Fluoridation may be immoral with benefits exaggerated and risks minimized. Ethically, it cannot be argued that past benefits, by themselves, justify continuing the practice of fluoridation.

Fluoridation is a scientific controversy and substantial benefits recorded in early fluoridation trials, 50 years ago, are no longer found today.

Although current studies indicate that water fluoridation continues to be beneficial, recent reviews have shown that the quality of the evidence provided by these studies is poor.

The few sound studies that exist indicate small differences in decay between fluoridated and nonfluoridated child populations. Studies on Canadian populations show even less evidence that systemic fluoride reduces tooth decay; further, studies on adults are largely absent.

Fluoridation does have risks. "Fluoridation increases the prevalence and severity of dental fluorosis" (white spotted, yellow or brown permanently stained teeth).

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.

The impact of dental fluorosis from water fluoridation should not be underestimated. The percentage of the population with severe enough dental fluorosis requiring costly dental restorations to repair defective tooth structure has been steadily increasing.

Dental fluorosis should never have been classified as a simple 'cosmetic' side effect - it is a biomarker for systemic fluoride poisoning during early childhood. Research being conducted at the University of Toronto has shown that low daily doses of systemic fluoride from drinking water and other sources permanently affect bone and tooth growth and the mechanical properties of these hard tissues.

Standards regarding the optimal level of fluoride in the water supply were developed on the basis of epidemiological data collected more than 50 years ago. There is a need for new guidelines for water fluoridation that are based on sound, up-to-date science and sound ethics.

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. In the absence of a full account of benefits and risks, communities cannot make a properly informed decision whether or not to fluoridate.

Psychological studies on adolescents show effects of dental fluorosis are as serious a concern as overbite and overcrowded teeth.

Paul Beeber, NYS Coalition Opposed to Fluoridation

Journal of the Canadian Dental Association November 2001

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