# Geographic access to emergency pediatric dental care during COVID-19: a population-based study from Israel

## TL;DR

This study found significant geographic disparities in emergency pediatric dental care access in Israel during the first COVID-19 lockdown, highlighting the need for better planning to ensure equitable access.

## Contribution

The study introduces a novel analysis of geographic access disparities in emergency pediatric dental care during a pandemic using spatial metrics and regional comparisons.

## Key findings

- Emergency dental visits for children dropped by 40.2% during the first lockdown, with regional decreases ranging from 31.2% to 44.8%.
- Ultra-Orthodox neighborhoods showed a smaller decline in emergency visits compared to the national average.
- The Central region had the highest service burden despite having the highest geographic availability of dental services.

## Abstract

The COVID-19 pandemic created unprecedented challenges for healthcare systems, particularly affecting specialized services like pediatric dental care. This study examined geographic disparities in emergency dental service access for children during the first COVID-19 lockdown in Israel.

We analyzed data from a major healthcare provider serving 25% of Israel’s population, comparing 6,024 emergency dental visits of children under 12 across three time periods: pre-pandemic (March-May 2019), first lockdown (March-May 2020), and post-lockdown (March-May 2021). Using spatial analysis methods, we evaluated the distribution and accessibility of emergency dental services across four main geographic regions through metrics including Load Ratio (LR), Geographic Availability Index (GAI), and Rate of Change in Service Utilization (ROCSU).

During the lockdown, emergency visits decreased by 40.2% compared to the pre-pandemic period, with significant regional variations ranging from 31.2% in the Northern region to 44.8% in the Central region. The mean age of children seeking emergency care during lockdown (6.2 years) was significantly lower than in both pre-pandemic (7.1 years) and post-lockdown periods (6.8 years). Analysis revealed substantial regional disparities in service burden, with the highest Load Ratio in the Central region (1.86) and lowest in the Northern region (1.24), despite the Central region having the highest Geographic Availability Index (2.46). The Jerusalem area had the highest proportion of invasive treatments (40.4%) and swelling/abscess cases (22.4%). Ultra-Orthodox neighborhoods demonstrated distinct utilization patterns, with a lower decrease in emergency visits (29.8–36.8%) compared to the national average (40.2%).

This study identified significant geographic inequities in emergency dental care access during crisis periods, with a paradoxical relationship between service availability and utilization across regions. Our analysis suggests that emergency dental service planning should incorporate strategic facility placement to minimize travel barriers, consideration of population-specific utilization patterns, and balanced resource allocation that maintains proportional service capacity across diverse geographic contexts. These findings provide important insights for health system preparedness to ensure equitable access to essential pediatric dental services during future crises.