End of Mandatory Fluoridation in Israel , Ministry of Health

End of Mandatory Fluoridation in Israel

Subjects:
Public health; Dental Health; Environmental health
Publish Date:
17/08/2014 11:00

End of mandatory fluoridation in Israel - starting from 26-Aug-2014  

On 26th August 2014, the clause in the Water Regulations that ends the obligation to fluoridate water in Israel will come into force, and practically speaking, there will be no fluoridation in Israel. The Water Regulations were formulated in accordance with the recommendations of the “Adin Committee”, which considered the issue, and recommending ending mandatory fluoridation in Israel. The Regulations were approved by the Internal Affairs and Environment Committee of the previous Knesset. The Regulations determine that within a year of their publication, mandatory fluoridation will stop in Israel.

With the cancellation of the obligation to fluoridate, Israel joins the vast majority of countries in the world in which fluoridation is not mandatory. Furthermore, according to data from the World Health Organization, there is a decline in dental caries also in countries that did not fluoridate their drinking water. At the international level, mandatory fluoridation exists only in Ireland. There are countries, such as Holland, Sweden and the Czech Republic, in which it is forbidden to fluoridate drinking water.

In the framework of the process of stopping fluoridation, guidelines will be refreshed in respect of the need for dental health education for all professional parties in the field - at Tipat Halav mother and infant care centers, at dental clinics, at HMOs (kupot cholim), at student health services in schools and dental health services in schools, in parallel with guidelines to kindergarten teachers and school teachers in the education system. 
 
The guidelines are to carefully adhere to the rules for brushing teeth twice per day with toothpaste that contains fluoride. 

The Minister of Health, Yael German: “I am pleased that we have joined the majority of countries in the world that do not fluoridate or that even forbid the fluoridation of drinking water. Adding fluoride to drinking water forces the consumption of fluoride also upon those who are not desirous of this, an approach that is not accepted in the vast majority of countries of the world.”
 

The main points of the Dental Health Promotion Program formulated by Ministry of Health experts as an alternative to mandatory fluoridation


Actions focused upon populations that are at elevated risk for dental caries

The program will operate in the following two frameworks, allowing access to and action among children in these age groups:

  • Family Health Centers (Tipat Halav mother and infant care centers)
    The only framework for infants up to the age of 3 is at the Tipat Halav mother and infant care centers. The organizational system that conducts health and developmental monitoring of toddlers is the Tipat Halav network, thus constituting the natural place for promoting dental health at these ages.
    The program proposed for this age groups includes:
    • During pregnancy: Guidelines to pregnant women regarding the maintenance of their own dental health, the need to expel foci of infection and to reduce the level of oral bacteria prior to childbirth.
    • From childbirth: Assessment of the child’s level of risk for caries and parental guidance will be performed during routine visits, together with child development examinations and administration of vaccines.
      Activity will include:  
      • Emphasis of breastfeeding in the context of oral health and development of the jaws.
      • Guidance for maintenance of oral hygiene of the child / family.
      • Examination of the oral cavity and the young deciduous dentition and assessment of risk for caries based on professional criteria.
      • Adaptation of counseling regarding dental health to the baby/toddler’s level of risk.
      • If needed, guidance for changing nutritional habits and oral hygiene. 
      • Application of a fluoride preparation on infants’ teeth, depending on the level of risk for caries. Monitoring in accordance with the level of risk. 
      • Referral to a dentist for infants who require this.
      • Training of Tipat Halav staff (public health nurse/ pediatrician) in the above fields. 
      • Implementation: Pilot at a number of Tipat Halav centers, with an emphasis on the South of Israel, one of them in the Bedouin dispersal. 
  • Kindergarten for Ages 3-5
    The extension of free education to young preschool ages enables the implementation of health promotion in an organized educational framework. The ages of the final year of preschool are included in student dental health services, and receive dental health education.
    The proposed program for this age group is brushing of teeth, under the supervision of the kindergarten teachers at kindergarten, using toothpaste that contains fluoride. Such programs have been scientifically assessed, and found to be effective in preventing caries.  
    This activity aims to change the system while creating new norms. Kindergarten teachers and their assistants will act as “sub-agents”, will operate the program and will facilitate its implementation, with the aim of empowering kindergarten teachers and parents to develop children’s personal skills. 
  • General activities:
    • Preventative health activities via student dental health services provided by the Ministry of Health in all schools.
    • Formulation of recommendations, and conveying guidelines to pediatricians, family physicians and dentists.
    • Later, in accordance with lessons that will be learned, activity in kindergartens is expected to be extended to all kindergartens.
Additionally, clinical monitoring surveys of dental morbidity will be performed. The surveys will be performed in a stepwise manner, at a frequency of once every 3 years, both for children and for the adult population (by accepted age groups), with the aim of the early recognition of changes in dental morbidity (from an epidemiologic viewpoint) and of the efficacy of the alternative programs.
 

