Dentistry in Israel

Israel's health system has offered universal coverage since the introduction of a progressively financed statutory health-insurance scheme in 1995.[4] Citizens choose among four competing nonprofit health maintenance organizations (HMOs) — Clalit, Maccabi, Meuhedet, and Leumit — which provide a government-defined benefits package.[4][5] The Ministry of Health serves as the central authority for licensing medical, dental, nursing, pharmaceutical, and paramedical professions and is responsible for implementing health legislation enacted by the Knesset.[5]

Historically, dental care was provided mainly through the private market, making it structurally distinct from hospital and general medical services.[6] National health-insurance premiums are proportional to income, with the National Insurance Institute distributing collected funds among the health organizations according to enrolled population and the special needs of particular groups.[5] Insured people may receive dental and optical care at reduced rates, while supplementary services can be purchased through health funds or private insurance companies.[5]

National spending on dental care, measured in NIS millions, grew from 806 in 1971 to 2,495 in 1991 and reached 4,227 in 2001 before stabilizing at around 4,700 through the late 2000s.[7] Total dentistry expenditure was NIS 5.3 billion in 2010 — representing 7.5% of national healthcare expenditure — and NIS 7.7 billion in 2020, equal to 6.9% of healthcare spending.[1]

Israel's National Health Insurance Law was enacted in 1994 and implemented in January 1995, initially excluding most dental services and leaving households to finance dental treatment out of pocket.[5][1] A 2013 Taub Center report found that among Israelis who needed medical attention, almost 50% forewent dental care for financial reasons, compared with 16% who forewent other medical treatment and 15% who forewent medicines. More than half of people in the 25th-to-50th income percentile and 35% of those earning above the median wage also forewent dental care because of cost.[8]

On July 21, 2010, the Knesset passed Amendment No. 50 to the National Health Insurance Law, extending dental-care coverage to all Israeli residents and authorizing the Minister of Health to recognize dental-insurance funds specifically for providing subsidized general dental care.[9] Under the amendment, eligible people could receive dental services through either designated dental-insurance funds or general health-care insurance funds. Companies seeking recognition as dedicated dental-insurance funds had to submit applications with financial guarantees and information about their financial condition.[9] The reform followed a prolonged legal and political dispute, including a petition to the High Court of Justice, while the proposed role of private dentists remained contested during implementation.[10][11]

Initial implementation in July 2010 covered children up to age eight without requiring supplementary health insurance.[10] Contemporary reporting said treatment required a participation payment of NIS 20 and that eligibility was planned to expand by two age years annually, reaching children up to age 14 by 2013.[11] A later academic study summarized the 2010 legislation as providing free care for children under age 10 and stated that coverage was gradually extended to adolescents under age 18 by 2018.[12]

In January 2019, the government expanded subsidized dental treatment to children and adolescents up to age 18. Some services were provided without a copayment, while others cost NIS 24 per procedure, with total payment capped at NIS 49 per visit.[13] The same reform package provided state-subsidized dental care for people aged 75 and older.[13] A May 2022 ministerial order subsequently expanded elderly eligibility to people over age 72, effective July 1, 2022.[1]

Nationwide water fluoridation began in 2002 and was associated with a significant reduction in childhood caries, but the practice was discontinued in 2014 following a legislative change.[12]

Children from birth through age 18 are entitled through their HMOs to preventive and restorative dental care under the national health-services basket.[14] Preventive services — including annual examinations, treatment-planning visits, dental X-rays, oral-hygiene instruction, scaling, fluoride treatments, and dental sealants — are provided without a copayment.[14] Restorative services such as emergency care, amalgam or composite fillings, pulp treatment and root canals, crowns, extractions, space maintainers, nitrous-oxide sedation, and general anesthesia for children up to age five with early-childhood caries are available with a low copayment.[14] Orthodontic treatment is excluded from the basket.[14]

Under current Ministry of Health rules, children under 18 receive covered dental care either free or for up to ILS 25.93 per treatment. The copayment is charged per course of treatment regardless of the number of visits and is capped at ILS 51.86 per visit when multiple chargeable treatments are provided.[15] Private treatments are not reimbursed.[15]

School-based dental-health services are administered by local authorities for students from kindergarten through ninth grade, with some authorities extending eligibility to pre-kindergarten.[14] These services include annual dental examinations, referrals for further care, toothbrushing instruction, fluoride-varnish application in preschools, annual distribution of toothbrushes and toothpaste, and oral-health education through the "Shenli" program. Dentists, dental hygienists, and dental assistants deliver the program in coordination with educational staff.[14]

In January 2019, 781 clinics participated in the children's dental reform: 253 associated with Clalit, 97 with Maccabi, 156 with Meuhedet, and 275 with Leumit.[13] In 2017, approximately 5.4 million dental treatments were provided to about 850,000 children. Approximately 34% of children ages two to 15 received treatment through the reform; among children ages six to 15, the participation rate was approximately 45%.[13] In 2021, approximately 3.1 million children were entitled to basket dental services, with an allocated budget of approximately NIS 750 million.[1]

