Dear Honorable Minister German,

We applaud your decision to end mandatory fluoridation in Israel and we look forward to the time that there is an outright ban on this reckless practice.

Your position is a model for the public health community both in Israel and in our respective communities. It is sound, based on the current literature and the need to protect the health of citizens from unnecessary ingestion of fluoride.

It is unfortunate that in making the best decision for the health and welfare of your citizens that you have been subjected to criticism and bullying as noted in the June 22rd article, Backlash against Health Minister Yael German for her decision to stop fluoridation, published in The Jerusalem Post (Siegel-Itzkovich).

Professor Paul Connett, co-author of The Case Against Fluoride (Chelsea Green, 2010), is willing to travel to Israel and publicly debate any of those who are organizing against you. However, in our experience the pro-fluoridation advocates are unable to defend their position in open public debate. This is not through a lack of debating skills on their part but rather the fact that science simply does not support their claims that swallowing fluoride is safe or that it dramatically reduces tooth decay.

The following facts and arguments underline the inappropriateness of this outdated practice:

Delivering any medicine via the water supply is reckless

Fluoridation violates all principles of modern pharmacology. Once added to water there is no way of controlling the dose or the people who get the medicine – it goes to everyone regardless of age, weight, health, need or nutritional status. Moreover, it violates the individual’s right to informed consent to medical treatment. (

Swallowing fluoride is particularly inappropriate

Fluoride is not a nutrient. Not one biochemical process in the body needs fluoride. Underlining this fact is the exceedingly low level of fluoride in mother’s milk (0.004 ppm, NRC, 2006, p.40). Formula-fed infants in fluoridated communities (at 0.7 to 1.2 ppm) receive 175 to 300 times more fluoride than a breast-fed infant.

Making matters worse is the fact that fluoride is known to have toxic properties at low doses (NRC 2006, Barbier et al., 2010; Varner et al., 1998). It also accumulates in the bone and builds up there over a lifetime. Early signs of fluoride poisoning of the bone (skeletal fluorosis) are identical to arthritis and lifelong accumulation can make bones brittle and more prone to fracture.

Dental fluorosis

While we do not see the crippling effects of skeletal fluorosis observed in countries like India and China, which have areas of high natural levels of fluoride, children in fluoridated countries are experiencing a very high prevalence of dental fluorosis. According to the CDC (2010) 41% of American children aged 12-15 have dental fluorosis. Black and Mexican American children have significantly higher rates of the more severe forms of dental fluorosis (CDC, 2005, Table 23).

Fluoridation promoters acknowledge that dental fluorosis indicates over-exposure to fluoride but refuse to admit other harm. A review of the toxicology of fluoride by the U.S. National Research Council of the National Academies in 2006 revealed that fluoride is an endocrine disruptor and causes many health problems at levels close to the exposure levels in fluoridated communities. This panel also reported that bottle-fed babies are exceeding the EPA’s safe reference dose when drinking fluoridated water (NRC, 2006, p85).

Fluoride impacts the brain

Many animal and human studies indicate that fluoride is a neurotoxin ( In 2012, a team that included Harvard University researchers reviewed 27 studies that showed an association between fairly modest exposure to fluoride and lowered IQ in children (Choi et al., 2012). In nine of these studies the so-called “high fluoride” village had fluoride levels less than 3 ppm. Such levels provide no adequate margin of safety to protect all children –especially the most vulnerable- from lowered IQ when drinking fluoridated water.

An incredible lack of oversight

Fluoridation is designed to treat a disease but has never been approved by the Food and Drug Administration (FDA); it classifies fluoride as an “unapproved drug.”

How strong is the evidence that swallowing fluoride reduces tooth decay?

Fluoridation advocates claim that it is very strong. However, if you look at the actual science it is a different story. The effectiveness of swallowing fluoride to reduce tooth decay has never been demonstrated via a randomized controlled trial (RCT), the gold standard of epidemiology (McDonagh et al., 2000). Two key U.S. studies – both government funded and by pro-fluoridation researchers – have failed to produce convincing evidence of benefit.

A very large study, administered by the U.S. National Institute for Dental Research, examined the permanent teeth of 39,000 children (aged 5-17) from 84 communities. The average saving in Decayed Missing and Filled Surfaces (DMFS) when comparing children in fluoridated and non-fluoridated communities was 0.6 of a tooth surface out of 128 tooth surfaces, and this was not shown to be statistically significant (Brunelle and Carlos, 1990). Even if it were, the average saving is remarkably small considering what risks are being taken to achieve this result.

As part of the “Iowa Fluoride Study,” where children’s tooth decay and fluoride intake has been tracked from birth, researchers examined the relationship between tooth decay and individual exposure to fluoride from all sources, including water, food and dental products. They were attempting to find the so-called “optimal dose” needed to reduce tooth decay, however they concluded that, “achieving a caries-free status may have relatively little to do with fluoride intake…” (Warren et al., 2009).

The most likely explanation for the weak evidence of benefit

Even fluoridation advocates have acknowledged that the predominant benefit of fluoride is topical, not systemic (CDC, 1999). In other words, fluoride works on the outside of the tooth not from inside the body. This acknowledgement removes the whole rationale for fluoridating water and forcing people who don’t want it to ingest it.

Most countries don’t fluoridate their water

The vast majority of countries (including 97% of Europe) neither fluoridate their water nor their salt. However, WHO figures indicate that tooth decay in 12-year-olds is coming down as fast in non-fluoridated countries as fluoridated ones (http://fluoridealert-migrate.local/issues/caries/who-data/ ).

Tooth decay in low-income families can be reduced by safer means

Many countries have been able to reduce tooth decay in low-income families using cost-effective programs without water fluoridation. The Scottish Childsmile program involves a) teaching tooth-brushing in nursery schools; b) advising parents on better diets; c) annual check-ups and d) fluoride varnishes where necessary. The number of 12-year-olds without caries has increased to over 70% using these methods and in the process costs have been cut by half (BBC Scotland, 2013).

Added benefit of emphasizing education

Making education, not fluoridation, the center of the fight against tooth decay has the added advantage of attacking the cause of obesity, an issue which threatens to cost health services billions of dollars over coming decades.

References after signatures


Paul Connett, PhD, Director, Fluoride Action Network, USA

Mary Lou Andersen, MS, Bellingham, Washington

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Bobbie Beckman, DDS, Bassano del Grappa, Italy

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