Questions and Answers Concerning the Ending of Fluoridation on Israel

  • When will mandatory fluoridation be stopped in Israel, and what is the significance of mandatory fluoridation?
    On 26th August 2014, the clause in the Water Regulations that ends the obligation to fluoridate water in Israel will come into force. The Water Regulations were formulated in accordance with the recommendations of the “Adin Committee”, which considered the issue, and recommending ending mandatory fluoridation, and practically speaking, there will be no fluoridation in Israel. The Regulations were approved by the Internal Affairs and Environment Committee of the previous Knesset. As has been stated, the Regulations determine that within a year of their publication, mandatory fluoridation will stop in Israel. 
  • What was the situation in Israel until August 2014?
    Until now, approximately 70% of the water in Israel was fluoridated, in accordance with legislation requiring towns with over 5,000 residents to receive fluoridated water. 
  • What are the reasons for ending mandatory fluoridation in Israel?
    Only some 1% of the water is used for drinking, while 99% of the water is intended for other uses (industry, agriculture, flushing toilets etc.). There is also scientific evidence that fluoride in large amounts can lead to damage to health. When fluoride is supplied via drinking water, there is no control regarding the amount of fluoride actually consumed, which could lead to excessive consumption. Supply of fluoridated water forces those who do not so wish to also consume water with added fluoride. This approach is therefore not accepted in most countries in the world. 
  • What is the international situation in all that pertains to mandatory fluoridation?
    Mandatory fluoridation exists only in Ireland.
    There are countries, such as Holland, Sweden and the Czech Republic, in which it is forbidden to fluoridate drinking water.
    Below is a table that details levels of fluoridation in countries that fluoridate (as at November 2012). In the remaining countries, drinking water is not fluoridated.
  • Are there differences in the level of dental caries between countries that fluoridate water and those that do not fluoridate?
    Data from the World Health Organization indicate that there is no significant difference in the level of dental caries between countries that fluoridate and those that do not fluoridate.
  • Are there guidelines to the public following the end of fluoridation?
    The guidelines are to carefully maintain proper nutrition, adhere to the rules for brushing teeth twice per day with toothpaste that contains fluoride, and regularly visit the dentist.Fluoride supplementation for children will be given in as decided by the dentist. 
  • What do the Ministry of Health’s plans following the end of mandatory fluoridation include?
    In the Ministry of Health, a Dental Health Promotion Program has been formulated as an alternative to mandatory fluoridation:
    Children up to the age of 5 - The program will operate in the following two frameworks, allowing access to and action among children in these age groups: 
    • Family Health Centers (Tipat Halav mother and infant care centers) - The only framework for infants up to the age of 3 is at the Tipat Halav mother and infant care centers. The organizational system that conducts health and developmental monitoring of toddlers is the Tipat Halav network, thus constituting the natural place for promoting dental health at these ages.
      The program proposed for this age groups includes:
      • During pregnancy: Guidelines to pregnant women regarding the maintenance of their own dental health, the need to expel foci of infection and to reduce the level of oral bacteria prior to childbirth.
      • From childbirth: Assessment of the child’s level of risk for caries and parental guidance will be performed during routine visits, together with child development examinations and administration of vaccines. In general terms, activity will include:  
        • Emphasis of breastfeeding in the context of oral health and development of the jaws.
        • Guidance for maintenance of oral hygiene of the child / family.
        • Examination of the oral cavity and the young deciduous dentition and assessment of risk for caries based on professional criteria.
        • Adaptation of counseling regarding dental health to the baby/toddler’s level of risk.
        • If needed, guidance for changing nutritional habits and oral hygiene. 
        • Application of a fluoride preparation on infants’ teeth, depending on the level of risk for caries. Monitoring in accordance with the level of risk. 
        • Referral to a dentist for infants who require this.
    • Kindergarten for Ages 3-5. Implementation of health promotion in an organized educational framework. The ages of the final year of preschool are included in student dental health services, and receive dental health education. 
The proposed program for this age group is brushing of teeth, under the supervision of the kindergarten teachers at kindergarten, using toothpaste that contains fluoride. Such programs have been scientifically assessed, and found to be effective in preventing caries.  
  • What is the significance of the research that will accompany the ending of fluoridation?
    The research is intended to assess the long-term effect of stopping fluoridation from the viewpoint of the incidence of caries, and monitoring of the applicability and efficacy of the alternative intervention program.
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