Defluoridation - What If?
It is not an easy time to be an advocate for fluoridation of the public water supplies. A UK study published in August 2024, suggested that recipients of water fluoridation received smaller positive health benefits than previously reported. It was seized on by those opposed to the public health measure.
Then, during the US election campaign, Robert F Kennedy Junior spoke of removing fluoride from water in states where levels had been added. From January 20th he will be the President’s Department of Health and Human Services Secretary.
So it might be useful if there was an example to show what happens when a country decides to stop fluoridating its water supplies. And, as it happens, there is.
The debates familiar here and in the USA lay at the root of the decision in 2013 by Israel’s Health Minister to end water fluoridation there. A decade on, it offers a case study into the effects of defluoridation. The debate continues there, with public health experts and some parents agitating for fluoride to be reinserted in the water, backed up by reports of worsening children’s dental health.
“The success of water fluoridation serves as a beacon for public health in general, and by extension, opposition to it should serve as a warning,” said Shlomo Zusman, who served as Israel’s Chief Dental Officer for over two decades and was a vocal critic of the 2014 policy change. He said modern water purification methods mean that fluoridation is far from the only way the water supply is altered. “The idea that water without added fluoride is ‘natural,’ as if it comes straight from a spring, is mistaken – there’s no such thing, it’s all manipulated,” he said.
Israel began mandating fluoridation in nearly all municipalities, decades ago, following the first local American fluoridation efforts. An Israeli Health Ministry webpage calls fluoridation “the most efficient, safest, simplest, cheapest, and most equal measure, by a significant margin, among all methods for preventing dental diseases in the general public.”
Then, in 2013, the health minister, pledged to stop requiring fluoridation the following year, citing unnamed doctors who she said had personally told her that fluoridation presents risks to pregnant women, people with thyroid problems and the elderly. Like Kennedy and his followers, she also cited the importance of individual choice.
Since discontinuing fluoride in tap water, Israeli dentists have observed a significant rise in children’s decay experience and have urged its reinstatement, though some parents remain firmly against the idea. A study published in September 2024 found a significant increase in dental restorations and crowns among children aged 3 to 5, attributing the rise to fluoride’s absence. The researchers, concluded that the results provided “further proof of the need to restore community water fluoridation in Israel.”
Another study, published in January 2022, analysed six years of data from dental clinics affiliated with a national healthcare network, and showed children aged between 3 and 12 needing nearly double the number of restorative treatments compared to before fluoridation ended. Researchers emphasized that even Israel’s expansion of free dental care for all children, failed to offset the worsening dental health.
Israel is not the only place to adjust its approach over time. Juneau, Alaska, saw child dental health worsen after eliminating fluoride in 2007, according to a study that examined the cost and frequency of dental treatment for children from low income families. In Canada, the city of Calgary, recorded higher rates of cavity-related treatments under general anaesthesia among children after it stopped adding fluoride to its water in 2011. Interestingly, Calgary has now decided to resume fluoridation.
A report on the debate in the Times of Israel which gave considerable space to anti-fluoridation views, drew criticism from public health experts. In the UK, Simon Hearnshaw, Chair of the North Yorks and Humber LDN, and Coordinator of the National Community Water Fluoridation Network, noted the increase in restorations required in Israel as well as the Calgary experience. He pointed out that recent research from Australia found no effect on child IQ from the very low concentrations of fluoride used in community schemes. He concluded: “The importance of science based public health decision making is key. Supporting improved health, particularly that of children in more deprived areas, must be a priority for all of us.”
