Uptake of dental hygienist services by the Israeli 65+ age group.

OBJECTIVES: To learn about the use patterns of dental hygienist services, by the 65+ age group in Israel and to identify the main barriers facing different population groups. METHODS: Telephone interviews with a representative sample of 512 older adults aged 65 and over were conducted from February to April 2020. RESULTS: About 50% of the older adults aged 65 and over visited a dentist (2.9 visits on average) and 35% visited a dental hygienist in the year preceding the interviews. 17% reported never visiting a dentist and 45% never received care from a dental hygienist. Dental care use rates are lower in the outlying areas of the country, among non-Jews and among those who find it difficult to cover monthly household expenses. Those who regularly visit a dental hygienist maintain a preventive oral health routine, including tooth brushing and visits to the dentist for periodic preventive check-ups. They are aware of the harmful effects of eating sweets in between meals. Most of the older adults aged 65 and over are unaware of the reform under which hygienist' care was included in the basket of services provided by health plans. CONCLUSIONS: There is underutilization of dental hygienist services and lack of awareness of proper oral health behaviour in the lower socioeconomic group. As less than 50% of older adults are aware of the legal rights for dental care, there is a need to raise awareness of the reform and the services provided under it.

Methylphenidate use and restorative treatment needs in young adults with attention deficit hyperactivity disorder.

OBJECTIVE: To assess the effect and dose-response of methylphenidate (MP) use on the restorative treatment needs in young adults with attention deficit hyperactivity disorder. PARTICIPANTS AND METHODS: This retrospective study comprises a cohort of military recruits aged 18-25 who served for 12 to 48 months between 2005 and 2017. The medical records of 213 604 participants were assessed of which: 6875 participants with ADHD who received treatment with MP, 6729 participants with ADHD who had no prescriptions for MP, and 200 000 healthy participants. The outcome was restorative treatment needs, which served as an indicator of caries: having at least one prescription for restorative treatment during the study period. RESULTS: Frequency of prescription for restorative treatment among the treated, the untreated and the control groups was 24%, 22%, and 17%, respectively (p < .0001). On multivariate analysis, the dose-response association between MP use and the odds of having at least one restorative treatment was confirmed (OR = 1.006 for each additional 1 gr of MP; 95% CI [1.004:1.009]) CONCLUSIONS: Participants with ADHD who receive chronic treatment with MP have higher restorative treatment needs than participants with untreated ADHD and healthy participants. Our results show that chronic MP medication among young adults leads to an elevated need for restorative treatment and implies a significant impact on oral health (OH).

Factors affecting the use of dental services among Arab children in Israel: a qualitative study.

BACKGROUND: In 2010, Israel reformed its hitherto dominantly privately financed dental services and included preventative and restorative dental care for children in the publicly-funded basket of healthcare services. A survey conducted by Brookdale Institute, found that only 67% of low-income Israeli-Arab children were using the new service (compared to 85% of Jewish children) while the majority of others continue using privately funded services. The aim of this study is to explore and explain Israeli-Arab children's low utilization of publicly-funded preventive and restorative dental care. METHODS: A qualitative study designed to describe and understand the parents' motivations and choices. As a preliminary stage, eight semi-structured interviews were conducted with directors of HMO dental departments and Israeli-Arab dentists. In the second stage, ten one-on-one interviews with parents, and five focus group discussions with 55 parents held on February-March 2017. All discussions in the focus groups were conducted in Arabic and each group was moderated by one of the research team accompanied by another person who documented and recorded the discussion. All interviews and discussions were recorded, transcribed in full and translated into Hebrew. RESULTS: The prevalent attitude is that one goes to the dentist only when there is a serious problem. The importance of preventive care is not appreciated. A childhood fear of the drill is very remembered and passed onto the children. Social and cultural factors such as kinship with service providers (GPs and dentists) influence the choice and utilization of health services. Economic barriers are still existing since even the small co-payment is daunting to low-income parents of large families. Provision of the public service is inadequate in some Arab villages. CONCLUSIONS: The extension of Israel's National Health Insurance Law's basket of services to include dental care for children, while important, is not sufficiently embraced by Israeli Arab children. The remaining barriers include poor living conditions, low educational level that requires very clear sharing of information about the new service, and the resistance of cultural and social traditions. Public dental services providers should focus on conveying relevant oral health messages to the parents too, either through their children or directly.

