Ethical aspects of water fluoridation in pseudoscience and digital social media times

Abstract

Water fluoridation is a technology used to prevent tooth decay, which is still a major public health problem. It began to be used in 1945 in the United States. However, changes resulting from Donald Trump’s 2024 election to the U.S. presidency led to a halt in its implementation there. In 1985, the city of São Paulo began fluoridating its water. Forty years later, the measure has proven effective. This critical essay analyzes ethical, or supposedly ethical, objections to the use of this technology while discussing, from the perspective of bioethics, the US decision, the results of 40 years of fluoridation in São Paulo and the possible influence of the US decision to discontinue fluoridation and its consequences, in Brazil and other countries. Certain objections are presented as ethical, but they are not, as they are based solely on scientific ignorance. Most truly ethical objections are based on principlism, which is admittedly limited when problems involving public health interventions are analyzed. One single question arises from this analysis: the ethical admissibility of forgoing the use of a technology proven to be effectual, effective, efficient, and safe for human health, without any justification on the basis of scientific evidence.