Milieu in Dental School and Practice

Fluoride Knowledge and Prescription

Practices Among Dentists
Sena Narendran, B.D.S., D.D.P.H., M.Sc.; Jarvis T. Chan, D.D.S., Ph.D.;
Stewart D. Turner, Ph.D.; Harris J. Keene, D.D.S.
Abstract: The purpose of this study was to assess dentists knowledge about fluorides as well as their prescription practices. The
study population consists of all general and pediatric dentists in Houston, and the sample consists of 360 general and forty-one
pediatric dentists. Data were collected with a self-administered mail questionnaire, which consisted of thirteen open-ended and
twenty-nine precoded items. After three mailings, the effective response rate was 46.4 percent. Respondents had been in practice
on an average of 18.9 6.6 years; the majority were male. More than 75 percent of respondents believed fluoride level in drinking
water is an important determinant of fluoride supplement prescription, and 29 percent felt the same about a patients weight. The
correct ages at which to begin (six months) and to discontinue (sixteen years) the fluoride supplements to children were identified
by 14.7 and 14.9 percent of the respondents, respectively. Only 6.7 percent of those prescribing fluoride supplements routinely
tested the fluoride level in the patients drinking water. Even though pediatric and general dentists differed in certain items, the
two groups did not differ significantly in prescribing fluorides (OR=2.4, 95% CI=0.94, 6.27). Deficiencies and ambiguity in
respondents fluorides knowledge as well as prescription practices indicated a need for educational interventions.
Dr. Narendran is Associate Professor, Department of Community Dentistry, Case School of Dental Medicine; Dr. Chan is Professor, Department of Integrative Biology and Pharmacology, University of Texas Health Science Center at Houston; Dr. Turner is
Associate Professor, Department of Neurobiology and Anatomy, University of Texas Health Science Center at Houston; and Dr.
Keene is Adjunct Professor, Department of Head and Neck Surgery, M.D. Anderson Cancer Center, Houston. Direct correspondence and requests for reprints to Dr. Sena Narendran, Department of Community Dentistry, Case School of Dental Medicine,
10900 Euclid Avenue, Cleveland, OH 44106; 216-368-1311 phone; 216-368-0145 fax; sena.narendran@case.edu.
This study was funded as a special interest project by the Division of Oral Health, Centers for Disease Control and Prevention,
through the Center for Health Promotion and Prevention Research, School of Public Health, University of Texas Health Science
Center at Houston.
Key words: fluorides, supplement, prescription, knowledge, dental education, fluoride testing, continuing education
Submitted for publication 2/26/06; accepted 6/2/06

ollowing the success of water fluoridation as

well as fluoride supplement trials during the
1940s, the Council on Dental Therapeutics of
the American Dental Association (ADA)1 published
its first fluoride dosage schedule in 1958. The American Academy of Pediatrics (AAP)2 published its first
fluoride supplement dosage in 1972. Subsequently,
various national associations,3-6 federal agencies,7
and researchers8 have proposed revisions to the
fluoride supplement schedule, particularly in light
of increased availability of fluorides from multiple
sources. It is believed that increased availability of
fluorides has resulted in an increased prevalence of
dental fluorosis9; such an increase is generally seen
in the milder forms of fluorosis with the increase in
the most severe forms being minimal or negligible.
The fluoride schedule has undergone periodic revisions, with the general trend being a reduction in

956

the fluoride supplement dosage and/or downward

adjustments of fluoride levels in drinking water.
During 1979, the existing fluoride schedule was independently revised by the ADA, American Association
of Pediatric Dentistry (AAPD), and AAP.3-4 Revised
recommendations from these three organizations
were somewhat similar, with minor differences in
the ages at which fluoride supplements should be
started and discontinued. The new recommendations
were reiterated by these associations during the late
1980s.5,6
Some researchers9 believe that the prevalence
of dental fluorosis continued to increase during the
1980s and 1990s, which led to further revisions to the
fluoride schedule in the early 1990s. In their secondary analyses of data from 1930 to 1980, researchers
found the highest increase in the prevalence of fluorosis among children living in suboptimally fluoridated