Oral health disparities among the 65+ age group.

OBJECTIVE: Oral and dental health significantly impacts the quality of life and nutrition of the older population. While government action has been taken in Israel to reduce barriers to using dental care services by welfare recipients among older adults, there are still disparities associated with socioeconomic status in the older adult population. In 2019, a dental care reform for the older adults was implemented in Israel assuring dental Universal Health Coverage (UCH) for them. This has improved accessibility to dental services and reduced cost barriers. The aim of the present article was to explore the oral health disparities among the 65+ age group by their socioeconomic situation, and their additional barriers to using dental services at the start of the reform. METHOD AND MATERIALS: Telephone interviews were conducted with a representative sample of 512 older adults aged 65+ from February to April 2020. RESULTS: The self-perceived oral health status was rated as better in the higher socioeconomic group (73.4% perceived their oral health status as good or very good), compared with the lower socioeconomic group (52.5%). In the lower socioeconomic group, 38.5% were edentulous, compared with 18.1% of the higher socioeconomic group. The latter group had four more natural teeth, on average, than the former. Regarding the prevalence of dental problems, double and triple gaps were also found, as well as loose, sore, and sensitive teeth, and difficulty chewing. Oral health behavior, as reflected in tooth brushing patterns and routine preventive check-ups, was found to be better in the higher socioeconomic group than in the lower socioeconomic group. Dental care costs were found to be a barrier to dental care, primarily in the lower socioeconomic group (18.2%, compared with 4.8% of the higher socioeconomic group, were faced with a financial barrier). At the same time, 66.7% of the higher socioeconomic group were aware of the inclusion of dental care services for the older adult population in the basket of health services provided by the health plans, compared with 27.8% of the lower socioeconomic group. CONCLUSIONS: Lack of awareness to proper oral health behavior and to their legal rights were the main barriers to dental care in the lower socioeconomic groups. Dental practitioners play a vital role and have an opportunity to lower these barriers. Existing disparities and barriers should be monitored as a vital part of including dental care in Universal Health Coverage.

Dental team member compliance with personal protective equipment and aerosol-generating procedure recommendations during the COVID-19 pandemic in Israel: An observational study.

INTRODUCTION: Coronaviruses which have been responsible for numerous epidemics worldwide, share common transmission modalities and pose a risk within dental clinics. Updated, COVID-19-specific infection control and personal protective equipment (PPE) guidelines for dental settings, including minimizing aerosol-generating procedures (AGPs), were issued by the Israeli Ministry of Health (MoH) in spring 2020. This study investigated dental team members (dentists, dental assistants and hygienists) compliance with MoH recommendations exposed to asymptomatic COVID-19 positive patients. METHODS: The MoH analysed exposure reports from dental clinics to asymptomatic SARS-CoV-2 positive patients following their reopening (April 2020). Exposure reports were verified against a COVID-19 national database. A cumulative transmission rate was calculated and compared to the rate in the population. RESULTS: One thousand three hundred twenty-third exposure reports were received (May 1-December 31, 2020) regarding dental team members who treated asymptomatic SARS-CoV-2 positive patients: 525 (39.7%) were dentists, 656 (49.6%) dental assistants and 126 (9.5%) hygienists. Practitioner type was not reported in 16 (1.2%) cases. Most dental team members reported full PPE use and performance of short/non-aerosol-generating procedures. Dentists and hygienists reported higher compliance compared with dental assistants. 8 (0.6%) dental team members (four dentists, four dental assistants) were positive post-exposure, with an average of 5.4 days (median 5 days, SD = 4.8) from dental treatment to a positive COVID-19 test. PRINCIPAL CONCLUSIONS: Most dental team members complied fully with the MoH recommendations. Differences were found between the dental team members (hygienists being most adherent). Further efforts are required to encourage full compliance.

Oral health of the 65+ age group in Israel-2020.

