Kol Torah proudly presents this third part of a Halachic piece written by Rabbi Dr. Ephraim Rudolph, a TABC alumus. His discussion on the permissibility of tooth brushing on Shabbat will be continued in this issue and concluded next week. Rabbi Dr. Rudolph grapples with recent scientific evidence that tooth brushing not only prevents oral diseases but might cure them as well. This raises the possibility that teeth brushing runs afoul of the rabbinic prohibition of Refuah, taking medicine on Shabbat. This issue will begin by advancing possible reasons to permit brushing teeth on Shabbat despite the recent findings.
Ma’achal Beri’im, Medicine:
Another leniency that might allow tooth-brushing on Shabbat is the heter of ma’achal beri’im. A sick person is allowed to eat and drink items on Shabbat that are normally consumed by healthy people, even if the sick person is using them for healing purposes. For example, many healthy people drink tea. Therefore, a sick person is also allowed to drink tea even if he does so in order to heal a sore throat. Perhaps fluoridated toothpaste should be considered a ma’achal beri’im, as it is used by healthy people, and it should therefore be permitted for use even by people with cavities or other dental problems.
However, the recent research regarding demineralization has demonstrated that a significant portion of the world’s population should be considered cholim with regard to their teeth, and it has also been found that a significant percentage of the population has gum disease. Furthermore, if ma’achal beri’im is dependent on specific times and places, there are many cities and areas in the world where the majority of people in that location have cavities. Therefore, given that many of the people using toothpaste are really “sick,” perhaps toothpaste cannot be considered a ma’achal beri’i.
Perhaps it be could argued that toothpaste is a ma’achal beri’im due to the fact that, as pointed out earlier, a sizable portion of the population does not need or benefit from remineralization. Their teeth are usually never found to be in a significantly demineralized state, or even if their teeth do become demineralized, the caries process rarely progresses from demineralization to cavity formation. These individuals should not be considered cholim regarding their teeth. Maybe their population numbers are large enough to create a ma’achal beri’im status for toothpaste.
However, even if it is argued that the non-cholim population is sizable enough to create a ma’achal beri’im status, toothpaste may still not be considered a ma'achal beri’im due to the fact that fluoride still affects refuah through remineralization for those who are considered cholim regarding their teeth. In a personal conversation, R. Schachter agreed that the classification of fluoride as a ma’achal beri’im is questionable. He compared this case to that of aspirin. Many people take aspirin on a daily basis, yet it is still forbidden for one to take aspirin on Shabbat for a minor headache. R. Schachter explained that even though many non-cholim take aspirin, aspirin is itself a medicine, and a medicine cannot be considered a ma’achal beri’im. The Minchat Yitzchaksimilarly writes that aspirin is “ikran lerefuah,” and it therefore cannot be considered a ma’achal beri’im. Similarly, even though most people do not know how toothpaste works, it is nevertheless ikran lerefuah and therefore should not be considered a ma’achal beri’im.
The Shulchan Shlomo (quoted above) also writes that if toothpaste can disinfect or reduce gingival inflammation, even though healthy people use it, it is still a question of whether or not there is a problem of refuah.
However, R. Moshe Stern writes that he heard that R. Yonasan Steif permitted the use of aspirin on Shabbat based on its classification as a ma’achal beri’im, and R. Schachter noted that R. Yosef Dov Soloveitchik also permitted taking aspirin on Shabbat. Therefore, according to these opinions, if most people are not considered cholim regarding their teeth, even if toothpaste is comparable to aspirin, brushing teeth with fluoridated toothpaste should be permitted on Shabbat due to it being considered a ma’achal beri’im.
Similarly, according to the view that use of fluoride does not constitute refuah, fluoride is more comparable to vitamins, as opposed to medication such as aspirin. There is a debate as to whether nowadays vitamins are considered ma’achal beri’im. In the view of R. Moshe Stern and R. Moshe Sternbuch, vitamins are permitted nowadays according to all opinions because so many people take them that they should be considered ma’achal beri’im. While other modern day poskim believe that vitamins are still not considered ma’achal beri’im, according to R. Moshe Stern and Rabbi Moshe Sternbuch’s view, if we accept the argument that fluoride can be compared to vitamins, toothpaste should also be considered a ma’achal beri’im. According to the other position, even if toothpaste is comparable to vitamins, toothpaste would still not be considered a ma’achal beri’im.
However, R. Sternbuch himself concludes that there is a distinction between who is taking the vitamin. If one is taking the vitamin for “refuah” because he has a weakness, then one should be strict and not take the vitamin on Shabbos. But if one is healthy and the vitamin is purely for prevention, then it should be allowed. The same distinction should apply to tooth brushing. For those who are brushing for oral hygiene and for those who have many cavities, it should be forbidden for them to brush on Shabbat. But for those who have good teeth and are brushing for prevention, brushing is allowed on Shabbat.
