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Water Fluoridation in Israel: Ethical and Legal Aspects

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Fluoridation of community drinking water for prevention of dental caries commenced in the United States in 1945 and has become one of the major achievements of public health according to the US Center for Disease Control. It has been adopted widely, mainly on voluntary basis by local authorities responsible for community water supplies. Fluoridation is the most effective method to prevent dental caries at the community level and promotes equality because all benefit regardless of their awareness or the importance they give to dental health. However, fluoridation is still regarded as an unnecessary and allegedly harmful intervention by a few dedicated opponents who express their views through aggressive postings on the internet and all other channels of communication.

After many years of failed attempts to implement “voluntary” fluoridation by local authorities, Israel implemented mandatory fluoridation legislation in 2002. Public controversy and persistent opposition led to challenges to the legislation passed by the Israeli Knesset (parliament) and brought the matter to the Supreme Court. The Court confirmed the Ministry of Health’s responsibility for the health of the public and that the evidence presented indicated fluoridation was a safe and reasonable measure to help achieve that mandate. Fluoridation has since been implemented across the country based on this legislative mandate. In 2012, a private bill to stop fluoridation was defeated in the Knesset. This case represents an ideological struggle between opponents to a public health measure and its resolution in a higher court decision in favor of safe and effective public health benefits and in legislation.


  1. 1.

    McKay FS. Relation of mottled enamel to caries. J Am Dent Assoc. 1928;1429–37.

  2. 2.

    Churchill HV. Occurrence of fluorides in some waters of the United States. J Ind Eng Chem. 1931;23:996–8.

  3. 3.

    Dean HT. On the epidemiology of fluorine and dental caries. In: Gies WJ, (editor). Fluorine in Dental Public Health. New York, NY: New York Institute of Clinical Oral Pathology; 1945. p.19–30.

  4. 4.

    Ast DB, Schlesinger ER. The conclusion of a 10-year study of water fluoridation. Am J Public Health. 1956;46:265–71.

  5. 5.

    World health Organization. Fluoridation and Dental health. WHO. 23 July 1969.

  6. 6.

    Centers for Disease Control and Prevention. Ten great public health achievements. MMWR Morb Mortal Wkly Rep. 1999;48:241–3.

  7. 7.

    British Fluoridation Society. One in a Million: the facts about water fluoridation, 3rd edition. March 2012. Available from URL: (accessed 31 October 2012).

  8. 8.

    Centers for Disease Control and Prevention. Achievements in public health, 1900–1999: fluoridation of drinking water to prevent dental caries. Morb Mortal Wkly Rep. 1999;48:933–40.

  9. 9. Staff and Associated Press. Portland approves fluoride: ‘science is on the side of fluoridation’. 12 September 2012. Available from URL: http:// (accessed 31 October 2012).

  10. 10.

    Mullen J. History of water fluoridation. Br Dent J. 2005;199:1–4.

  11. 11.

    No author. Southampton water fluoridation was not unlawful. 11 February 2011. Available from URL: (accessed 31 October 2012).

  12. 12.

    Toubi T. Knesset proceedings parliamentary question no. 3378. Israel. 1967.

  13. 13.

    Laws of Israel. Amendment No.4 to the Public Health Ordinance. 1970. para 52B(a) p.102.

  14. 14.

    Department of Environmental Health. Drinking water quality, report of Advisory Committee, Ministry of Health. 1973. [In Hebrew].

  15. 15.

    Public Health Regulations. Drinking water quality, 3117. Israel; 1974. p.556–65.

  16. 16.

    Kelman AM. Fluoridation of community drinking water. Jerusalem: Department of Dental Health, Ministry of Health; 1976. [In Hebrew].

  17. 17.

    Department of Dental Health. Fluoride in water reduces dental caries. Jerusalem: Ministry of Health, Department of Health Education; 1979. [In Hebrew].

  18. 18.

    Crain RL, Katz E, Rozenthal DB. The Politics of Community Conflict: The Fluoridation Decision. Indianapolis, IN and New York, NY. The Bobbs-Merrill Co., Inc.; 1969.

  19. 19.

    Kelman AM. The social strategy of fluoridation — The Israel Case Study. National Workshop on Health Service Planning and Management. Ministry of Health; 1982.

  20. 20.

    Grinplastch BS. Assignment report — fluoridation of water supplies in Israel. WHO; 1982.

  21. 21.

    Atzmon I. From fluoride to hydrofluorosilycic acid. The big absurd: from the Nazi era to coercion in Israel. 2002.

  22. 22.

    Sixtieth World Health Assembly. WHA60.17. 23 May 2007.

  23. 23.

    Nuffield Council on Bioethics. Public health: ethical issues. London; 2007.

  24. 24.

    Zadik D, Zusman SP, Kelman AM. Caries prevalence in 5- and 12-year-old children in Israel. Community Dent Oral Epidemiol. 1992;20:54–5.

  25. 25.

    Zusman SP, Ramon T, Natapov L, Kooby E. Dental health of 12-year-olds in Israel-2002. Community Dent Health. 2005;22:175–9.

  26. 26.

    Milgalter N, Zadik D, Kelman AM. Fluorosis and dental caries in Yotvata area. J Israel Dent Assoc. 1974;23:104–9.

  27. 27.

    Zadik D, Kelman AM, Vered Y. Prevalence and severity of fluorosis in Israel. J Israel Dent Assoc. 1998;15:13–6.

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Correspondence to Shlomo P. Zusman DMD, MSc(DPH), MPA.

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Zusman, S.P. Water Fluoridation in Israel: Ethical and Legal Aspects. Public Health Rev 34, 6 (2012) doi:10.1007/BF03391658

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Key Words

  • Community water fluoridation
  • ethics in public health
  • legislative mandate in public health
  • Israel