title: Fluoride Supplementation Adherence and Barriers in a Community Without Water Fluoridation.
abstract: To prevent early childhood caries, the American Dental Association recommends oral fluoride supplementation for children in communities lacking water fluoridation who are at high caries risk. However, patient adherence to oral fluoride supplementation has not been studied in this population. This study assessed adherence to oral fluoride and barriers to adherence in a community lacking water fluoridation.
  
  
  
  A self-administered survey was completed in a systematic sample of 209 parents of children aged 6 months to 4 years, during a primary care visit in an urban academic medical center. Participants reported frequency of administering oral fluoride to their children, as well as agreement or disagreement with proposed barriers to supplementation. Bivariate and multivariate analyses were used to assess adherence with oral supplementation and the association of barriers to supplementation and child receipt of fluoride on the day before.
  
  
  
  More than half of parents either had not or did not know if their child had received fluoride on the day before. Approximately 1 in 4 of parents had given fluoride in 0 of the previous 7 days. Difficulty remembering to give fluoride and agreeing that the child does not need extra fluoride were associated with not receiving fluoride on the day before.
  
  
  
  Adherence to oral fluoride supplementation in the primary care setting is low. Difficulty remembering to give fluoride daily is the greatest barrier to adherence. Further research on interventions to reduce common barriers is needed to increase fluoride administration and reduce early childhood caries in communities lacking water fluoridation.
authors.affiliation: School of Medicine, Oregon Health and Science University, Portland, Ore. Electronic address: Shannon.flood@childrenscolorado.org.
authors.forename: Shannon
authors.initials: S
authors.lastname: Flood
authors.affiliation: School of Medicine, Oregon Health and Science University, Portland, Ore.
authors.forename: Karin
authors.initials: K
authors.lastname: Asplund
authors.affiliation: Doernbecher Children's Hospital, Portland, Ore.
authors.forename: Benjamin
authors.initials: B
authors.lastname: Hoffman
authors.affiliation: School of Medicine, Oregon Health and Science University, Portland, Ore.
authors.forename: Allison
authors.initials: A
authors.lastname: Nye
authors.affiliation: Doernbecher Children's Hospital, Portland, Ore.
authors.forename: Katharine E
authors.initials: KE
authors.lastname: Zuckerman
mesh_terms: D001294:Attitude to Health; D002327:Cariostatic Agents / Q000627:therapeutic use*; D002675:Child, Preschool; D003731:Dental Caries / Q000517:prevention & control*; D004522:Educational Status; D005006:Ethnicity; D005260:Female; D005457:Fluoridation; D005459:Fluorides / Q000627:therapeutic use*; D006801:Humans; D007223:Infant; D008297:Male; D015999:Multivariate Analysis; D010290:Parents; D011320:Primary Health Care; D011795:Surveys and Questionnaires; D016903:Drug Monitoring
chemical_list: D002327:Cariostatic Agents; D005459:Fluorides
keywords: adherence; community water fluoridation; early childhood caries; fluoride