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.

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.

Dental Health and the Type of Antipsychotic Treatment in Inpatients with Schizophrenia.

AIM: This study examined the association between dental conditions in hospitalized patients with ICD-10 schizophrenia and type of antipsychotic treatment. Based on the literature suggesting that atypical antipsychotics are thought to be more tolerable than typical antipsychotics, we hypothesized that hospitalized patients with schizophrenia treated with atypicals would have better dental health than those treated with typicals alone or with a combination of both (combined group). METHODS: A representative sample of 348 patients (69% males), aged 51.4 (SD=14.5, range 31-58) years, was assessed on the standardized criteria of the Decayed, Missing and Filled Teeth (DMFT) index and component scores. Data on medication were extracted from patients' electronic medical records. RESULTS: Patients treated with typicals had significantly higher DMFT index scores than those who received atypicals (23.5±9.9 vs. 19.0±10.5; p < 0.05), and higher Missing (20.2±11.6 vs. 13.5±11.2; p < 0.01) and lower Filled (1.0±2.4 vs. 2.1±3.9; p < 0.05) teeth component scores. No between-group differences in Decayed component scores were found (2.3±3.4 and 3.4±5.0, respectively; p > 0.05). The combined treatment group was situated in between the typicals and atypicals groups on all measures. CONCLUSIONS: The results suggest that patients with schizophrenia maintained on atypicals have better dental health than patients treated with typicals or with a combination of both. From an oral health perspective, monotherapy with atypicals is superior to both typical and atypical/typical treatments. Although the choice between typical and atypical antipsychotic agents is based mainly on clinical psychiatric efficacy, the benefit of atypicals with regard to dental health should be taken into consideration in clinician's decision making.

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.

Dental attendance and self-assessment of dental status by Israeli military personnel according to gender, education, and smoking status, 1998-2006.

OBJECTIVE: The goal of the study was to analyze dental attendance and self-assessment of dental status among Israeli military personnel, according to gender, education, and smoking status. METHODS: Data were analyzed from a computerized questionnaire on dental attendance and dental status, completed by military personnel who attended one medical clinic for the required periodic medical examination between 1998 and 2006. RESULTS: For 60% of the respondents, the last dental visit was within the previous 12 months. The last dental visit was for scheduled treatment for 49.8%, a dental examination for 21.5%, and emergency dental treatment for 12.2%. College graduates rated their dental self-care higher than non-college graduates, and nonsmokers rated their self-care higher than smokers. Of the participants, 50.9% considered their own dental status good or excellent and 7.2% considered their oral health status poor. No significant differences were found according to gender. CONCLUSIONS: The findings indicated high dental attendance but low self-perception of dental status in Israeli military personnel in comparison with the Israeli general population and low attendance in comparison with U.S. Army personnel. A compulsory periodic dental examination among Israeli military personnel, similar to the required periodic medical examination, is recommended.

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.

Validation of a Hebrew version of the Oral Health Impact Profile 14.

OBJECTIVE: This study determined the validity of a Hebrew version of the Oral Health Impact Profile in a cross-sectional study of a general dental practice in Israel. METHODS: The original English version of a short-form oral health impact profile (OHIP-14) was translated into Hebrew using the back-translation technique. Participants were interviewed and examined clinically by a calibrated dentist. Information on the subjects' sociodemographic background and oral health conditions was collected. RESULTS: A total of 142 persons were interviewed and clinically examined. The Cronbach's alpha and the standardized item alpha for OHIP-14 were both 0.88. Cronbach's alpha of the translated OHIP-14 subscales ranged from 0.48 to 0.76. Construct validity of the translated Hebrew version was supported by the finding that the total OHIP score correlated with the number of decayed teeth, missing teeth, need for prosthodontic treatment, and pattern of dental attendance. Participants with oral pain were more likely to report impact on one of the OHIP subscales and to have more impacts than participants who were pain free. CONCLUSIONS: The Hebrew version of OHIP-14 presented acceptable validity and reliability. Further research is needed to assess the value of this measure in Israel.