Word of Mouth

Misunderstandings about oral health are on the rise. This is how dentists are dealing with it

By Diane Peters

Three years ago, the team at Yonge Eglinton Dental in Toronto got help creating video content for its web-site. Everyone liked it, so they did more, posting clinic tours, staff introductions and health discussions on Instagram and TikTok.

“We use video as a springboard to talk about something we think is important and try to share information,” says clinic partner Randy Fisher, a University of Toronto engineering grad who studied dentistry at Western University. He often stars in clinic videos while his dentist partners and other members of staff take their turns as well.

Fisher recently shared his own journey with having an extraction, orthodontics and veneers, and has done segments on “wisdom on wisdom teeth,” the limitations of brushing with activated charcoal and the myth that baby teeth are not important.

He’s found that misunderstandings about dentistry are becoming increasingly common. “I’d say once a day someone asks me about something their friend said or did, or something they researched online,” says Fisher. “People have more information now. Not all of it’s accurate or applicable.” Sharing evidence-based guidance has served as a marketing strategy for the clinic, but also triggered thoughtful conversations online and in the office. Meanwhile, other dentists and dental associations have been tackling dental myths via content on their websites and private conversations — any opportunity to curb misconceptions related to daily oral hygiene, programs such as the Canadian Dental Care Plan (CDCP) and the risks of procedures.

“Misinformation is a really big thing,” says Faculty professor Laura Dempster 7T7 Dip DH, 8T1 BSc D, who conducts research and teaches on communication and behavioural sciences. “Information is far more available than it used to be.” Companies marketing products, social media influencers hyping theories and those with political agendas disseminating disinformation — deliberately mis-leading information — make for a confusing world. “There are a lot of competing thoughts out there, and our role as practitioners is try to streamline and try to educate,” says Fisher. It’s now just a part of the job of being a healthcare provider to have to cope with this, often daily. The University of Toronto is now offering a course on the subject that’s open to students from all its health faculties as misinformation impacts dentistry and well beyond.

Not so long ago, dental patients would consent or not to treatment based on what they were told in the chair, perhaps after consulting a pamphlet.

Now, easy access to digital information means many show up for appointments with a sense of how much braces cost and the recovery time for a root canal. However, on their digital research travels, they’ve often been exposed to less-than-helpful mate-rials and many can’t distinguish solid oral health tips from unproven treatments boosted by conspiracy-theory-driven hype. They might be open to believing even outlandish ideas, as Dempster notes that mis-trust in institutions, governments and healthcare professionals has spiked since the pandemic.

“People are misinformed for many reasons that were not there 10 or 15 years ago,” says Aviv Ouanounou 0T0, associate professor, teaching stream at the Faculty. “One of them is social media. It really amplifies things.” He recently spent time answering questions about dental health from a woman in her 90s. “She says she saw it on TikTok. So, it’s not only for the young,” he notes.

People are somewhat wary of what they see online. A 2024 survey found 46.4 per cent of people who looked to social media for oral health information were unsure of how much they trusted it, with 42.3 per cent mistrusting what they saw and read. While most respondents visited the dentist when they had an oral health concern, 10.3 per cent followed the advice they read on social media instead.

Meanwhile, Dempster’s study of social media use in orthodontic patients found many looked to social media for treatment information and had realistic expectations around esthetics but over-blown expectations related to functional impacts on such things as eating and speech. “Some patients thought they’d breathe better, some patients thought they’d have a better career,” says Dempster.

Digital information in general seems to sway people. A 2022 review study published in the Canadian Journal of Dental Hygiene looked at 13 previous reports on patients who seek oral health information online, with 11 of those studies concluding that media outlets influence perceptions. This is impacting all of health care. A 2025 survey from the Canadian Medical Association of more than 3,700 Canadians found 35 per cent avoided effective health treatments due to false information, with 31 per cent saying they followed medical information they found online over that of a health professional.

Dentistry might be particularly vulnerable to so-called fake news. “Dentistry triggers a lot of anxiety, a lot of fear in people,” says Ouanounou. Worries about pain or being overcharged can entice people to seek workarounds, including around daily hygiene. He admits two minutes of brushing is challenging. “I’m a dentistry professor and some-times I time myself. I do one minute and 20 seconds and I’m tired,” he says. So, people assume brushing harder is better and some can be swayed to believe that diet and exercise can transform their oral health. Ouanounou says people have heard it’s fine to avoid going to the dentist if they have other symptoms but not pain, plus they hear and believe that dental X-rays are dangerous.

Enticed by dental companies and influencers, patients will look to such toothpaste variations as hydroxyapatite, charcoal and purple pastes, or try oil pulling, all in hopes of bypassing traditional methods of good oral hygiene, or gaining other health benefits.

More dramatically, people may believe you can put aspirin directly on a painful tooth to fix it. “Aspirin is an anti-inflammatory and so your pain is supposed to go away. That’s not true. In fact, it can cause damage, it can burn,” says Ouanounou.

Some patients have also heard of remineralizing products, and believe they can just buy some, put it on their teeth and avoid getting caries drilled and filled, which is not true.

While working with orthodontic patients, Dempster heard about mewing, which suggests flattening your tongue against the roof of your mouth can lead to skeletal facial changes. “I’ve seen a TikTok on it in which you can’t even see what was really happening, and I watched it six times,” says Dempster. The American Association of Orthodontists warns that mewing cannot replace braces and messing with your tongue position can negatively impact teeth.

