Some of the fundamental questions about the fluoridation of public water supplies are ethical in nature: e.g. Is medication with an uncontrolled dose wrong? Is mass medication, which is either compulsory or expensive to avoid, wrong? is fluoridation right if its risks are less than its benefits? Some leading proponents of fluoridation attempt to evade such ethical issues by quasi-scientific argument. For instance, they claim that fluoridation is not medication, but merely an 'adjustment' of the natural fluoride concentrations in drinking water to the 'optimal' level for reducing tooth decay. Or they allege that fluoride is an essential nutrient, rather than a medication. But, ethical questions cannot be so easily transformed into scientific and technical ones to be answered glibly by dentists and medical practitioners. This paper assists the elucidation of several ethical questions about fluoridation by first clarifying several related questions of science, technology and logic. This clarification leads to the conclusions that fluoride, at the levels recommended by pro-fluoridationists for reducing tooth decay, is not an essential nutrient; is not a natural substance for babies or for most adults; is not a compulsory medication, but is an expensive-to-avoid medication with an uncontrolled dose; and is harmful to some people. There is scientific evidence that the benefits of fluoridation have been greatly overestimated, but the actual magnitude of benefits is still unclear. It is now clear that any benefit comes from the action of fluoride on the surface of teeth, but there is negligible benefit from swallowing fluoride. It is not possible to weigh risks against benefits in a value-free manner. These scientific, technical and logical conclusions prepare the way for ethicists and others to examine the fluoridation issue, unencumbered by the usual 'scientific' myths. The original ethical concerns about fluoridation are found to be well-posed questions, an ethical question used by proponents to justify fluoridation is found to be improperly posed, and a new ethical question arises from the analysis.
