As debates surrounding fluoride gain attention across the U.S., a dental student from the University of Iowa is tackling the issue head-on. Alex Harper, a fourth-year dental student, is investigating attitudes about fluoride and tap water. As misinformation erodes trust in science, Harper’s research provides timely insights into public perceptions and oral health behaviors. 

“There’s a lot of pushback on water fluoridation right now,” Harper explained. “People hear that fluoride can be toxic, but they often don’t realize it’s safe in the quantities used in community water fluoridation and has significantly reduced tooth decay.” 

Motivated by his personal ties to Green Hill, Alabama, Harper surveyed adults in the rural community where he grew up about their knowledge, attitudes, and behaviors related to water fluoridation. 

Revealing Public Perceptions of Fluoride 

In his survey conducted in 2022-23, Harper found that 92% of participants believed fluoride prevents cavities, and 84% considered it when choosing toothpaste. Nevertheless, two-thirds reported primarily drinking bottled water at home instead of tap water, although fluoride levels in their tap water did not significantly impact that choice. 

“Some results were surprising,” Harper said. “We expected people from lower socioeconomic backgrounds to be less accepting of fluoride, but the knowledge, attitudes, and behaviors were consistent across all educational and socioeconomic levels.” 

The findings highlight a disconnect: while residents recognize fluoride’s importance, they tend to prefer bottled water, which almost always does not have the optimal level of fluoride. Harper sees this as a call to action for better public education on fluoride’s benefits and safety. And it could be that more recent fluoride controversies in the U.S. would shift these findings. 

The Dental Student Research Group and Mentorship 

Harper credits much of his success to Dr. Steven Levy, the Wright-Bush-Shreves Endowed Professor of Research at the University of Iowa College of Dentistry. 

“Dr. Levy has been a great mentor from day one,” Harper said. “When I started, I didn’t realize how famous he was, but his knowledge and guidance have been incredible. He’s a great mentor, but he hasn’t made it easy—he challenges me to think critically.” 

As a world-renowned leader and mentor in the field, Dr. Levy understands how important it is to understand both the science and public attitudes for public health educational efforts to be successful. “Alex’s research provides a window into the effectiveness and limits of public health messaging about community water fluoridation,” Dr. Levy said. 

Harper’s research journey began in his first semester, when he joined the Dental Student Research Group (DSRG). Weekly online classes introduced him to research opportunities and helped him develop his project.

“I didn’t have much research experience during my undergraduate education,” Harper said. “But I knew I wanted to pursue it in dental school, especially since research is so important in specialties like orthodontics, which I hope to pursue.” 

Looking Ahead: Research in Practice 

As Harper prepares to graduate, he envisions a career blending private practice with ongoing research. 

“In some capacity, I want to stay involved in research,” Harper said. “Understanding how it’s conducted and being able to evaluate the quality of studies will help me make better decisions for my patients. I also hope to move the needle forward by contributing to the field.” 

Harper is eager to publish a manuscript based on his findings, ensuring his work informs broader conversations about fluoride and public health. “My educational career might end, but my learning career will never end,” he reflected. 

As the dental profession grapples with misinformation, Harper’s work highlights the importance of understanding current knowledge, attitudes, and behaviors for advancing public health. By bridging the gap between science and local communities, his efforts show the power of mentorship and evidence-based practice for the next generation of dental leaders.