{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,12]],"date-time":"2026-01-12T01:57:44Z","timestamp":1768183064996,"version":"3.49.0"},"reference-count":29,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2026,1,12]],"date-time":"2026-01-12T00:00:00Z","timestamp":1768176000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2026,1,12]],"date-time":"2026-01-12T00:00:00Z","timestamp":1768176000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Isr J Health Policy Res"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We analyzed data from a major healthcare provider serving 25% of Israel\u2019s 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).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>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\u201336.8%) compared to the national average (40.2%).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1186\/s13584-026-00745-4","type":"journal-article","created":{"date-parts":[[2026,1,11]],"date-time":"2026-01-11T23:02:12Z","timestamp":1768172532000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Geographic access to emergency pediatric dental care during COVID-19: a population-based study from Israel"],"prefix":"10.1186","volume":"15","author":[{"given":"Dana","family":"Atia Joachim","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9692-7430","authenticated-orcid":false,"given":"Ephraim","family":"Shapiro","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1875-7402","authenticated-orcid":false,"given":"Thabet","family":"Asbi","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Doron","family":"Haim","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3577-276X","authenticated-orcid":false,"given":"Michael V.","family":"Joachim","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"297","published-online":{"date-parts":[[2026,1,12]]},"reference":[{"key":"745_CR1","doi-asserted-by":"publisher","DOI":"10.1186\/s13584-024-00607-x","volume":"13","author":"J Benbassat","year":"2024","unstructured":"Benbassat J. Trust in public health policy in the time of the COVID-19 epidemic in Israel. Isr J Health Policy Res. 2024;13:24.","journal-title":"Isr J Health Policy Res"},{"key":"745_CR2","unstructured":"Data world -. Israel Ministry of Health [Internet]. [cited 2025 Feb 21]. Available from: https:\/\/datadashboard.health.gov.il\/portal\/dashboard\/health"},{"key":"745_CR3","doi-asserted-by":"publisher","first-page":"17","DOI":"10.1186\/s13584-021-00450-4","volume":"10","author":"Z Haklai","year":"2021","unstructured":"Haklai Z, Aburbeh M, Goldberger N, Gordon E-S. Excess mortality during the COVID-19 pandemic in Israel, March\u2013November 2020: when, where, and for whom? Isr J Health Policy Res. 2021;10:17.","journal-title":"Isr J Health Policy Res"},{"key":"745_CR4","doi-asserted-by":"publisher","first-page":"2251","DOI":"10.3201\/eid2609.201476","volume":"26","author":"E Leshem","year":"2020","unstructured":"Leshem E, Afek A, Kreiss Y. Buying time with COVID-19 outbreak response, Israel. Emerg Infect Dis. 2020;26:2251\u20133.","journal-title":"Emerg Infect Dis"},{"key":"745_CR5","doi-asserted-by":"publisher","DOI":"10.1038\/s41467-021-22214-z","volume":"12","author":"H Rossman","year":"2021","unstructured":"Rossman H, Meir T, Somer J, Shilo S, Gutman R, Ben Arie A, et al. Hospital load and increased COVID-19 related mortality in Israel. Nat Commun. 2021;12:1904.","journal-title":"Nat Commun"},{"key":"745_CR6","doi-asserted-by":"publisher","first-page":"e0240393","DOI":"10.1371\/journal.pone.0240393","volume":"15","author":"M Last","year":"2020","unstructured":"Last M. The first wave of COVID-19 in Israel\u2014initial analysis of publicly available data. PLoS One. 2020;15:e0240393.","journal-title":"PLoS One"},{"key":"745_CR7","doi-asserted-by":"publisher","first-page":"481","DOI":"10.1177\/0022034520914246","volume":"99","author":"L Meng","year":"2020","unstructured":"Meng L, Hua F, Bian Z. Coronavirus disease 2019 (COVID-19): emerging and future challenges for dental and oral medicine. J Dent Res. 2020;99:481\u20137.","journal-title":"J Dent Res"},{"key":"745_CR8","first-page":"418","volume":"51","author":"I Abramovitz","year":"2020","unstructured":"Abramovitz I, Palmon A, Levy D, Karabucak B, Kot-Limon N, Shay B, et al. Dental care during the coronavirus disease 2019 (COVID-19) outbreak: operatory considerations and clinical aspects. Quintessence Int. 2020;51:418\u201329.","journal-title":"Quintessence Int"},{"key":"745_CR9","unstructured":"DTI JB. Israel and its dentists are on lockdown [Internet]. Coronavirus (COVID-19) microsite. 