Yohanan, a 16-year-old autistic teen who does not speak and uses an iPad to communicate, arrived about three years ago at the dental clinic of Beit Issie Shapiro after months of tooth pain. His parents had tried several clinics, but he would not even sit in the chair. At Beit Issie Shapiro, staff first showed him the equipment, explained each step in language he could understand, and let him stop the treatment at any moment using an agreed signal. When he wrote on the iPad that he was afraid and wanted more explanation, they paused, answered him, and the treatment succeeded.
Since then, Yohanan has come for a checkup every six months and can receive the care he needs. After each visit, he emails the team. Dr. Shelah Malmud, the clinic director, said he writes that he feels “like everyone else,” because he is treated “eye to eye,” understood, and not feared. Beit Issie Shapiro says the approach is built on trust, patient control, and visual communication, especially for people who do not speak or struggle with verbal communication.
The model addresses a broader problem in dentistry. About 45% of people with disabilities are referred to general anesthesia for dental care, often because they cannot cooperate, not because anesthesia is medically required. General anesthesia brings risks, high costs, and long waits. Malmud said many patients with intellectual and developmental disabilities, autism, dementia, post-trauma, or communication difficulties are sent to anesthesia by default, not because no alternative exists, but because no alternative was developed.
The clinic now treats about 1,700 people with disabilities a year, and only about 60, or 4%, need general anesthesia. The model won the Zero Project international innovation award this year. Until now, the knowledge stayed inside Beit Issie Shapiro, but this semester Tel Aviv University’s dental school and Beit Issie Shapiro launched Israel’s first joint course for final-year dentistry students. The course combines lectures on ethics, accessibility, special dental characteristics, and treatment challenges with practical observation and debriefing in the clinic. Prof. Rachel Sarig, head of the dental school, said the goal is to give future dentists the tools they need, noting that many patients also come with dental anxiety, trauma, or PTSD-related jaw clenching and grinding. She added that people with disabilities make up about 20% of Israel’s population and should be able to choose where and how to receive dental care.
