Oral Health and the Use of Dental Services by Older Adults Age 65+ in Israel


Oral health has a considerable effect on the quality of life and nutrition of older adults, since healthy natural teeth affect a person’s ability to chew, swallow, and speak. The aging process includes physiological changes, some of which have a negative effect on the person’s teeth and gums and their chewing ability, which are detrimental to physical health, social involvement, and the self-image of the older person.

International comparative studies show an inferior standing in the oral health of older adults in Israel compared to older adults in many other developed countries. This can be partially explained by the existence of barriers that make it hard for older adults in Israel to use dental services.

In 2019, a reform in dental services for the elderly was introduced, with the goal of improving access to the services and reducing some of the barriers. The reform, implemented in February 2019, made people aged 75+ eligible for preventive and preservative dental care through the basket of services under the National Health Insurance Law and from October 2019, prosthetic dental treatments would be included for those aged 80+.

The Myers-JDC-Brookdale Institute (MJB) and the Dental Health Department of the Ministry of Health jointly initiated the current study, since there is a lack of up-to-date epidemiologic information in Israel regarding the dental health of people aged 65+. The study will help policymakers to better tailor the provision of dental services to this population following the reform and make it possible to explore socioeconomic and geographical inequalities in the use of dental health services. Twenty years ago, MJB conducted a similar nationwide study,[1] which examined social and economic aspects of dental care in Israel among the whole population. The study findings served as an important basis for the changes that have taken place over the past two decades in aspects examined in the current study.

Study Goals

To learn about the oral health of individuals aged 65+ in Israel, to assess the extent of use of dental services, to examine the level of satisfaction with the services, and to identify the main barriers to their use.

Study Method

Telephone interviews with a representative sample of 512 people aged 65+ conducted from February to April 2020.

Main Findings

  • About two-thirds of people aged 65+ perceive their oral health to be good or very good.
  • 24% of people aged 65+ do not have any natural teeth. The remainder have on average 19 teeth. Ten percent have not lost any teeth. This is an improvement compared to the situation 20 years ago, when 52% of people aged 65+ had no teeth and the remainder had on average 10 teeth, while only 3% had lost none.
  • In the current study, in the 65-74-year age group, 19% have no teeth at all and the remainder have an average of 20 teeth. In contrast, among individuals aged 85+, 38% have no teeth at all and the remainder have an average of 13.
  • 39% of people who have difficulty covering their monthly expenses have no teeth – twice as many as those who manage to cover their monthly expenses (19%).
  • 39% of people aged 65+ have implants – 43% of those aged 65-74 and 26% of those aged 85+.
  • 44% of people aged 65+ have dentures – 37% among those aged 65-74 and 65% among those aged 85+.
  • Approximately 40% of those aged 65+ go to the dentist for preventive check-ups. The remainder do not, mainly due to lack of awareness of the importance of doing so. The aforementioned study conducted twenty years ago, found that 21% of people aged 65+ went to the dentist for a preventive check-up. Twenty-eight percent of those who find it hard to cover their monthly expenses go for preventive check-ups compared with 51% who do not have difficulty.
  • Almost half of the people aged 65+ went to the dentist in the previous year (three visits on average) and 20% reported that they have never been to the dentist. Thirty-five percent saw the hygienist in the previous year. The rates of use of dental services are lower in the periphery and among non-Jews and those who have difficulty covering their monthly expenses.
  • Approximately a quarter of the respondents who went to the dentist did so for urgent treatment. Almost a third reported that it was for prosthetic treatment and a third went for preventive treatment. The remainder went for other reasons.
  • The cost of dental treatment currently constitutes a barrier to service use, especially for those with difficulty covering their monthly expenses. Among all respondents, 38% of those who did not complete treatment noted this was due to cost, while 67% of respondents with difficulty covering monthly expenses reported this reason.
  • 75% of those aged 65+ go to private clinics and only 18% go to their health-plan clinic. The waiting time for an appointment is shorter in the private clinics and the percentage of respondents reporting that they are given explanations is higher, as is the overall rate of satisfaction with the clinic.
  • 95% of individuals aged 65+ are satisfied with their dentist. The relatively high rate of satisfaction was attributed to the orderliness and cleanliness in the clinic.
  • Fewer than half of those aged 65+ (43%) knew that dental care for older adults had been added to the basket of services provided by the health plans. In the 75-84-year-old age group, approximately half of them were aware, compared with 28% of those aged 85+.

Conclusions and Recommendations

  • The self-reported oral health of individuals aged 65+ is better today than it was 20 years ago.
  • Despite this improvement in the state of oral health and preventive health behaviors, there are still barriers to the use of the services. Lack of awareness regarding health behavior and the cost of treatment are the main barriers for people whose financial situation is inferior.
  • This study can inform policymakers regarding the provision of dental services at the national level and their geographic distribution. It can also assist them in setting goals for the coming years at the national level as well as for accessibility to dental health services for vulnerable population groups.
  • The finding that fewer than half of the people aged 75+ were aware of the reform in dental services requires a reconsideration of how to raise awareness of the changes it includes, particularly among those with lower economic status.

[1] Berg, A., Zusman, S. & Horev, T. (2001). Social and economic aspects of dental care in Israel in the era of National Health Insurance. RR-359-01 (Hebrew).