Journal of Dental Education Volume 70, Number 9

areas from 6.5 to 15.5 percent. Lack of consensus

exists among researchers: some support the retention
of the existing fluoride schedule,10 while others feel
strongly about reducing11 or completely eliminating12
the fluoride supplement as a caries prevention agent.
As lifelong learners, dentists are bound to pay attention to the equivocal evidence for fluoride supplementation. It is not certain how the conflicting messages
from the research community have impacted the
fluoride knowledge of dental practitioners as well as
their fluoride prescription practices.
Diffusion of new knowledge among health
care providers including dental practitioners is a
slow process. Various barriers, outlined in Rogerss
theory of innovation diffusion, impede the dissemination process of new knowledge as well as technical
advances among the practicing community.13 The
barriers to diffusion include relative advantage,
economics, incompatibility with existing value system, and complexity of the innovation. Following
publication of the revised fluoride supplementation
schedule by the ADA, AAP, and AAPD in the late
1970s, a series of studies examined various health
care providers knowledge and their prescription
practices: dentists,14 pediatric dentists,15 family physicians,16-17 and pediatricians.18 These studies were
conducted at the local, state, and national levels; two
local studies were done in Houston.17-18 The general
consensus among the studies was that health care
providers possessed inadequate knowledge about
fluoride supplements, which resulted in inappropriate
fluoride prescription.
Following a workshop in 1994, three professional organizations jointly recommended a new
fluoride supplement schedule.19-21 Studies about
health care providers knowledge about fluoride
supplements and prescription practices following
the 1990 recommendations appear to be sparse. In
one study that investigated the phenomena among
pediatric faculty members in North Carolina,21
more than 90 percent of respondents assessed the
fluoride needs of the patients. While 87.5 percent
started supplements at the appropriate age, a lesser
proportion was knowledgeable of the correct fluoride
dosage. Similar studies among dental practitioners,
however, are lacking. Despite the revisions to the
fluoride schedule in the 1990s by the professional
associations, yet another set of new guidelines7 was
published by the Centers for Disease Control and
Prevention (CDC) in 2001.
Dental caries, the most common childhood
disease, is preventable with a judicious preventive

September 2006 Journal of Dental Education

regimen including fluorides. Thus, it is important for

dental practitioners, particularly general and pediatric
dentists, to have a thorough knowledge of fluorides
as well as their appropriate use. The objectives of this
study were to investigate dentists knowledge about
fluorides as well as their prescription practices and
to ascertain the trends in these phenomena among
dentists in Houston as a follow-up to the previous
studies.

Materials and Methods

The study population consisted of 401 dentists,
including 360 general dentists and forty-one pediatric
dentists, practicing in Houston, Texas. The Texas
State Board of Dental Examiners (TSBDE) provided
the sampling frame to the investigators, which included more than 1,200 dentists licensed to practice
in Houston. First, the general dental practitioners
were chosen by a simple random sampling method
from the master list of dentists. All pediatric dentists
on the list were then added to the chosen random
sample of general dentists. Data were collected by
a self-administered mail questionnaire, which consisted of forty-two items, of which twenty-nine were
precoded and thirteen open-ended.
The CDC provided questionnaires from previous studies,22 and we developed an initial set of questions that was circulated for review and consultation
by researchers at two other academic institutions
and the CDC. Based on discussions in conference
calls among the investigators and researchers, a draft
questionnaire was developed. The draft questionnaire was pilot-tested among dental faculty members
who were also part-time private practitioners, and
revisions were made. The survey instrument in its
final form collected data on demographics, types of
dental practice, fluoride knowledge, attitude towards
fluoride supplements, and fluoride prescription
practices. Items on knowledge investigated factors
affecting fluoride prescription practices as well as
those responsible for excessive exposure to fluoride.
Additional items assessed fluoride dosage for different ages living in communities with certain fluoride
levels in the water, as well as the ages at which to
commence and stop fluoride supplements.
After three mailings, a total of 183 completed
questionnaires were returned for an effective response
rate of 46.4 percent; these included 159 general and
twenty-four pediatric dentists, whose responses for
the majority of the questionnaire items did not dif-

