Bioethical considerations about water fluoridation: a critical review.

María Elisa Quinteros


Dental caries is one of the oral pathologies with greater disease burden in the Chilean population. Fluoridation of drinking water has been used as a caries prevention strategy. However, its application as a public policy has been questioned since its implementation. The aim of this article is to analyze whether fluoridation of drinking water is a justified measure in reducing the incidence and prevalence of caries from the perspective of bioethics, taking into account the current evidence on its effectiveness. The arguments reviewed are based on the belief that water fluoridation is effective and, in general terms, ethically acceptable. A recent systematic review concludes that there is not enough evidence to support fluoridation as a public policy. There is a gap of knowledge that ought to be closed so that public health authorities can assess the significance of the intervention and make a democratic decision on its continuation or suspension based on scientific evidence. This decision should be informed and disseminated within the community.


Fluoride water; bioethics; caries; fluorosis; public health.


Olate V, Olate G, Cártes B, Olate S. Urgencias Odontológicas en la Provincia de Cautín - Chile, entre los Años 2009 a 2013. Int J Odontostomat. 2014; 8: 447-52.

Hoffmeister L, Moya P, Vidal C, Benadof D. Factors associated with early childhood caries in Chile. Gac Sanit. 2016; 30(1): 59-62.

Giacaman RA, Bustos IP, Bravo-Leon V, Marino RJ. Impact of rurality on the oral health status of 6-year-old children from central Chile: the EpiMaule study. Rural Remote Health 2015; 15(2): 3135.

Badenier A. Estudio de prevalencia de las enfermedades buco dentales y necesidades de tratamiento en la V región. Viña del Mar: Universidad de Valparaiso; 2006.

Divaris K. Predicting Dental Caries Outcomes in Children: A "Risky" Concept. J Dent Res. 2016; 95(3): 248-54.

Afuakwah C, Welbury R. Why do you need to use a caries risk assessment protocol to provide an effective caries preventive regime? Prim Dent J. 2015; 4(4): 56-9, 61-6.

Tapias-Ledesma MA, Garrido PC, Y Peña ME, Hernánez-Barrera V, de Miguel AG, Jiménez-Garcia R. Use of dental care and prevalence of caries among immigrant and Spanish-born children. J Dent Child (Chic) 2011; 78(1): 36-42.

Bommireddy VS, Koka KM, Pachava S, Sanikommu S, Ravoori S, Chandu VC. Dental Service Utilization: Patterns and Barriers among Rural Elderly in Guntur District, Andhra Pradesh. J Clin Diagn Res. 2016; 10(3): Zc43-7.

Moshkelgosha V, Mehrzadi M, Golkari A. The public attitude towards selecting dental health centers. J Dent. (Shiraz) 2014; 15(3): 129-34.

Peres MA, Peres KG, Barbato PR, Hofelmann DA. Access to Fluoridated Water and Adult Dental Caries: A Natural Experiment. J Dent Res. 2016; 95(8): 868-74.

U.S. Department of Health and Human Services Federal Panel on Community Water Fluoridation. U.S. Public Health Service Recommendation for Fluoride Concentration in Drinking Water for the Prevention of Dental Caries. Public Health Rep 2015; 130(4): 318-31.

Minsal. Norma de uso de los fluoruros en la prevención odontologica. Santiago: Ministerio de Salud, Gobierno de Chile; 2008.

Guerrero S, Cisternas P, González S, Uauy R. Contenido de Fluor de las Aguas Naturales de Chile y Recomendaciones para la Suplementación. Rev Chil Pediatr. 1983; 54(3): 162-6

Urbina T, Vincent M, Nacrur J, Vargas S. Dental caries in pre-school and basic school children from Santiago. Rev Dental Chile 1987; 18: 43-58.

Fernández CE, Giacaman RA, Cury JA. Concentración de fluoruro en aguas embotelladas comercializadas en Chile: importancia en caries y fluorosis dental. Rev Med Chile 2014; 142: 623-9.

Mariño R. Evaluación económica del programa de fluoración del agua de beber en Chile Rev Chil Salud Pública 2013; 17(2): 124-31

Connett C, Beck J, Connett M. 50 razones para oponerse a la fluoración del agua potable. New York: Flouride Action Network; 2011.

Jones S, Lennon K. One in a Million: the facts about water fluoridation. Manchester: The British Fluoridation Society; 2012.

Bianchi A, Bergren MD, Lewis PR. Portland Water Fluoridation: A Newspaper Analysis. Public Health Nurs. 2016. In Press.

Iheozor-Ejiofor Z, Worthington HV, Walsh T, et al. Water fluoridation for the prevention of dental caries. Cochrane Database Syst Rev 2015; 6: CD010856.

Young N, Newton J, Morris J, et al. Community water fluoridation and health outcomes in England: a cross-sectional study. Community Dent Oral Epidemiol. 2015; 43(6): 550-9.

Schluter PJ, Lee M. Water fluoridation and ethnic inequities in dental caries profiles of New Zealand children aged 5 and 12-13 years: analysis of national cross-sectional registry databases for the decade 2004-2013. BMC Oral Health 2016; 16: 21.

Szklo M, Nieto J. Epidemiology: Beyond The Basics. Burlington, Massachusetts: Jones & Bartlett Learning 2014.

McLaren L, Singhal S. Does cessation of community water fluoridation lead to an increase in tooth decay? A systematic review of published studies. J Epidemiol Community Health 2016. In press.

Jiang Y, Foster Page LA, McMillan J, Lyons K, Broadbent J, Morgaine KC. Is New Zealand water fluoridation justified? N Z Med J. 2014; 127(1406): 80-6.

Awofeso N. Ethics of Artificial Water Fluoridation in Australia. Public Health Ethics 2012; 5(2): 161-72.

Coughlin SS, Lewis SR, Smith SA. Ethical and Social Issues in Health Research Involving Incarcerated People. J Health Care Poor Underserved 2016; 27(2a): 18-28.

Nuffield Council on Bioethics. Public Health: ethical issues. London: Cambridge; 2007.

Kottow M. Bioética en salud pública: una mirada latinoamericana. Santiago: Editorial Universitaria; 2014.

Ferreira R, Marques R, Menezes L, Narvai P. Aspectos éticos e o uso de produtos fluorados na visão de lideranças de saúde. Physis Rev Saúde Coletiva 2014; 24: 491-505.

Full Text: PDF


  • There are currently no refbacks.

Creative Commons License
This work is licensed under a Creative Commons Attribution 3.0 License.

Corresponding: Facultad de Odontología, Universidad de Concepción, Chile. Roosevelt 1550, Concepción, Chile. Phone +56-41-2204232 - Fax +56-41-2243311- Mailbox 160-C, Concepción, Chile. E-mail