Fluoridation News Israeli study shows significant narrowing of dental health inequalities in fluoridated Haifa

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1 September 2013 Fluoridation News Israeli study shows significant narrowing of dental health inequalities in fluoridated Haifa Twelve year old Israeli children who live in the fluoridated city of Haifa have, on average, less tooth decay than those in nonfluoridated Kfar Saba, according to a recent comparison of dental health in these two communities. Conducted in 2011/12 by the Department of Community Dentistry in the Dental Faculty of Jerusalem's Hebrew University, a study found that Haifa s 12-year olds had an average of 0.98 decayed, missing and filled teeth, compared with 1.38 in Kfar Saba. The study also found a much narrower gap in dental health between children from the most and least affluent backgrounds in Haifa than between the same groups in Kfar Saba. In fluoridated Haifa, children from the least affluent backgrounds have only 4.1% more decayed, missing and filled teeth than those from the most affluent backgrounds. By contrast, in non-fluoridated Kfar Saba children from the least affluent backgrounds have 26.7% more teeth affected than those from the most affluent backgrounds. A higher proportion of Haifa children from all social groups are also completely free of decay. As the table shows, many more Haifa children from the least affluent backgrounds are free of decay than Kfar Saba children from the most affluent backgrounds. Comparison of children in fluoridated Haifa and non-fluoridated Kfar Saba Average number of decayed, missing and filled teeth per child % of children free of decay Fluoridated Haifa All 12-year olds examined % Children from the most affluent backgrounds % Children from the least affluent backgrounds % % difference in decayed, missing and filled teeth between the most and least affluent 4.1% Non-fluoridated Kfar Saba All 12-year olds examined % Children from the most affluent backgrounds % Children from the least affluent backgrounds % % difference in decayed, missing and filled teeth between the most and least affluent 26.7%

2 These statistics from Israel add to the body of evidence suggesting that water fluoridation helps to reduce dental health inequalities between children from different social groups. The study was commissioned by the Israeli Ministry of Health. For more information about studies that have found reduced differences in tooth decay rates among children from the most and least affluent backgrounds in fluoridated areas, compared with children from the same social groups in non-fluoridated areas, please see pages 10 to 18 of the Dental Benefits section of One in a Million on this British Fluoridation Society website.

3 Fluoridated Haifa Lower rate of tooth decay among children than in non-fluoridated Kfar Saba Higher proportion of decay-free children than in non-fluoridated Kfar Saba Narrower dental health gap between children from most and least affluent backgrounds than between those in non-fluoridated Kfar Saba Non-fluoridated Kfar Saba Higher rate of tooth decay among children than in fluoridated Haifa Lower proportion of decay-free children than in fluoridated Haifa Wider dental health gap between children from most and least affluent backgrounds than between those in fluoridated Haifa

4 September 2013 Water fluoridation in Israel - no Supreme Court ban Fluoridation News Contrary to reports on some anti-fluoride websites, the Israeli Supreme Court has not banned water fluoridation, whether on health grounds or on any other grounds. The story about what is going on in Israel right now is much more complex and nuanced than fluoride opponents would have us all believe. Mandatory fluoridation introduced in 2002 Since 2002 (not 1974 as some reports have claimed), Israel has had legislation in place that requires all water suppliers to communities with populations of 5,000 or more to fluoridate their water. Before 2002 there was legislation that allowed local decision-making on schemes. Over recent years there has been a significant expansion of fluoridation schemes across the country. As many as 70% of the whole Israeli population are now benefiting, including residents in the three major cities of Jerusalem, Tel Aviv and Haifa. Study confirms significant dental benefits A recently reported study of 12-year olds in fluoridated Haifa and non-fluoridated Kfar Saba has confirmed the dental health benefits. Conducted in 2011/12 by the Department of Community Dentistry in the Dental Faculty of Jerusalem's Hebrew University, the study found that 12-year olds in fluoridated Haifa had an average of 0.98 decayed, missing and filled teeth, compared with 1.38 in non-fluoridated Kfar Saba. Fluoridated Jerusalem Fluoridated Haifa Fluoridated Tel Aviv

5 The study also found a much narrower gap in dental health between children from the most and least affluent backgrounds in Haifa than between the same groups in Kfar Saba. In this way, water fluoridation has helped to reduce health inequalities between Israeli children from relatively affluent and relatively deprived backgrounds. Legal manoeuvres by fluoridation opponents Despite the demonstrable benefits of water fluoridation, anti-fluoride groups in Israel have continued to campaign against it. Just after the 2002 legislation on mandatory fluoridation was enacted, the mayor of Herzliya, Yael German, took legal action to try to stop it from being implemented. The case she launched some ten years ago went right up to the Israeli Supreme Court, which dismissed it. In doing this, the judges confirmed that the Ministry of Health had responsibility for fluoridation under the legislation and that the evidence presented to the Court indicated that fluoridation was safe. More recently, in 2012, a private member's bill to stop fluoridation was defeated in the Knesset. Then, in November of that year fluoride opponents lodged another case with the Supreme Court. The main petitioner in this instance was not Yael German but the Izun Hozer Association for the Dissemination of Health Education in Israel, which is also opposed to a campaign by the Israeli government to vaccinate children against polio. Recent political changes and their impact A third key event in recent months also had major implications for fluoridation. In January 2013, a change of government occurred following Knesset elections. This brought Yael German to national office as the Minister of Health in the new coalition. As mayor of Herzliya, she had opposed mandatory fluoridation when it was being introduced in 2002/03 and has been an ardent opponent ever since. Inside the Knesset Israel Supreme Court

6 New regulations and their effect on fluoridation On becoming Minister of Health, Yael German declined to sign an order that would have allowed the mandatory fluoridation regulations to continue in force. Instead, she signed new regulations which perpetuate mandatory fluoridation for one year (up to August 2014), after which the mandatory component will lapse. Latest Supreme Court case struck from the list While all this post-election activity was taking place, the case lodged by fluoride opponents last November was waiting its turn to be heard. In July of this year it went before the Supreme Court which, on learning that the new Minister of Health had signalled the end of mandatory fluoridation from next year, decided that it was not worth allowing the case to go ahead. It was therefore struck from the Court list. There was no ban imposed from the highest judicial body in the land, as some elements of the anti-fluoride movement would apparently like everyone to believe. Lack of clarity on what will happen after August 2014 So what happens after August 2014? The situation is, to say the least, very confusing. Some commentators have interpreted the new regulations as, in effect, removing any statutory authorisation for fluoridation to take place, even on a voluntary basis in individual local authorities. However, comments by the Supreme Court on the wording of the new regulations suggest it is not clear whether, from that time, there will be no fluoridation at all or whether, as some have suggested, it will be up to individual local authorities to decide. From a dental public health perspective, it is to be hoped that Israeli children will not be denied the protection against tooth decay that many of them currently enjoy. Yael German, Israeli Minister of Health since 2013 and former mayor of Herzliya

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