• Howard Cohen, BA, MA, PhD • David Locker, BDS, PhD •

A statement concerning the ethics of water fluoridation was published in a recent issue of the Journal of the Canadian Dental Association. The arguments presented in that paper did not constitute what would be considered a complete and systematic account of the scientific and moral issues involved.

Water fluoridation, by the very nature of the way it is administered, engenders a number of moral dilemmas that do not admit to any easy solution. In this paper, we attempt to elucidate the particular problems posed by this public health initiative, according to the principles of bioethics.

Truthfulness
An assessment of the ethics of water fluoridation must also take into account the moral issues surrounding scien-tific inquiry in order for health professionals to be justified in advising or compelling others how to act.

Truthfulness entails a proper appraisal of the benefits and risks. Currently, the benefits of water fluoridation are exaggerated by the use of misleading measures of effect such as percent reductions. The risks are minimized by the characterization of dental fluorosis as a “cosmetic” problem.

Yet a study of the psychosocial impact of fluorosis found that “10 to 17 year olds were able to recognize very mild and mild fluorosis and register changes in satisfaction with the colour and appearance of the teeth.” The investigators also stated, “The most dramatic finding was that the strength of association of [fluorosis] score with psycho-behavioural impact was similar to that of overcrowding and overbite, both considered key occlusal traits driving the demand for orthodontic care.”

In the absence of a full account of benefits and risks, communities cannot make a properly informed decision whether or not to fluoridate, and if so at what level, on the basis of their own values regarding the balance of benefits and risks.

In the absence of comprehensive, high-quality evidence with respect to the benefits and risks of water fluoridation, the moral status of advocacy for this practice is, at best, indeterminate, and could perhaps be considered immoral.

[full 3 page article]