Bioethics Blogs

Forced Medication: The Ethics of Tap Water Fluoridation

Elena Rowan calls for a change to North America’s water fluoridation practices


Fluoride is a naturally-occurring chemical ion of the element fluorine. It can be found naturally in some water sources, based on geographical location and natural sediments. Fluoride is purported to help prevent cavities by reducing the prevalence of tooth decay in the population that consumes it. It is thought that fluoride protects teeth from demineralization caused by acid produced when sugar is ingested, as well as to remineralize any damage that may have already occurred. Scientists inferred these outcomes from the lower incidences of cavities in individuals who grew up in areas with a higher concentration of naturally-occurring fluoride in their water.

Because of the perceived benefits of fluoride, governments in the United States and Canada began adding a synthetic version of fluoride—sodium fluoride—to national water supplies decades ago. Many have argued that water fluoridation represents a great achievement in public health. However, 97% of European countries, including Belgium, Denmark, France, Germany, Italy, Luxembourg, Norway, Netherlands, Scotland, Sweden, and Switzerland have banned water fluoridation for health reasons as well as ethical reasons.

The most common disease caused by ingestion of fluoride is fluorosis, which has causational links to dental and skeletal erosion. Moderate amounts of ingested fluoride are known to cause staining and pitting in teeth, leading to irreversible enamel damage. In higher amounts skeletal fluorosis can occur, with symptoms ranging from stiffness and pain in the joints to calcified bones and ligaments, which can lead to impairment in muscle functioning.

The views, opinions and positions expressed by these authors and blogs are theirs and do not necessarily represent that of the Bioethics Research Library and Kennedy Institute of Ethics or Georgetown University.