Dental services for people over age 75 entered the national health-services basket in February 2019, and a May 2022 ministerial order expanded eligibility to people over age 72.[1] In 2021, approximately 480,000 elderly people were entitled to basket dental services, with an allocated budget of approximately NIS 320 million.[1]

Use of the elderly dental entitlement was substantially lower than among children. In 2019–2020, approximately 5% of entitled elderly people received preventive or preservative treatment and approximately 2% received restorative treatment.[1] In 2021, HMOs used only 18% of the NIS 322 million allocated for elderly dental services — approximately NIS 57 million. Separately, the rate at which elderly members used their treatment entitlement was highest in Clalit at approximately 15% and lowest in Leumit at 4%.[1]

The State Comptroller's 2023 report listed 12,370 dentists and 1,240 specialists in its 2020 workforce figures, with specialists constituting about 10% of the total.[1] The Ministry of Health's target for 2030 is for specialists to constitute 30% of dentists.[1] In 2022, Israel had 0.84 employed dentists per 1,000 residents, compared with an OECD average of 0.71.[16] In 2023, Israel issued 575 new dental licenses; 19% went to graduates of Israeli dental schools and 47% to Israelis who had graduated abroad.[16]

The four HMOs deliver dental services through different organizational models: Clalit operates Clalit Smile and also contracts private dentists; Maccabi uses MaccabiDent alongside contracted private dentists; and Meuhedet and Leumit operate through private dentists.[1] Adult dental care remains generally outside the national health basket, although HMO-affiliated clinics may offer services and discounts through supplementary insurance.[1]

Practicing dentistry in Israel requires a work permit, also called a license or rishayon (רישיון).[17] Standard licensing under the Dentists Ordinance requires passing an examination set by the Ministry of Health's director general in consultation with the Science Committee of the Dental Medicine Association in Israel.[18] The licensing examination has written and practical components; the practical examination includes making a diagnosis, preparing a treatment plan, and performing manual tasks.[18] Examinations are held in Hebrew or, when authorized by the examining committee, in an examinee's own language to the extent possible.[18]

The Ministry of Health's Dental Health Department sits within the Medical Division and is responsible for setting dental-health policy, advising the Licensure Division, planning and training the professional workforce, setting standards, and supervising dentistry professions and dental services across different frameworks.[1]

Foreign-trained dentists seeking to practice in Israel must submit documents to the Ministry of Health so that their dental degree and professional experience can be recognized.[17] The required document checklist includes a Hebrew health-professions form, identification photographs, a passport or Israeli identity documents, a final dentistry degree from a recognized university or an official certificate of completed academic requirements, an official certificate stating the dates of study, and a professional-regulatory certificate showing registration details, current practice location, and whether the applicant has received professional sanctions.[17]

Applicants must also document at least five years of dental work during the seven years preceding the application. This documentation may be supplied by the dentist's accountant, while salaried dentists must additionally obtain employment attestations covering the required period.[17] Applications are directed to the Ministry of Health's Medical Professions Licensing Department in Jerusalem.[17]

On January 25, 2016, the Knesset passed an amendment authorizing the Minister of Health to establish conditions under which new immigrants trained abroad could receive either full or partial exemption from the licensing examinations otherwise required in Israel.[18] The explanatory notes described the measure as having been proposed "in view of the expected immigration wave among practicing dentists and to assist these new immigrants to integrate and practice the profession also in Israel."[18] The exemption applied to applicants who were licensed and had practiced dentistry lawfully in a foreign country at a "proper professional level" for at least five years.[18]

The State Comptroller recorded that 267 of 440 dentists in its 2020 studies-abroad measure, or 61%, had studied outside Israel, illustrating the workforce's reliance on foreign dental education.[1]

Israel's two established dental schools are located at Hebrew University–Hadassah and Tel Aviv University.[19][5] After Israeli independence, Hebrew University–Hadassah built a dental school for 250 students at the Ein Kerem medical campus, where a larger Hadassah University hospital opened in 1961 alongside a medical school.[20] In the mid-1990s, an additional story was added to the School of Dental Medicine at Ein Kerem, providing space for training dental practitioners and researchers, including a laboratory for experimentation and documentation involving dental implantations.[20] By 2005, Dental Medicine was listed among the university's faculties and schools.[20]

Israel has produced several notable dental innovations originating from its academic and commercial sectors. The Faculty of Dental Medicine at the Hebrew University developed "Perio," a tiny biodegradable chip that treats gum disease by slowly releasing chlorhexidine; the product originated from the Hadassah Faculty of Dental Medicine and was sold to Israel Chemicals.[21] Another Israeli innovation, CAPTEK, is a dental-material product described as a gold, platinum, and palladium metal composite for aesthetic, high-strength crowns and bridges, with the reported property of reducing plaque by 10% on natural teeth.[21]