The much-criticized 2018 documentary Root Cause reinvigorated the unproven focal infection theory, which says bacteria is left behind after a root canal that can trigger heart disease or cancer — digital influencers routinely pick up the idea. The Canadian Dental Association (CDA), Canadian Academy of Endodontics and the Canadian Cancer Society have issued public statements to dispel the myth.

Meanwhile, the public has had to adjust to the CDCP. One CDA survey during rollout showed that nearly 30 per cent of people using the program were surprised by out-of-pocket costs. Ontario Dental Association (ODA) surveys have found that the main issue for dentists related to the program has been dealing with patient misconceptions.

“There’s been a lot of misinformation from the beginning,” says David Brown, president of the ODA, who recalls politicians mentioning free dental care. “It was never meant to be free.”

The CDCP keeps evolving, with changes to how the government calculates income eligibility and around covering lab fees and some procedures — Brown says approvals now take a month on average, with 70 per cent of preauthorizations for procedures being rejected. “We knew there were going to be concerns and problems, and we urged the government to iron out these problems before they expanded eligibility to the entire population,” says Brown of the ODA’s advocacy efforts. Fortunately, Canadians are getting used to the CDCP, with recent surveys showing more people understand how the program works and that it is intended to subsidize the cost of dentistry.

Tackling misinformation in the dental office may entail addressing misunderstandings — but if patients are quietly avoiding care, dentists might not know what has happened. “The onus is on the clinician to talk about it,” says Dempster. She suggests dentists be detailed and clear when they present treatment plans and try to suss out expectations, which could reveal if the patient is buying into myths.

Jennifer Lake, assistant professor, teaching stream at the Leslie Dan Faculty of Pharmacy, helped create and teaches the U of T interprofessional elective course Meeting People Where They’re At: Relationship-Centered and Evidence-Informed Approaches to Addressing Mis/Disinformation. She recommends healthcare professionals stay open as they talk to patients. “As clinicians, we have been focused historically on trying to fix incorrect facts by educating. Nowadays, we have to manage some of the cognitive and social issues, too. You can’t just educate past misinformation,” says Lake.

As part of the course, Lake and her colleagues have students role-play speaking to a patient who is not vaccinating because she believes mRNA shots contain trackers. In her own practice, she will sympathize with patients sharing non-evidence-based ideas. “That must be scary,” she will often say, finding common ground, such as wanting to keep one’s family safe. She will then try to discover which treatments they will accept.

Lake advocates for healthcare professionals to listen, take into account power dynamics and focus on small changes. “We’re all adults. And as adults, we can make bad decisions. I’m sure there are things I do that my family doctor would prefer I don’t.”

Ouanounou says that dentists should acknowledge education and power dynamic differences. “You have to speak to your patient in a respectful manner. And it’s OK if they don’t know the answers; they didn’t go to dental school.”

Dentists should do their best to stay up to date. “You have to be that reliable source and be confident in what you’re saying,” says Brown. “If you’re not sure, reach out to get the information you need.” Most of the dental associations publish patient-facing materials on common myths that can be tapped as resources.

Importantly, conversations should preserve trust. “We know that when you trust somebody,
you’re more willing to accept what they say,” says Dempster. She’s studied trust in clinical relationships, and has found it can be lost easily, and you don’t usually know it’s happened. She’s discovered that healthcare providers who are empathetic and who have strong communication skills are considered more trustworthy.

Ironically, just as patients seek easy, affordable solutions to their oral health problems and grasp at misinformation as they do so, dentists must resist one-and-done solutions to patient education. It’s a long and iterative process that’s going to be different for everyone. Says Fisher, who has found an approach to patient communication that works for him, at least for now, “There are no quick fixes in life.”

Fluoride: The controversy that never ends
Worries about fluoridated water just keep coming back

Last summer, the city of Calgary reintroduced fluoride to its drinking water after a 14-year gap, maintaining 0.7 mg/L of the mineral, as per Health Canada guidelines. The practice had been stopped in 2011 after 20 years of use.

Advocacy groups nudged the change forward, looking to University of Calgary research published in 2021 that showed that in a group of roughly 2,600 Grade 2 students in that city, 64.8 per cent had caries in their baby teeth. A mere three hours up the road in Edmonton, which fluoridates, 55.1 per cent of a comparable group of kids had caries. “That represents a significant amount of suffering, along with social and financial costs, that is unnecessary because caries are preventable,” says Lindsay McLaren, the professor of population and public health who led the research.

The direct comparison between the two cities offered yet another compelling piece of evidence of the public health value of fluoride. Yet, worries over fluoride come back again and again, and its use has been up for debate in recent years in such places as Windsor, Waterloo and Regina, while U.S. states Utah and Florida recently out-and-out banned it.

Currently, about 38 per cent of Canadians have access to municipally fluoridated drinking water. Fluoride has been heavily studied since it became used widely in the 1940s. The latest concern has been a possible connection between the mineral and lower IQ levels in children, which is not con-firmed or shown to be causal.

McLaren says objections to fluoridation tend to follow three lines of concern: it’s not effective, it’s unsafe and it’s not ethical to give it to everyone in a community without their individual consent.

Associate professor Aviv Ouanounou thinks the cycle of debate will continue. “The fluoride argument hasn’t changed in the last 20 or 30 years. There will always be people who will keep arguing it.”

“In a way, these debates are a good thing,” says McLaren, who worries when the discourse gets dominated by misleading narratives. “We should be having these conversations as a society.”

Top illustration: Doug Panton