# Changes in Toothbrushing Behaviors Following a Child Dental Care Reform in Israel

## TL;DR

A dental care reform in Israel increased toothbrushing among children, but some groups still lag behind.

## Contribution

This study evaluates the impact of a national dental care reform on children's toothbrushing behavior using longitudinal data.

## Key findings

- Toothbrushing compliance increased from 59–64% before the reform to 73% after the reform.
- Predictors of compliance included being female, younger, Jewish, non-observant, and having higher socioeconomic and psychological status.

## Abstract

(1) Background: Toothbrushing behavior in children and adolescents is shaped by national dental health policies and sociodemographic and psychological factors. In 2010, child dental care was incorporated into Israel’s National Health Insurance Law (NHIL). This study explored toothbrushing behavior and its predictors before and after this reform. (2) Methods: Data from 36,755 students in grades 6–10 were analyzed from the Health Behaviour in School-Aged Children study conducted pre-reform (1998, 2002, 2006) and post-reform (2010, 2013, 2016). The dependent variable was toothbrushing behavior, while the independent variables included sociodemographic and psychological characteristics. Chi-squared tests compared proportions of compliant toothbrushing behaviors, and logistic regression identified significant predictors. (3) Results: According to recommendations, 59–64% of children brushed their teeth before the reform. This proportion increased significantly post-reform, reaching 73% in 2018. Predictors of compliance included being female, younger, Jewish, and non-observant, having a higher socioeconomic status, and having a better psychological status. These predictors were consistent in pre- and post-reform regression models. (4) Conclusions: The dental care reform positively influenced toothbrushing habits among children and adolescents. However, disparities remain among specific communities. Interventions tailored to address sociodemographic and psychological factors are recommended to enhance regular toothbrushing habits across all populations.