of oral and maxillofacial surgery: official journal of the American Association of Oral and Maxillofacial Surgeons, 76(6), pp. 1160–1164.
  73. Wong, D., Perez-Spiess, S. and Julliard, K. (2005) ‘Attitudes of Chinese parents toward the oral health of their children with caries: a qualitative study’, Pediatric dentistry, 27(6), pp. 505–512.
  74. Wright, J. T. et al. (2014) ‘Fluoride toothpaste efficacy and safety in children younger than 6 years’, The Journal of the American Dental Association, pp. 182–189. doi: 10.14219/jada.2013.37.
  75. Zhou, Y., Forbes, G. M. and Humphris, G. M. (2013) ‘The behaviour of preschool children receiving fluoride varnish application in a community setting’, British Dental Journal, pp. E11–E11. doi: 10.1038/sj.bdj.2013.990.