BACKGROUND: In 2019, a reform of dental services for older adults was implemented in Israel to improve access and reduce barriers that stood in their way. The reform stipulated that preventive and restorative dentistry would be included in the basket of services of the National Health Insurance Law. The current study was conducted by the Myers-JDC-Brookdale Institute (MJB) and the Division of Dental Health of Israel's Ministry of Health to examine the dental status and patterns of utilizations of dental services among the 65+ age group. This paper reports on the dental status of the 65+ age group in comparison with the same population two decades earlier. GOALS: To describe the dental status of Israel's 65+ age group, and to identify the population at risk of dental morbidity. METHODOLOGY: Telephone interviews were conducted with a representative sample of 512 older adults aged 65+, from February to April 2020. MAIN FINDINGS: Some two-thirds of the 65+ age group assessed their oral health as good or very good. Twenty-four percent did not have natural teeth, while the rest had 19 teeth on average. Ten percent had not lost any teeth. In the 65-74 age group, 19% had no natural teeth and the rest had 20 teeth on average. In contrast, in the 85+ age group, 38% were edentulous and the rest had 13 teeth on average. Of the older adults who found it difficult to cover their monthly expenses, 39% were edentulous-twice the percentage of those who did manage to cover their monthly expenses (19%). Of the 65+ age group 44% had dentures-37% in the 65-74 age group, and 66% in the 85+ age group. Approximately 40% of the 65+ age group saw a dentist for preventive check-ups. The rest did not, mainly due to lack of awareness of the importance of doing so. CONCLUSIONS AND RECOMMENDATIONS: The perceived status of oral health among the 65+ age group is currently better than it was 22 years ago. However, despite the improvement in oral health and health behavior, there are still barriers to the utilization of dental services. The main barriers are a lack of awareness of the importance of proper health behavior, and the cost of care for people with financial difficulty. This study provides decision-makers with data on the status of oral health, the utilization of dental services and the geographical disparities. The findings will help policy makers evaluate the effectiveness of the reform and fine tuning it in the future. Policies should be instated to increase awareness of constituencies and their access to the services, in addition to the entitlements the reform granted.

Risk of SARS-CoV-2 transmission following exposure during dental treatment - A national cohort study.

OBJECTIVES: Health care workers are at an increased risk of SARS - CoV-2 transmission. The risk of infection for dental teams is assumed to be high, due to work settings, proximity to mouth, exposure to saliva and aerosols. There is a lack of evidence that quantifies the risk of SARS-CoV-2 transmission for dental patients and staff. Our objective was to assess SARS-CoV-2 transmission risk for dental staff members (DSMs) and patients following exposure in dental clinics during the second wave of the pandemic in Israel. METHODS: The study analyzed new positive SARS-CoV-2 cases following exposures in dental clinics from May to September 2020. Two data sources were used: case report forms (CRFs) and epidemiological investigations. CRFs were developed by the MoH and distributed to dental clinics to identify DSMs exposed to SARS-CoV-2 positive patients, and patients exposed to positive DSMs. SARS-CoV-2 status was diagnosed using MoH approved tests in certified laboratories and verified against the national COVID-19 database. Statistical analysis on a non-identified basis was performed. The population incidence and dental setting transmission rates were calculated for the study period with 95% Confidence Intervals. RESULTS: Following 962 reported exposures of DSMs to 508 SARS-CoV-2 positive patients, 7 DSMs were SARS - CoV-2 positive with a 0.7% cumulative transmission rate. Following 507 reported exposures by 43 SARS-CoV-2 positive DSMs, 3 patients were SARS - CoV-2 positive, with a 0.6% cumulative transmission rate. During the study period, the SARS-CoV-2 incidence rate in dental clinics was significantly lower when compared to the population. CONCLUSIONS: The transmission rate of SARS-CoV-2 in dental settings was very low for both patients and DSMs. CLINICAL SIGNIFICANCE: Our results suggest that routine dental care could be safely provided during the pandemic. Continuous monitoring should be performed due to the emergence of new variants and the vaccination programs.

Dental health of preschool children after two-years of a supervised tooth brushing program in Southern Israel.

