The Child Dental Care Reform in Israel - Age-related Patterns of Uptake: 2011 to 2022

Background : The Child Dental Care Reform introduced in Israel in 2010 aimed to provide universal dental coverage for children, addressing high caries morbidity and inequalities in access to care. The reform initially covered ages 0-8 and expanded to include all children up to age 18 by 2019. This study examines age-related patterns of dental service utilization during the first decade of its implementation. Methods : This retrospective study analyzed anonymized dental service data from 2011-2022, submitted by the four Health Maintenance Organizations to the Israeli Ministry of Health. The data included the number of children treated, categorized by age group, and the types of treatments provided. Results: Service utilization showed distinct age-related patterns, with rates peaking at age 8 (48%) and gradually declining through adolescence (p<0.001). Restorative treatments consistently outnumbered preventive care across all age groups (p<0.001), with children aged 3-5 receiving the most restorative procedures per child. Preventive treatments increased with age, from 1.0 per patient in young children to 1.5 in teenagers, transitioning from mainly dental examinations in younger children to hygienist visits in adolescents. Restorative treatments included dental restorations (peaking at 50% at ages 8-9), extractions (25% at ages 10-11), and pulp treatments (25% at ages 6-8). Emergency dental visits were most common in infants and increased by 83% over the course of a decade (p<0.001). General anesthesia utilization increased significantly in the younger age groups, with the 4-5 age group showing the most dramatic increase (2.39-fold increase, p<0.001). Conclusion: This study highlights distinct age-related patterns in dental service utilization among children in Israel, emphasizing the need for targeted prevention strategies and policy reforms to address current challenges disparities, including the increasing rate of treatment under general anesthesia. Preventive interventions, such as community water fluoridation and early childhood programs, alongside improved access to specialized dental care, are essential for fostering better long-term oral health outcomes. Integrating quality indicators will facilitate better incorporation of dental services into the national health system, ensuring comprehensive and equitable oral care.