From Fluoride to Flavours: Dental Undergraduates and Dentists’ Perspectives on Non Therapeutic Additives in Pediatric Toothpaste in Pakistan

Abstract

Background: Pediatric toothpastes commonly combine therapeutic fluoride with non-therapeutic additives (flavors, sweeteners, colors, preservatives, surfactants) to improve child acceptability; however, inappropriate fluoride use and uncertainty about additive safety may influence professional recommendations and parental counseling. Objective: To assess knowledge, perceptions, and self-reported practices regarding fluoride use, fluoride-free alternatives, and non-therapeutic additives in pediatric toothpaste among dental undergraduates and dentists in Pakistan. Methods: A cross-sectional observational survey was conducted from September 2025 to January 2026 using a structured, content-validated online questionnaire distributed via academic/professional networks. Clinical-year undergraduates, house officers, general dentists, and postgraduates/specialists were eligible. Descriptive statistics were reported, and group comparisons between undergraduates and qualified dentists were evaluated using chi-square tests (α=0.05) in IBM SPSS Statistics v26. Results: Of 302 responses, 294 were analyzed; 67.9% were undergraduates and 76.2% were female. Awareness of recommended pediatric fluoride concentration was 77.5% overall and higher among dentists than undergraduates (86.3% vs 73.0; p=0.011). Agreement that fluoride prevents caries (91.7%) and concern about fluorosis with overuse (89.1%) were high and similar between groups. Dentists more often recommended the guideline-preferred smear/rice-grain amount for children <3 years (54.7% vs 42.0; p=0.005). Nearly all participants endorsed flavors as important for compliance (99.7%) and supported stricter regulation of fluoride/additives (95.0%). Conclusion: Pakistani dental professionals strongly endorse fluoride efficacy but show clinically relevant gaps in guideline-concordant dosing and variable fluoride knowledge, supporting targeted education and clearer regulation of pediatric toothpaste formulations