 There is a debate among the Rishonim regarding the reason that ma’achal beri’im is permitted on Shabbat. Rashi (Shabbat 108b) is of the opinion that consumption of ma’achal beri’im creates a “refuah she’einah nikeret” – in Rashi’s words, “lo muchacha milta.” Since healthy people use this item, if a sick person uses it on Shabbat, it would not be evident that he does so for refuah purposes. The Rashba (Berachot 38a) suggests another explanation: any normal food item that healthy people eat or drink is not included in the decree of shechikat samamanim. See also Ra’ah, Berachot 38a; Ritva, Shabbat 111; and possibly Rambam, Hilchot Shabbat 21:21-22.
According to the second approach it could be that anything that is not a food or drink (or ointment) item would automatically not be considered a ma’achal beri’im. However, the Sha’arei Teshuvah 328:30 discusses whether or not snuff is a ma’achal bri’im and snuff is not a food item. Therefore it could be that l’halacha, even non-food items can be classified as ma’achal bri’im.
 Rav Asher Weiss also utilized this leniency in his teshuva addressed to this author.
 J.M. Albandar and T.E. Rams, “Global Epidemiology of Periodontal Diseases,” Periodontol 29 (2002): 7-10; R.C. Oliver, L.J. Brown, and H. Löe, “Periodontal Diseases in the United States Population,” J Periodontol 69 (1998): 269-78.
 It may be important to note that Rabbi Moshe Zweig, who ruled that brushing was forbidden on Shabbat based on the issur of refuah, clearly did not believe that ma’achal beri’im was a valid leniency. Also, Rabbi Ovadia Yosef does not use ma’achal beri’im as another reason to reject Rabbi Zweig’s opinion.
 Minchat Yitzchak 3:35:2. Rabbi Moshe Sternbuch, in Teshuvot V’Hanagot Orach Chaim 3:104, writes that vitamins are not a problem even according to the Magen Avraham because the Magen Avraham was talking about a case where even though healthy people are using an item and perhaps the item could be considered a ma’achal beri’im nevertheless, since the item is “ikar l’refuah”, essentially medicine, it is not allowed to be used on Shabbat even for prevention. But vitamins in general are not “ikram l’refuah.” Therefore, even the Magen Avraham would permit it for prevention on Shabbat. However, this may not be true of fluoride. Fluoride in the scientific community may be viewed as a vitamin that is “ikram l’refuah,” meant to heal cavities. Therefore, even if it used for prevention, according to Rabbi Sternbuch it may be problematic.
Be’er Moshe 1:33:5 and 2:32. R. Stern writes that he is personally wary of this psak.
 Yalkut Yosef (328:51) writes that although some authorities are lenient, the halacha follows the view of those who are strict. See also Pitkei Teshuvot 328, n. 499, who lists additional Poskim who agree with the lenient approach, but writes that the practice is to be strict, as many Poskim are machmir.
 Be’er Moshe 1:33:4; Teshuvot V’Hanagot Orach Chaim 3:104.
Minchat Shlomo Tinyana 60:16. See Pitei Teshuvot 328, n. 496, for a list of Poskim who prohibit vitamins on Shabbat.
 The comparison to vitamins based on the idea that fluoride does not create refuah is not exact. As noted above, n. 26, there may be some vitamins that can create refuah. R. Stern distinguishes between vitamins that are used to strengthen and fortify, used for prevention, and vitamins that are “lerefuah.” Regular vitamins are ma’achal beri’im, while vitamins lerefuah are not. If one does not want to compare fluoride to a real medication yet still views remineralization as refuah, fluoride should be compared to vitamins that are lerefuah, and it would not be ma’achal beri’im.
It is unclear from the Be’er Moshe why the classification of ma’achal beri’im does not apply to these types of vitamins. It appears that he does not include this category of vitamins as ma’achal beri’im because he considers them a completely separate category from regular vitamins. Vitamins taken lerefuah therefore cannot be subsumed under the regular vitamins’ heter of ma’achal beri’im; they would need to be evaluated independently. This implies that vitamins lerefuah could theoretically be considered ma’achal beri’im; they aren’t simply because the consumption of that category of vitamins is not widespread. If so, even if toothpaste is comparable to a vitamin lerefuah, since the use of toothpaste is widespread, it should be considered a ma’achal beri’im.
 Ibid. Additionally, R. Sternbuch writes that some Poskim do not allow the use of vitamins on Shabbat because vitamins have a bad taste and are not fit to be eaten. Therefore, he writes, even if they are consideredma’achal beri’im, it is best not to take them if there is no real need to do so on Shabbat. Similarly, toothpaste is not fit for consumption.