957

fer significantly. The few items on which the two

groups of dental providers differed significantly are
described in the results section. Respective response
rates for general and pediatric dentists were 44.2 and
58.5 percent. Data were appropriately coded and
entered into the data editor of the statistical packages
for social sciences, SPSS. The whole data set was
scrutinized for accuracy of data entry and coding,
and the subsequent statistical analysis consisted of a
descriptive and an analytic component.
The descriptive phase examined the knowledge,
attitude, and fluoride recommendations of dentists
practicing in Houston as well as their demographic
attributes. A majority of the questionnaire data was
categorical, and the results of such data are presented
mainly in the form of percentages/proportions and/or
frequency distribution. Medians, means, and standard
deviations represent the continuous variables such as
age, number of patients, and continuing education
hours. Some of the questionnaire items were on a
five-point scale: strongly agree, agree, not sure, disagree, and strongly disagree. For analytical tests, the
first two responses (strongly agree and agree) were
grouped together as agree, and the last two (disagree
and strongly disagree) into disagree categories.
Similarly, the five-point items on importance (very
important to not at all important) were collapsed into
three categories: important, neutral, and not important.
Respondents who graduated after 1980 were classified
as post-1980 graduates and those graduated before
1980 as pre-1980 graduates. Dentists who had been
in practice for less than twenty years were classified as
experienced dentists, and those with twenty years or
more experience as more experienced practitioners.
Analytical bivariate tests (2 x 2 contingency tables)

Table 1. Demographic attributes of respondents and

their practice profile
Ethnicity
Asian or Pacific Islander
Hispanic
Native American
Non-Hispanic Black
Non-Hispanic White
Other
Personnel Profile of Respondents
Number of Dentists
Number of Hygienists
Number of Assistants

958

Percent
9.1
5.9
1.1
4.3
66.8
12.8
Mean SD
1.6 1.7
1.2 1.2
2.2 2.1

computed odds ratios (OR) as well as chi squared

statistic, both of which investigated relationships
between dependent variables (knowledge of fluorides,
fluoride prescription) and independent variables (years
in practice, years since graduation, etc.). The level of
significance for the analytical tests was set at alpha
less than or equal to 0.05.

Results
Most respondents to the survey were males
(73.8 percent), and the ethnic distribution was 66.8
percent Non-Hispanic Whites, 9.1 percent Asians, 5.9
percent Hispanics, 4.3 percent Non-Hispanic Blacks,
and 12.8 percent from various other ethnic groups
(Table 1). The average number of dentists, dental
hygienists, and dental assistants among respondents
practices were 1.6, 1.2, and 2.2 respectively. The
study population predominantly consisted of experienced practitioners who had been in practice for
nearly twenty years with a mean of 18.91.5 years.
The average number of patients who are less than
sixteen years of age seen by the respondents was
nearly twenty per week. Slightly more than one-half
reported that they do not prescribe fluoride supplements. Nearly one half of the respondents (48.9 percent), however, reported prescribing fluoride supplements, and 6.7 percent of those prescribing fluoride
supplements routinely analyzed fluoride levels in the
drinking water of their patients. The mean number
of weekly water analyses performed/requested by
respondents was 0.31.9, and the mean number of
fluoride prescriptions written per week was 1.96.6.
Similar values for those prescribing fluoride supplements were 0.73.0 and 6.915.3.
A wide range of responses were reported to
the question about the appropriate age at which to
begin fluoride supplements (Figure 1). One-third
of those prescribing fluoride supplements indicated
that fluoride supplements should be started after two
years of age. Figure 2 shows varying responses to
the appropriate age at which fluoride supplements
should be discontinued. The correct ages at which to
begin (six months) and to discontinue (sixteen years)
fluoride supplements to children were identified by
14.7 and 14.9 percent of the respondents, respectively. While the incorrect reported ages at which to
begin prescribing fluoride supplements ranged from
prenatal to greater than twenty-four months, the
range for discontinuing the supplements was seven
to fifteen years.

Journal of Dental Education Volume 70, Number 9

40
35
30

Percent

25
20

Percent

15
10
5

si
is
M

Su
ot
N

ng

re

s
th
m
4

>2

m
4
-2
13

on

th
on

on
m

7-

12

m
6
4-

s
th

s
th
on

on
m
<3

Pr

en

at

th

al

Age
Figure 1. Responses to age at which to begin fluoride supplements for children

