Health minister attacks dental health protection

Fluoridation of community water supplies is under attack by the new health minister, despite its success in Israel in reducing dental caries in children

By T. TULCHINSKY, J. MANN, H. SGAN-COHEN
Dentists Chair 370 (photo credit: Wikimedia Commons)
Dentists Chair 370
(photo credit: Wikimedia Commons)
Fluoride is an element naturally present in water, and at specific levels improves dental health.
However, fluoridation of community water supplies is under attack by the new health minister, despite its success in Israel in reducing dental caries in children, with important health benefits especially to poor and middle class population groups. When economic cutbacks are threatening to worsen the situation of the poor in Israel, the minister, and the government, should reconsider and retract her act to stop this important public health measure.
Fluoridation when implemented by the ministry was challenged legally, but supported by the Supreme Court. Unfortunately the minister apparently believes non-facts and total distortions. As one example, the minister claims that fluoridation causes cancer. This is untrue. Israel has had fluoridation for much of the population since 2002. Data from the World Health Organization European Region shows the total standardized cancer mortality rate in Israel is low compared with those of Ireland (fluoridated since the 1960s), Netherlands (not fluoridated) and the UK (limited fluoridation), and has declined steeply in the past decade.
In July 2011, the American Public Health Association reported: “Health advocates fighting myths about fluoridation with science: Misinformation endangers oral health. Dental advances over the past six decades mean that many Americans do not remember a time when tooth decay and disease was a major national public health problem. But in the 1940s, more than 15 percent of World War II recruits were denied the ability to enlist in the Army because they lacked six pairs of opposing teeth. The adult human mouth contains 32 teeth, and yet just 70 years ago a large number of 21- to 35-yearolds did not have even 12 good teeth.”
Much of the credit for the nation’s better oral health can be attributed to the decision in the 1940s to begin adding fluoride to public drinking water systems. According to the American Dental Association, fluoridation reduces tooth decay in all age groups by 20% to 40% “even in an era with widespread availability of fluoride from other sources, such as fluoride toothpaste.”
In April 2013, the US Surgeon-General, Dr. Regina Benjamin, officially endorsed community water fluoridation, stating that, “Fluoridation’s effectiveness in preventing tooth decay is not limited to children, but extends throughout life, resulting in fewer and less severe cavities.... In fact, each generation born since the implementation of water fluoridation has enjoyed better dental health than the generation that preceded it.”
Every surgeon-general for the past 50 years has endorsed fluoridation of community water supplies as a safe and effective weapon in the war against tooth decay.
The minister met with senior medical and dental professionals from the ministry and academia on April 8, 2013, along with a number of nonmedical anti-fluoridationists. All the medical-dental participants strongly supported fluoridation. The minister was given a detailed report of a nation-wide survey conducted by one of us (HSC), which clearly showed the effectiveness of fluoridation, particularly in poor communities.
The minister raised her view that the state should not impose on people the level of fluoride in the water.
Several days later she signed a decree that can potentially cease fluoridation in Israel within a year. Her libertarian view has been refuted by leading ethicists, and by the Supreme Court.
In nature there is no water without fluoride, but the level varies widely and there is no basic right for any specific level. No person has the right to deprive large, vulnerable parts of society (such as children) of the beneficial effect of the fluoride.
The minister expressed concern about that only a small fraction of the fluoridated water is used for drinking; the majority is used for anything from washing clothes to irrigating vegetables. She seeks other ways to achieve the same effect, but the accumulated evidence of many decades, as stated by the US surgeongeneral, shows that fluoridation of community water to a specific level is the safest and most cost-effective method to prevent dental caries and its painful consequences and achieve better dental health for the nation.
It is the responsibility of the health minister and the government to use the best dental, medical and public health professional judgments from within the ministry and academia.
The professional support for fluoridation by leading medical, dental, academic and public health authorities should convince the minister to maintain our achievement in this field. Fluoridation is safe and costeffective in preventing poor dental health and improves the health of our children and adults, especially the poor.
Ted Tulchinsky is an associate professor, Braun School of Public Health, the Hebrew University-Hadassah, Jerusalem. Jonathan Mann is a professor and chairman of the Department of Community Dentistry, Hadassah Medical Center. Harold Sgan-Cohen is a professor, Department of Community Dentistry at the Hadassah Medical Center.
Elliot M. Berry is a professor and head of Department of Human Nutrition and Metabolism and director at the World Health Organization Collaborating Center for Capacity Building in Public Health, Braun School of Public Health at the Hebrew University-Hadassah, Jerusalem. Rifaat Safadi is a professor and director of the Liver Unit at the Institute of Gastroenterology and Liver Diseases, Division of Medicine, Hadassah Medical Center and Ronny Starkshall has a PhD from the Braun School of Public Health and Community Medicine.