The Ethics of Water Fluoridation
Water fluoridation is known to be one of the greatest public health and disease preventive measures of all time. Its greatest documented benefit is that, by reducing caries, tooth structure is preserved and much pain, infection, tooth loss and restorative treatments are prevented. Water fluoridation protects everyone and is easy to deliver, safe, equitable and economically effecient.
There are considerable economic benefits associated with water fluoridation. By reducing caries, water fluoridation minimizes the need for restorative dental treatment and thus has an enormous impact on lifetime oral health utilization costs.
It might be argued that restricting choice about the public source of drinking water is morally wrong because it violates the principle of respect for the autonomy of individuals by taking away their freedom to choose not to consume fluoride. It might also be argued that this violation of autonomy is indefensible given that the benefits of fluoride can be realized in other ways such as supplements, fluoride mouth rinses and professionally applied fluorides. However, restricting choice for the entire population may be defended on the basis that it benefits vulnerable populations. Commercially availabe sources of fluoride and professional treatments can be costly and not everyone in society can afford these. Regardless of education, socioeconomic status, age, race, or access to professional dental care, everyone can benefit from fluoride simply by drinking fluoridated water. When it is available in public water supplies, fluoride is no longer a discretionary commodity available only to those who are familiar with its benefits, can afford it and have access to it. When public policy supports fluoridation of water supplies, it is the most vulnerable in our society that benefit the most.
On the basis of the evidence currently available, the physical benefits of fluoridation outweigh the harms.
The Canadian Dental Association and our team are in acceptance of the fluoridation of municipal drinking water. Having minimal levels of fluoride in our water supply and having it regularly monitored and adjusted to avoid fluctuations is considered a safe and effective way to prevent dental caries in all members of the community. A healthy balance should be maintained to properly receive the benefits of preventing tooth decay and avoid the risk of developing dental fluorosis, a change in the appearance of teeth from higher than optimal consumption of fluoride (most noticeably appears as small white flecks on a tooth).
References: Journal of the Canadian Dental Association and CDA Member Information Bulletin