30
25

Percent

20
15

Percent

10
5
0
7-9
years

10-12
years

13-15
years

16
years

Not Sure

Missing

Age
Figure 2. Responses to age at which to discontinue fluoride supplements

September 2006 Journal of Dental Education

959

Table 2 shows respondents knowledge about

factors affecting fluoride supplement prescription to
a child. While nearly three-fourths of the respondents
identified fluoride level in water at home as well as
patients age as important factors to be considered
before prescribing fluoride supplements, a lesser
proportion of the respondents cited the patients caries activity (61.7 percent) and fluorides prescribed
by other health care providers (59.6 percent). Significantly lower proportions reported that the recommended fluoride dosage schedule (54.1 percent),
patients weight (29 percent), parents caries activity
(54.1 percent), siblings caries activity (47.5 percent),
and fluoride dentifrices (42.3 percent) affected their
fluoride prescription practices. All factors listed
in the table must be considered by dentists before
prescribing fluorides.
One of the items in the questionnaires investigated respondents knowledge of factors responsible
for excessive fluoride exposure to children less than
six years of age (Table 3). Almost all respondents
(98.9 percent) correctly reported that fluoride mouth
rinses could not be a factor in excessive fluoride
exposure. While nearly 60 percent believed that fluoride in drinking water could be a factor in excessive
exposure to fluoride among children aged less than

six years, 26.2 percent attributed the excessive exposure to fluoride in the toothpaste and 15.5 percent
to dietary supplements.
Table 4 illustrates respondents rating of factors
that are important in determining the use of fluoride
toothpaste by a two-year-old child. According to most
respondents (77.1 percent), the fluoride level in drinking water was the most important factor, followed by
the use of fluoride supplements (69.9 percent), use
of baby bottle (63.9 percent), and caries history of
siblings (60.7 percent). Nearly 10 percent of respondents failed to answer this question. All factors listed
in the table are important in determining the use of
fluoride dentifrice.
Analytical tests did not find any significant association between the fluoride prescription practices
of respondents and certain demographics or practice
attributes (Table 5).The proportion of respondents
prescribing fluoride supplements was higher among
pediatric than general dentists. No significant difference, however, was observed between the proportions
of general dental practitioners and pediatric dentists
who prescribed fluoride supplements (OR=2.4,
95% CI=0.94, 6.27). Similarly, respondents year
of graduation from dental school or type of practice
(solo vs. others) was not associated with the fluoride
prescription practices.
General and pediatric
dentists
differed from each
Table 2. Respondents knowledge of factors affecting their decision to prescribe
other
significantly
in five
fluoride supplements
items
as
illustrated
in
Table
Factors
Agree (%)
Disagree (%)
6. While a greater proporF Level in Drinking Water at Home
77.0
23.0
tion of pediatric dentists
F Level in Drinking Water at Day Care, etc. 48.1
51.9
believed that excessive levels
Patients Age
76.0
24.0
of fluoride in drinking water
Caries Activity of the Patient
61.7
38.3
result in excessive chronic
Recommended Dosage Schedule
54.1
45.9
exposure to fluoride, a higher
Patients Weight
29.0
71.0
proportion of general dentists
Motivation of Patient and Parent
42.6
57.4
felt the same about ingesting
F Prescribed by Other Providers
59.6
40.4
Use of Fluoride Dentifrice
42.3
57.7
fluoride-containing dentiCaries History of Parents
41.5
58.5
frice. Pediatric dentists were
Caries History of Older Siblings
47.5
52.5
more than six times more
likely than general dentists
to know the correct fluoride
Table 3. Respondents knowledge of possible causes of excessive fluoride expodosage for a two-year-old
sure among children less than six years old
child (OR=6.23, 95% CI=2.3,
17.4). Similarly, pediatric
Possible Causes
Agree (%)
Disagree (%)
dentists were more than 3.5
Dietary Fluoride Supplements
15.5
84.5
times more likely than general
Fluoride Mouthrinses
1.1
98.9
dentists to consider patients
Fluoride in Drinking Water
58.8
41.2
caries activity (OR=3.52,
Fluoride in Dentifrices
26.2
73.8
95% CI=1.06, 12.9) as well

960

Journal of Dental Education Volume 70, Number 9

Table 4. Respondents rating of important factors in determining fluoride toothpaste use by a two-year-old child (%)

Important

Fluoride Level in Water

Clinical Appearance of Teeth
Caries History of Parents
Caries History of Siblings
Fluoride Level in Toothpaste
Use of Baby Bottle
Use of Fluoride Supplements

77.1
53.0
57.4
60.7
50.8
63.9
69.9

Neutral
6.0
16.4
22.4
20.3
14.2
13.7
14.2

NI*

Missing

10.4
20.7
12.6
10.9
8.8
13.6
8.8

6.6
9.8
7.7
7.7
9.8
8.7
7.1

*NI=Not Important

Table 5. Relationship between fluoride supplement prescription practices (Rx) and certain attributes
Attributes