BACKGROUND: Supervised tooth brushing is an important part of leading national oral health improvement programs in different countries. With the cessation of water fluoridation in 2014, a new program was immediately required to provide community-based caries prevention, especially amongst young children. The aim of this study was to determine whether a supervised tooth brushing program (STBP) in kindergartens could reduce dental caries amongst preschool children, when compared with children from the same community who did not participate in the program. The study was performed 2 years after the start of the program. METHODS: Two Jewish and two Arab local authorities (one participating and one control) were randomly chosen. In each local authority, 4 kindergartens (children aged 5) were randomly chosen, giving a total of 16 kindergartens. Children in the intervention group brushed once daily at kindergartens, with fluoridated toothpaste, for two school- years. All the children were examined using the WHO Oral Health Survey Methods Ed.4. RESULTS: Two hundred eighty-three five-year-old children were examined, 157 of them Jewish (86 participants in STBP, 71 non-participants) and 126 Arab (59 vs 67 respectively). Among Jewish children, the fraction of untreated decayed teeth was 61% in the participant group and 65% for non-participants, and amongst the Arab children 69% vs. 90% respectively. The fraction of treated decayed teeth for the participant group was 37% compared to 29% for the non-participants among Jewish children, whilst for the Bedouin group it was 23% vs. 8% respectively. CONCLUSIONS: After 2 years, supervised tooth brushing with fluoride toothpaste shows a favorable effect. This study suggests that dental health of children participating in STBP was better than the control group. Fewer carious teeth and more treated carious lesions were recorded in this group. This program can be applied to low SES communities nationwide. Guidelines for fluoride concentration in toothpaste for children should be re-considered based on high caries levels.

Sustainability of Supervised Toothbrushing in Israeli Nurseries - Teachers' Perspective.

PURPOSE: The national supervised toothbrushing programme was implemented in 2015-2016 among 3- to 4-year-old children attending 600 nurseries in Israel. The objectives of this study were to assess factors associated with sustainability of programme implementation, based on nursery teachers' attitudes towards the programme, beliefs in its success and willingness to continue it in in the future. MATERIALS AND METHODS: A phone survey was conducted among nursery teachers participating in the programme. Study objectives were assessed using a 19-item structured questionnaire. A linear regression model was built to identify factors which contributed to the positive attitude of the teachers towards programme sustainability. RESULTS: Some 300 teachers were interviewed over the telephone. The programme was implemented daily or several times a week in 66% of the nurseries. Around 70% of teachers reported willingness to continue the programme in the future. Teachers' confidence in programme success (r = 0.73), acknowledgment of their role in teaching children to brush their teeth (r = 0.53), tendency to like teaching toothbrushing (r = 0.59) were positively associated with their willingness to continue the programme. Teachers who anticipated more problems were less willing to implement the programme in the future (r = -0.34). Statistically significant differences in frequency of programme implementation were found according to teachers' attitudes towards the programme. A strong relationship (adjusted r2 = 0.71) was found between the teacher's positive perception of programme sustainability and the attribute variables. The degree of interest in continuing a programme and the belief in their ability to operate it attributed most to teachers' positive perception of programme sustainability. CONCLUSION: A high percentage of teachers expressed a positive attitude towards the programme. Factors contributing to the positive attitude of teachers towards programme sustainability were identified. The survey's results may help in the implementation of similar programmes and contribute to their future success.

Caries risk assessment tool and prevention protocol for public health nurses in mother and child health centers, Israel.

OBJECTIVES: Dental caries is the most prevalent chronic disease in children. Caries risk assessment tools enable the dentists, physicians, and nondental health care providers to assess the individual's risk. Intervention by nurses in primary care settings can contribute to the establishment of oral health habits and prevention of dental disease. In Israel, Mother and Child Health Centers provide free preventive services for pregnant women and children by public health nurses. MATERIALS AND METHODS: A caries prevention program in health centers started in 2015. Nurses underwent special training regarding caries prevention. A customized Caries Risk Assessment tool and Prevention Protocol for nurses, based on the AAPD tool, was introduced. A two-step evaluation was conducted which included a questionnaire and in-depth phone interviews. RESULTS: Twenty-eight (out of 46) health centers returned a completed questionnaire. Most nurses believed that oral health preventive services should be incorporated into their daily work. In the in-depth phone interviews, nurses stated that the integration of the program into their busy daily schedule was realistic and appropriate. The lack of specific dental module for computer program was mentioned as an implementation difficulty. DISCUSSION: The wide use of our tool by nurses supports its simplicity and feasibility which enables quick calculation and informed decision making. The nurses readily embraced the tool and it became an integral part of their toolkit. CONCLUSION: We provide public health nurses with a caries risk assessment tool and prevention protocol thus integrating oral health into general health of infants and toddlers.