2020 [cited 2025 May 1]. Available from: https:\/\/coronavirus.dental-tribune.com\/news\/israel-and-its-dentists-are-on-lockdown\/?time=1586529626"},{"key":"745_CR10","doi-asserted-by":"publisher","DOI":"10.3389\/fpubh.2021.637351","volume":"9","author":"A Fux-Noy","year":"2021","unstructured":"Fux-Noy A, Mattar L, Shmueli A, Halperson E, Ram D, Moskovitz M. Oral health care delivery for children during COVID-19 pandemic\u2014a retrospective study. Front Public Health. 2021;9:504.","journal-title":"Front Public Health"},{"key":"745_CR11","doi-asserted-by":"publisher","DOI":"10.3390\/ijerph19041965","volume":"19","author":"T Sella Tunis","year":"2022","unstructured":"Sella Tunis T, Ratson T, Matalon S, Abba M, Abramson A, Davidovitch M, et al. The impact of the COVID-19 pandemic on Israeli orthodontic practice: a clinic\u2019s activity and patients\u2019 attitudes. Int J Environ Res Public Health. 2022;19:1965.","journal-title":"Int J Environ Res Public Health"},{"key":"745_CR12","doi-asserted-by":"publisher","first-page":"20","DOI":"10.1111\/ipd.12737","volume":"31","author":"V Luzzi","year":"2021","unstructured":"Luzzi V, Ierardo G, Boss\u00f9 M, Polimeni A. Paediatric oral health during and after the COVID-19 pandemic. Int J Paediatr Dent. 2021;31:20\u20136.","journal-title":"Int J Paediatr Dent"},{"key":"745_CR13","doi-asserted-by":"publisher","first-page":"2591","DOI":"10.1016\/j.sjbs.2021.02.002","volume":"28","author":"SR Samuel","year":"2021","unstructured":"Samuel SR, Mathew MG, Suresh SG, Varma SR, Elsubeihi ES, Arshad F, et al. Pediatric dental emergency management and parental treatment preferences during COVID-19 pandemic as compared to 2019. Saudi J Biol Sci. 2021;28:2591\u20137.","journal-title":"Saudi J Biol Sci"},{"key":"745_CR14","first-page":"788","volume":"52","author":"AA Masri","year":"2021","unstructured":"Masri AA, Abudrya MH, Splieth CH, Schmoeckel J, Mourad MS, Santamar\u00eda RM. How did the COVID-19 pandemic lockdown affect dental emergency care in children? Retrospective study in a specialized pedodontic center. Quintessence Int. 2021;52:788\u201396.","journal-title":"Quintessence Int"},{"key":"745_CR15","doi-asserted-by":"publisher","first-page":"976","DOI":"10.1016\/j.joms.2024.04.017","volume":"82","author":"S Sudri","year":"2024","unstructured":"Sudri S, Pharayra M, Ghantous Y, Abu El-Naaj I, Laviv A. Pediatric maxillofacial infections during COVID-19: what have we learned? J Oral Maxillofac Surg. 2024;82:976\u201383.","journal-title":"J Oral Maxillofac Surg"},{"key":"745_CR16","doi-asserted-by":"publisher","DOI":"10.3390\/ijerph19073774","volume":"19","author":"A Elalouf","year":"2022","unstructured":"Elalouf A, Moran R, Yaron B, Oman M. Pediatric dental emergency visits and treatment during lockdown in the COVID-19 pandemic: a retrospective study. Int J Environ Res Public Health. 2022;19:3774.","journal-title":"Int J Environ Res Public Health"},{"key":"745_CR17","doi-asserted-by":"publisher","DOI":"10.1186\/1476-072X-3-3","volume":"3","author":"MF Guagliardo","year":"2004","unstructured":"Guagliardo MF. Spatial accessibility of primary care: concepts, methods and challenges. Int J Health Geogr. 2004;3:3.","journal-title":"Int J Health Geogr"},{"key":"745_CR18","doi-asserted-by":"publisher","first-page":"131","DOI":"10.1016\/j.healthplace.2004.02.003","volume":"11","author":"F Wang","year":"2005","unstructured":"Wang F, Luo W. Assessing spatial and nonspatial factors for healthcare access: towards an integrated approach to defining health professional shortage areas. Health Place. 2005;11:131\u201346.","journal-title":"Health Place"},{"key":"745_CR19","first-page":"247","volume":"32","author":"Z Lazarus","year":"2015","unstructured":"Lazarus Z, Pirutinsky S, Korbman M, Rosmarin DH. Dental utilization disparities in a Jewish context: reasons and potential solutions. Community Dent Health. 2015;32:247\u201351.","journal-title":"Community Dent Health"},{"key":"745_CR20","doi-asserted-by":"publisher","first-page":"865","DOI":"10.1068\/b29120","volume":"30","author":"W Luo","year":"2003","unstructured":"Luo W, Wang F. Measures of spatial accessibility to health care in a GIS environment: synthesis and a case study in the Chicago region. Environ Plann B Plann Des. 2003;30:865\u201384.","journal-title":"Environ Plann B Plann Des"},{"key":"745_CR21","doi-asserted-by":"publisher","first-page":"1033","DOI":"10.1016\/j.adaj.2021.07.002","volume":"152","author":"SE Choi","year":"2021","unstructured":"Choi SE, Simon L, Basu S, Barrow JR. Changes in dental care use patterns due to COVID-19 among insured patients in the United States. J Am Dent Assoc. 