Categories

Rx
Yes

No

Gender


Ethnicity


Year of Graduation


Continuing Education Hours
During the Previous Year

Male
Female

Caucasian
Others

67
21

59
16

0.70

0.87 (0.39, 1.93)

61
24

55
18

0.86

0.83 (0.38, 1.80)

1980 or later
1979 or earlier

37
45

31
40

0.85

1.06 (0.53, 2.12)

5 hours
<5 hours

80
8

81
4

0.26

0.49 (0.12, 1.91)

Type of Practitioner


Type of Practice

Pediatric dentist
General dentist

Solo
Other

16
71

7
75

0.06

2.4 (0.94, 6.27)

64
24

57
28

0.41

1.31 (0.65, 2.65)

p*

OR (95% CI**)

*Chi square test

**95% Confidence Interval for odds ratio

Table 6. Differences between general and pediatric dentists about fluoride knowledge and fluoride prescription
Items

Dentist

Yes

No

Excessive F in water results in

excessive chronic exposure

Ingestion of fluoride toothpaste
causes excessive exposure

Correct fluoride prescription
for a two-year-old child

Consider patients caries activity
when prescribing fluoride
supplements

Pediatric
General

15
49

9
89

0.01

3.0 (1.14, 8.16)

Pediatric
General

Pediatric
General

14
111

10
27

0.02

0.34 (0.12, 0.93)

13
22

11
116

0.00

6.23 (2.26, 17.38)

Pediatric
General

20
81

4
57

0.02

3.52 (1.06,12.90)

Consider siblings caries activity Pediatric

when prescribing fluoride
General
supplements


*Chi square test
**95% Confidence Interval for odds ratio

18
63

6
75

0.01

3.57 (1.24, 10.78)

September 2006 Journal of Dental Education

p*

OR (95% CI**)

961

as siblings caries activity (OR=3.57, 95% CI=1.24,

10.78) when prescribing dietary fluoride supplements
to a child.

Discussion
The response rate to this study is acceptable,
despite being lower than the anticipated rate of 55-60
percent. This response rate appears to be the norm
for self-administered mail surveys to health care
providers,23 particularly dentists. Dental practitioners
are inundated with mail surveys to the point that they
demonstrate apathy towards such surveys, which
could explain the lower than expected response rate
in our study. The simple random sampling method
of general practitioners and inclusion of all pediatric
dentists eliminate any potential selection bias, thus
improving the validity of the findings. The present
study follows the previous ones, conducted more
than ten years apart during 1979 and 1992, in the
City of Houston and Harris County, Texas. The study
population, however, is slightly different from the
previous ones, which did not include general dental
practitioners in their samples. Thus, this is the first
study in the Greater Houston area to investigate the
fluoride knowledge and prescription practices among
general dental practitioners.
Despite the respondents being knowledgeable
about certain aspects of fluoride supplements, certain
gaps in knowledge as well as inappropriate prescription practices were apparent. Deficiencies and ambiguities in the respondents knowledge of fluorides
as well as the fluoride dosage schedule demonstrate
a need for increased educational strategies/interventions, both at the undergraduate and practitioner
levels. Addressing educational issues among professional students including residents in pediatric
dentistry is important, particularly at a time when
uncertainties about the general use of fluorides exist
among researchers.10-12 The dental curriculum should
emphasize the importance of caries risk assessment
as well as comprehensive preventive regimens for
dental caries. Instruction on caries risk assessment
should include fluoride history, fluoride analysis of
drinking water, diet history, and comprehensive clinical investigations. A thorough fluoride history will
enlighten dental students as to whether the patient is
taking the necessary amount of fluoride supplement
or not. Following a fluoride analysis of the patients
drinking water, dental students can judiciously use
the information from the fluoride history to eliminate,

