title: Does dental health of 6-year-olds reflect the reform of the Israeli dental care system?
abstract: The National health insurance law enacted in 1995 did not include dental care in its basket of services. Dental care for children was first included in 2010, initially up till 8 years of age. The eligibility age rose to 12 years in 2013. The dental survey of 6 year-olds in 2007 found that the average of decayed, missing and filled teeth index (dmft) was 3.31 and 35 % of children were caries free. The current cross sectional survey of dental health for 6 year-olds was conducted as a comparison to the pre-reform status.
  
  
  
  Twenty-three local authorities were randomly selected nationwide. Two Grade 1 classes were randomly chosen in each. The city of Jerusalem was also included in the survey because of its size. The children were examined according to the WHO Oral Health Survey Methods 4th ed protocol. The dental caries index for deciduous teeth (dmft: decayed, missing, filled teeth) was calculated.
  
  
  
  One thousand two hundred ten children were examined. 61.7 % of the children suffered from dental decay and only 38.3 % were caries free. The mean dmft was 2.56; d = 1.41 (teeth with untreated caries), f = 1.15 (teeth damaged by decay and restored), virtually none were missing due to caries. Dental caries prevalence was rather consistent, an average of over 2 teeth affected per child. Although there is no major change in comparison to former surveys, there is more treated than untreated disease. In the present survey the f component is higher than in the past, especially in the Jewish sector where it is the main component. It is still lower in the Arab sector.
  
  
  
  Although the level of dental disease remained rather constant, an increase in the treatment component was observed. In order to reduce caries prevalence, preventive measures such as school dental services and drinking water fluoridation should be extended and continued. Primary preventive dental services should be established for children from birth, with an emphasis on primary health care and educational settings, such as family health centers and kindergartens.
authors.affiliation: Division of Dental Health, Ministry of Health, 37 Yirmiyahu Street, Jerusalem, Israel.
authors.forename: Lena
authors.initials: L
authors.lastname: Natapov
authors.affiliation: Association of Public Health, Jerusalem, Israel.
authors.forename: Avi
authors.initials: A
authors.lastname: Sasson
authors.affiliation: Division of Dental Health, Ministry of Health, 37 Yirmiyahu Street, Jerusalem, Israel.
authors.forename: Shlomo P
authors.initials: SP
authors.lastname: Zusman
mesh_terms: D002648:Child; D003430:Cross-Sectional Studies; D019140:Dental Care for Children; D003731:Dental Caries / Q000453:epidemiology*; D003753:Dental Health Surveys; D005260:Female; D018166:Health Care Reform; D006801:Humans; D007347:Insurance, Dental / Q000331:legislation & jurisprudence; D007557:Israel / Q000453:epidemiology; D008297:Male; D009909:Oral Health / Q000706:statistics & numerical data*; D015995:Prevalence; D017678:Sex Distribution; D016388:Tooth Loss / Q000453:epidemiology*
keywords: Children; Morbidity; National health insurance law; Prevention of dental diseases; Public health policy; Reform; Tooth decay