Debate on the ethics must be informed by sound science

The British government has recently announced a new expert review of fluoride and health with a view to strengthening the legislation that underpins fluoridation of water supplies if the findings are supportive.1 The epidemiological evidence that fluoride protects against dental caries is overwhelming, but in England and Wales less than 10% of the population receives fluoridated water,2 and proposals to extend the coverage provoke strong opposition from a vociferous minority who view the intervention as hazardous and unjustified. The debate raises both scientific and ethical questions.

The scientific challenge is to quantify reliably the benefits and risks from fluoridation as compared with alternative strategies for preventing caries. Early surveys found that among children rates of decayed, missing, or filled teeth were some 50% lower in places with water fluoride concentrations of about 1 ppm than in those where they were 0.1 ppm or less.3 These differences …