962

decrease, or increase the fluoride supplement dosage

of their patients. Therefore, dental students should
also be competent in writing fluoride supplement
prescriptions, in addition to being knowledgeable
about testing fluoride levels in the water.
We believe that almost all dental schools in
the United States have fluoride testing equipment at
the institution, if not in the undergraduate clinics. It
would be an excellent teaching method to equip the
undergraduate clinics in dental schools with fluoride
testing equipment and teach dental students how to
perform the test, which should not consume a lot
of clinic time. This teaching strategy will not only
increase the knowledge level of dental students about
fluorides, but also their awareness for testing fluoride
in the drinking water. The increased awareness will
be helpful in their future practices and can be reinforced subsequently through appropriate continuing
education courses. Further, as community leaders,
while in practice they will be comfortable giving
advice on fluorides to those who seek such advice
as well as to communities at large when needed. As
for the practicing dentists, deficiencies/ambiguities in
fluoride knowledge and prescription practices could
be addressed through continuing education courses,
which should include the aforementioned concepts.
Such efforts will help to eliminate or minimize
the inappropriate fluoride prescription by dentists,
particularly the excessive use of fluorides. If not
controlled, excess prescription of fluoride supplements will aggravate the perceived increase in the
prevalence of fluorosis.
Numerous studies among health care providers in different settings have reported inadequate
proportions of respondents testing fluoride levels in
a patients drinking water before prescribing fluoride
supplements.15,21 A previous study in Houston reported that 61 percent of pediatric dentists and 52 percent
of pediatricians used the information about fluoride
levels in water as an important factor in prescribing
fluoride supplements.15 In a study of academic pediatricians, nearly 70 percent assessed the fluoride level
in their patients drinking water before prescribing
fluoride supplements,21 compared to the alarmingly
low proportion of less than 10 percent in our study.
In our study nearly 67 percent of the pediatric dentists took fluoride levels in water into consideration
before prescribing fluoride supplements, which is an
improvement over the previously reported 61 percent
in the same location. Certain differences between our
study and the previous ones could have been due to
the inclusion of general dentists in our study, which

Journal of Dental Education Volume 70, Number 9

was not done in the previous studies. The magnitude

of differences found between the present study and
others, however, could not be explained by sampling
variation alone and thus needs further investigation.
It appears that substantial proportions of health care
providers in academic settings as well as in private
practice have failed to adopt the fluoride testing of
drinking water despite it being such an important
determinant of fluoride supplement prescription.
Resources for testing fluoride levels in the drinking
water are available at dental schools as well as local
and state health departments.15 Further, in-office
fluoride testing equipment is available in the commercial market, which may be a quicker and more
efficient method of testing fluoride levels in the water
than by external agencies. Providers oversight in not
using this resource as well as deficiencies in their
knowledge further reiterate the need for reinforcing
the dental school curriculum as well as increasing
efforts to offer continuing education courses for
dental practitioners.
Surprisingly, pediatric and general dentists differed from each other only in five individual items:
two items related to factors causing excessive chronic
fluoride exposure in children (fluoride in water and
ingestion of tooth paste), correct dosage of fluoride
for a two-and-a-half-year-old child consuming water
with 0.1 ppm fluoride, and factors to be considered
(caries activity of the child and that of siblings) when
prescribing fluoride supplement to a child. Out of the
five items, a higher proportion of pediatric dentists
identified the correct responses for four items except
the ingestion of toothpaste being a risk factor in excessive chronic fluoride exposure. General dentists
were three times more likely than pediatric dentists
to identify correctly that the ingestion of toothpaste
with higher levels of fluorides results in excessive
exposure to fluoride. The higher knowledge levels
of fluoride supplementation reflect the additional
training that pediatric dentists received in the use
of fluorides.
It is heartening to note that substantial proportions of respondents were knowledgeable about
certain aspects of caries prevention, fluorides, and
factors affecting the prescription of fluoride supplements. For example, respondents were aware of most
risk factors of dental fluorosis such as high fluoride
levels in drinking water. A good proportion, however,
did not correctly identify fluoride supplements as a
risk factor of dental fluorosis as reported in the literature.24 Deficiencies in provider knowledge are not
unique to fluorides alone, as similar phenomena have

September 2006 Journal of Dental Education

been identified in studies pertaining to oral cancer

knowledge among dental practitioners. Academic
institutions, professional associations, and public
health agencies should bear the responsibility of
eliminating deficiencies and ambiguities in fluoride
knowledge among health care providers,21 which will
then reduce the frequency of inappropriate prescription practices of fluorides. Improved knowledge of
fluorides among health care providers, as well as
reduction of inappropriate fluoride prescription, will
maximize dental caries prevention and minimize such
deleterious effects as dental fluorosis.

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Journal of Dental Education Volume 70, Number 9