Does dental health of 6-year-olds reflect the reform of the Israeli dental care system?

BACKGROUND: 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. METHODS: 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. RESULTS: 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. CONCLUSIONS: 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.

Oral Health-Related Quality of Life in the Elderly in Israel--Results from the National Health and Nutrition Survey of the Elderly 2005-2006.

PURPOSE: To assess the oral health-related quality of life of the Israeli elderly. MATERIALS AND METHODS: Data were collected from a subsample of those interviewed for the cross-sectional Mabat Zahav National Health and Nutrition Survey of the Elderly, carried out in 2005 and 2006 by the Ministry of Health in Israel. In-person interviews were conducted in the interviewees' homes using a structured questionnaire which included 7 questions on subjective dental health status and the 14 questions of the Oral Health Impact Profile 14 (OHIP-14). Statistical significance of continuous variables was assessed with the Student t-test; categorical variables with normal distribution were analysed using the chi-square test and those with non-normal distribution with the Wilcoxon Mann-Whitney two-sample test. RESULTS: 828 Jews and 159 Arabs from the total survey population of 1852 elderly (1536 Jews and 316 Arabs) completed the OHIP-14 questionnaire. An impact of oral health on the quality of life was reported by 16.6% of the respondents, 19.2% of females and 13.9% of males (p<0.05). There were statistically significant differences in impact prevalence by gender, place of birth and economic status. No such differences were found by age group, population group or education. Significant statistical correlation was found between subjective assessment of general and dental health and OHIP impact prevalence, with poorer assessment correlated with increased prevalence of impact. CONCLUSIONS: The quality of life of 17% of Israeli elderly is affected by oral health. The OHIP-14 findings emphasise the importance of including basic dental treatment (treatment of dental pain and infections) in the range of services covered by the National Health Insurance Law.

Validation of a Hebrew version of the child-OIDP index, an oral health-related quality of life measure for children.

PURPOSE: Sociodental indicators assess to what extent oral conditions interfere with normal social functions and alter behaviour such as attending work or school, parenting or home chores. The child OIDP (oral impact on daily performance), a sociodental indicator developed by Adulyan and Sheiham, is easy to apply and has a scoring system that quantifies the effect both by extent and frequency. The purpose of this study was to adapt the child OIDP into Hebrew and evaluate its validity and reliability. MATERIALS AND METHODS: The questionnaire was translated from English into Hebrew and back again. After receiving permission from parents and from the children attending the consultation clinic of the Department of Children's Dentistry at the Hebrew University-Hadassah Dental School, we examined their dental condition and asked them to answer the questions. According to the results, we analysed the reliability and the validity of the questionnaire. RESULTS: 179 children aged 6-11 years answered the questions. 88.8% of the children that attended the dental clinic experienced an oral or dental problem and 52.5% of them experienced interference in at least one of 8 everyday activities because of oral or dental problems in the 3 months prior to the interview. The OIDP was found valid in the aspects of Face, Content and Construct validity and with good internal reliability. CONCLUSIONS: The validity and the reliability of the Hebrew child OIDP found in the present study enables its use in future studies to assess the impact of oral health on children's quality of life.

An assessment of the dental health of chronic institutionalized patients with psychiatric disease in Israel.