Israel developed a significant dental-implant industry involving companies such as MIS Implants Technology, Adin Dental Implant Systems, AB Dental, and Cortex Dental Implants Industries.[2] Reported technologies across the sector include antibacterial implant coatings, intraoral scanners, defense-derived 3D printing of perforated implants intended to promote bone growth, and 3D printing of dental crowns.[2]

The sector attracted major international acquisitions. Alpha Bio Tec was acquired by Nobel Biocare for $95 million in 2008.[2] MIS Implants Technology was acquired by Dentsply Sirona for $375 million in 2016; at the time of acquisition, MIS reportedly had annual sales of approximately $80 million, sold implants in 65 countries, and had been founded in 1995.[3] Because Israeli patients historically paid a significant proportion of dental costs themselves, companies could establish sustainable domestic businesses without first overcoming the insurance-access barrier common in other medical-device markets.[2]

A national dental-services study based on telephone interviews with Israelis over age 22, conducted from March through May 1998, compared accessibility, availability, quality, and satisfaction across service types.[22] In health-plan clinics, respondents most often reported the presence of auxiliary personnel and explanations from dentists.[22] Appointment waiting time was longest in health-plan clinics, but the time from appointment to treatment was shortest there; public clinics had the longest in-clinic waiting time.[22] Satisfaction with dentists' attitudes was 81% in health-plan clinics, compared with 79% in private and 55% in public clinics, while satisfaction with order and cleanliness was 90%, 78%, and 46%, respectively.[22]

The proportion giving their dentist an overall "very good" rating was highest in kibbutz clinics at 67% and private clinics at 63%, followed by public clinics at 55%, health-plan clinics at 49%, and company or commercial clinics at 43%.[22] The study noted that patients viewed prices as high in health-plan clinics relative to private clinics and recommended shortening waits in public clinics and improving the geographical distribution of dental services.[22]

Research has documented meaningful disparities in oral-health outcomes across Israel's diverse population. A 2025 cross-sectional study of 504 children aged three to six in South Tel Aviv compared migrant, Arab, and Jewish children.[23] Twice-daily toothbrushing was reported for 57.5% of migrant children, 47% of Arab children, and 63.7% of Jewish children.[23] Despite their intermediate brushing rates, migrant children had substantially higher rates of tooth fillings and urgent dental interventions under general anesthesia — 22.9%, compared with 11.1% among Arab children and 9% among Jewish children — indicating a gap between reported preventive practices and treatment needs.[23] The study found a strong parent-child association in twice-daily toothbrushing overall, at 69.8%, with the association particularly strong among migrant children at 70.9% and Jewish children at 72.3%, but weaker among Arab children at 63.0%. The authors concluded that culturally sensitive, family-focused interventions could help reduce oral-health disparities among underserved populations.[23]

A 2023 study analyzed dental records from 34,450 Israeli Defense Forces recruits inducted between 2012 and 2021, examining needs for restorations, root-canal therapy, and extractions.[12] Male sex, older age, lower intellectual-capability scores, and lower socioeconomic-cluster rankings significantly predicted greater caries-related treatment needs.[12] Childhood exposure to fluoridated water was associated with lower rates of caries-related treatment regardless of access to free dental care, whereas the study did not find a comparable association for the national free-dental-care legislation.[12]

A 2017 review of maternal and child health in Israel identified dental-health services as one component of targeted and culturally appropriate programs for communities with many at-risk children, noting that dental-health services were available to all children up to age 15 at the time of the review.[24] The review situated these services within Israel's universal healthcare system and community-based preventive care, while identifying child poverty — over 30% overall, including 63% among Arab children and 67% among ultra-Orthodox Jewish children — as a major challenge to health equity.[24]

The 2016 amendment authorizing licensing-examination exemptions for qualified immigrant dentists was opposed by Israeli dentists, who feared it could lower professional standards and harm patients. Dr. Itsik Chen, chairman of the Dental Medicine Association in Israel, argued that the law was unfair to Israeli dental students who sit the licensing examinations and stated that the association would press the Ministry of Health to consult it on implementation to ensure exempted dentists would meet the required standard.[18]

A 2023 audit documented persistent gaps between entitlements on paper and services actually received. The average percentage of children receiving at least one covered service across the four HMOs was approximately 30% during 2017–2021, with rates ranging from 14% among non-Jewish children in Leumit to 39% among Jewish children in Maccabi.[1] The Ministry of Health's maximum waiting-time standard for children's dental appointments was 30 days, but the audit's public-participation survey found that 65% of children waited longer than that standard. Twenty-one percent of parents failed to schedule a dentist appointment, and 42% were dissatisfied with appointment availability.[1] Ministry audits conducted from January 2018 through September 2021 found that all four HMOs failed to meet the Ministry's waiting-time targets.[1]

The audit also found that the Ministry had not established waiting-time standards for elderly dental treatments, had not systematically assessed national dental morbidity, and had not evaluated the effectiveness of the dental reforms.[1] These findings identified gaps between legislative entitlements and operational delivery at the time of the audit.