2021;152:1033-1043.e3.","journal-title":"J Am Dent Assoc"},{"key":"745_CR22","doi-asserted-by":"publisher","first-page":"4005","DOI":"10.3390\/jcm9124005","volume":"9","author":"F Schwendicke","year":"2020","unstructured":"Schwendicke F. Digital dentistry: advances and challenges. J Clin Med. 2020;9:4005.","journal-title":"J Clin Med"},{"key":"745_CR23","doi-asserted-by":"publisher","DOI":"10.1038\/s41598-024-67238-9","volume":"14","author":"S Rezaei","year":"2024","unstructured":"Rezaei S, Ghiasvand H, Brown H. Time series analysis of COVID-19\u2019s impact on physician and dentist visits in Iran. Sci Rep. 2024;14:16453.","journal-title":"Sci Rep"},{"key":"745_CR24","doi-asserted-by":"publisher","first-page":"1","DOI":"10.3390\/ijerph18041812","volume":"18","author":"MG Cagetti","year":"2021","unstructured":"Cagetti MG, Balian A, Camoni N, Campus G. Influence of the covid-19 pandemic on dental emergency admissions in an urgent dental care service in North Italy. Int J Environ Res Public Health. 2021;18:1\u201310.","journal-title":"Int J Environ Res Public Health"},{"key":"745_CR25","doi-asserted-by":"publisher","DOI":"10.1111\/fare.13132","author":"N Gemara","year":"2025","unstructured":"Gemara N, Kornik H. Challenges and coping of children in large Jewish Ultra-Orthodox families during the <Emphasis Type=\"SmallCaps\">COVID<\/Emphasis> \u201019 pandemic. Fam Relat. 2025. https:\/\/doi.org\/10.1111\/fare.13132.","journal-title":"Fam Relat"},{"key":"745_CR26","doi-asserted-by":"publisher","first-page":"56","DOI":"10.1177\/0034673X231220386","volume":"66","author":"R Pinchas-Mizrachi","year":"2024","unstructured":"Pinchas-Mizrachi R, Orr Z, Zalcman BG, Romem A. Barriers to the healthcare system faced by Ultra-Orthodox religious disaffiliates. Rev Religious Res. 2024;66:56\u201380.","journal-title":"Rev Religious Res"},{"key":"745_CR27","doi-asserted-by":"publisher","DOI":"10.36367\/ntqr.20.3.2024.e920","volume":"20","author":"MM Bautista-Gomez","year":"2024","unstructured":"Bautista-Gomez MM, Zuluaga LS, Medina-Tabares MF. Cultural adaptation of health interventions for ethnic communities in vulnerable settings: a qualitative data synthesis. New Trends in Qualitative Research. 2024;20:e920.","journal-title":"New Trends in Qualitative Research"},{"key":"745_CR28","volume-title":"GIS and public health","author":"EK Cromley","year":"2012","unstructured":"Cromley EK, McLafferty S. GIS and public health. 2nd ed. New York: The Guilford Press; 2012.","edition":"2"},{"issue":"Suppl 1","key":"745_CR29","first-page":"A1","volume":"11","author":"HS Schroeder","year":"2022","unstructured":"Schroeder HS, Numa R. Promoting a culturally adapted health-policy for the ultra-orthodox population during the COVID-19 crisis. BMJ Qual Improv Rep. 2022;11(Suppl 1):A1\u20132.","journal-title":"BMJ Qual Improv Rep"}],"container-title":["Israel Journal of Health Policy Research"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s13584-026-00745-4.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1186\/s13584-026-00745-4","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s13584-026-00745-4.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,1,11]],"date-time":"2026-01-11T23:02:14Z","timestamp":1768172534000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1186\/s13584-026-00745-4"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,1,12]]},"references-count":29,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2026,12]]}},"alternative-id":["745"],"URL":"https:\/\/doi.org\/10.1186\/s13584-026-00745-4","relation":{},"ISSN":["2045-4015"],"issn-type":[{"value":"2045-4015","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,1,12]]},"assertion":[{"value":"8 May 2025","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"2 January 2026","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"12 January 2026","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"This study was approved by the Institutional Helsinki Committee of Maccabi Healthcare Services (approval #MHS-0079-24) and the Ethics Committee of Ariel University. As this was a retrospective study based on existing medical records, the committee granted a waiver of informed consent.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"Not applicable.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"The authors declare no competing interests.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"2"}}