Many institutionalized patients with psychiatric disease have been discharged into the community and the patients who remain hospitalized are at a particularly high risk for dental disease. This study assessed the oral health and treatment needs of chronically hospitalized patients with psychiatric disease in Israel. A random sample of 301 patients hospitalized for more than 1 year in 14 of 18 psychiatric institutions in Israel was drawn from the National Psychiatric Hospitalization Registry, and 84.4% of them were examined. Their dental status was evaluated using decayed, missing, filled teeth (DMF-T) index and demographic and medical data were retrieved from the patients' files. Of the 254 patients examined, 4 (1.6%) were caries-free, 176 (69%) patients had only a partial natural dentition, while 66 (26%) were edentulous. The average DMF-T score was 23.8. The caries component accounted for 2.7 of the DMF-T, the missing teeth component was 20, and the restored teeth component was only 1.1. There was a negative correlation between age and treated caries, and a positive correlation between age and missing teeth. Not all edentulous patients had dentures. These findings confirm the need to improve the oral health of chronic psychiatric inpatients and the need for dental treatment. The existing policy should be adjusted to integrate the currently separated delivery of the dental services for institutions and community settings. Dental professionals in the health service should be rewarded to restore teeth in this population rather than just to extract them.

Effect of implementing dental services in Israeli psychiatric hospitals on the oral and dental health of inpatients.

OBJECTIVE: Psychiatric disorders (schizophrenia, mood disorders, and organic brain disorders) and their treatment may lead to oral diseases, but assessment of dental status and oral care needs among patients with these disorders is lacking. This study reports changes in dental health and oral care needs of psychiatric inpatients after 1998, when psychiatric hospitals in Israel were required to provide regular dental examinations and treatment for every inpatient hospitalized longer than a year. METHODS: Two epidemiological cohorts from 1997 and 2006 representing long-term psychiatric inpatients before (N=431) and after (N=254) the reform of dental services were compared on the standardized criteria of the Decayed, Missing, and Filled Teeth (DMFT) index scores and DMFT component scores, as well as on the use of and need for dentures. RESULTS: Compared with the prereform cohort, the postreform cohort had fewer decayed teeth and lower DMFT index scores. These differences were independent of gender and clinical diagnosis. No between-cohort differences were found in the use of and need for dentures. On-site dental services were more effective than outsourced services in improving dental health. CONCLUSIONS: The results suggest a substantial improvement in the dental health of this at-risk population after the dental reform in psychiatric hospitals. However, oral health needs are still not fully met, and therefore, additional organizational efforts for further prevention and treatment of dental diseases are required.

National oral health knowledge, attitudes and behaviour survey of Israeli 12-year-olds, 2002.

OBJECTIVE: To gather epidemiological information on oral health knowledge, attitudes and behaviour of Israeli 12-year-olds. MATERIALS AND METHODS: A stratified, cluster, random and convenience sample of 12-year-old children was drawn. Stratification was by size of community, by administrative areas (regions) and by ethnicity (Jewish/other). The representative sample of 12-year-olds was asked to self-complete the questionnaire of ICS II, which was translated into Hebrew. The questions gather information regarding knowledge, attitude and dental health behaviour. RESULTS: 1294 children completed the questionnaire, of which 84% reported brushing their teeth once or more per day. Girls brushed 1.68 times more frequently than boys. Of the children, 64% had visited a dentist in the last year. The vast majority of the children (90%) expressed satisfaction with their last visit. CONCLUSIONS: Oral health habits of 12-year-old Israeli children are comparable to those of other countries. The dental health education in Israel should focus health messages to different schoolchildren according to the differences found in this survey.

Dental health of 12-year-olds in Israel-2002.

OBJECTIVE: To gather epidemiological information on caries prevalence and treatment needs of Israeli 12-year-olds. RESEARCH DESIGN: Prevalence survey of a representative sample of 12-year- olds examined according to WHO Oral Health Survey methods. RESULTS: The mean DMFT was 1.66 (DT = 0.91, MT = 0.03 FT = 0.72), a 40% decline since the previous national survey in 1989. DT and DMFT were lower amongst males (p < 0.01). There were no differences between urban and rural communities. Arab subjects had a higher prevalence, higher DT, MT and DMFT (p < 0.01), but lower FT than the Jewish subjects. In fluoridated areas, the mean DMFT was 1.39 compared to 1.83 in the non-fluoridated areas (p < 0.01). SiC (Significant Caries Index which shows the average DMFT of the third of the population with the highest DMFT) was found to be 4.31. CONCLUSIONS: Caries prevalence has declined among 12-year-olds in Israel. However, 53.9% of the children still suffer from caries at this age. There are wide dental health disparities.