Prevalence of Dental Caries–An Ongoing Public Health Crisis: A Meta-Analysis

Prevalence of Dental Caries–An Ongoing Public Health Crisis: A Meta-Analysis | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Systematic Review Prevalence of Dental Caries–An Ongoing Public Health Crisis: A Meta-Analysis Hakeem Adekunle This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7322781/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background Dental caries is one of the oldest and most prevalent infectious diseases affecting humans. According to the American Dental Association, it is a biofilm-mediated, sugar-driven, multifactorial disease characterized by the cyclical demineralization and remineralization of dental hard tissues. Despite numerous global efforts to reduce its burden, comprehensive assessments of its prevalence in specific populations remain limited. Objective This study aimed to systematically review and analyze the prevalence and trends of dental caries among school-aged children in Saudi Arabia over the past 23 years. Methods A systematic search of Scopus, Google Scholar, ISI Web of Science, and MEDLINE via Ovid was conducted to identify relevant studies. A total of 20 eligible articles were included in the meta-analysis. Pooled prevalence estimates were calculated with 95% confidence intervals (CI), and heterogeneity was assessed using the I² statistic. Results The pooled prevalence of dental caries among children aged 5–7 years was 84% (95% CI: 0.82–0.86). Among children aged 12–15 years, the overall prevalence was 74% (95% CI: 0.67–0.79) with significant heterogeneity observed (I² = 83%). Conclusion Dental caries remains highly prevalent among school-aged children in Saudi Arabia, particularly in younger age groups. These findings underscore the need for enhanced preventive strategies and sustained public health interventions targeting oral health in this population. Biostatistics Dental Caries Prevalence Children Age Figures Figure 1 Figure 2 Figure 3 Figure 4 Figure 5 Introduction Dental caries is one of the oldest and most common human infections. As showed by the American Dental Association, dental caries can be characterized as a "biofilm-interceded, sugar-driven, multifactorial, powerful sickness that outcomes in the phasic demineralization and demineralization of dental hard tissues". Over the most recent couple of decades, various measures have been executed to prevent dental caries and other oral health problems in many populations over the world. Despite the tremendous endeavors made, it is still a worldwide public health problem and influences an enormous piece of the total population [ 1 ]. Although dental caries is preventable, the prevalence remains high in school-age children [ 2 ]. In 2010, this infection influenced 2.43 billion individuals (35.3% of the population) worldwide [ 3 ]. Different steps to avoid dental caries and other oral health conditions in various communities worldwide have been adopted over the last couple of decades, and true to nature, many people have benefited from these initiatives. However, there are still people who are still affected immensely by this health problem. Therefore, it is important to have additional measures in place to address this, based on the severity of the condition in each community. A useful resource that can be of incredible help is the dmft index. The dmft index can calculate the severity of dental caries; dmft refers to decayed, damaged caries, and filled teeth in the primary dentition. The DMFT corresponds to the permanent dentition number of decayed, absent because of caries, and Filled Teeth [ 6 ]. Centered on the global decayed, incomplete, filled (DMFT / dmft) index of oral health status predictor, the incidence of dental caries is rated as very moderate (0.0 -1.1), moderate (0.0 -1.1) low (1.2–2.6), moderate (2.7–4.4), high (4.5–6.5), and very high (> 6.6) [ 7 ]. According to WHO, poor oral hygiene may profoundly influence the overall hygiene of children's and adolescents' lives [ 8 ]. Therefore, caries may negatively affect the oral health-related quality of life (OHRQoL) of children and their parents during adolescence [ 9 ]. Caries is very popular among 5-year-old children in Saudi Arabia (SA), with a prevalence of 83.5 percent [ 10 ]. Untreated caries is often associated with pain, which influences weight gain, health, quality of life, and preschoolers' cognitive performance. Besides growth and development, caries can have a detrimental effect on education. Children with poor oral health are more likely to have a higher chance of exclusion from school and have lower school performance relative to children with better oral health [ 11 ]. A decrease in caries’ prevalence is mostly seen in nations that have built up public health programs using school health programs and school sealant programs for preventing dental caries. The United Kingdom (UK) used to witness high rates of dental caries. Nevertheless, by applying the oral health framework, the rates started to significantly change oral health prevalence in general and dental caries in particular. [ 18 ]. A British study of 69,318 children between the ages of 5–15 years uncovered a 31–51% decrease of caries over the last 40 years (1973–2013) [ 19 ]. It appears that these figures have improved with time. In 2019, a study conducted in the UK reported that the dental caries’ prevalence ranged from 25–26% among five-year-old children [ 20 ]. Additionally, a Dutch examination reported that the caries’ rate decreased in 1990–2009 among 8–21-year-olds. Among SA regions, the dental caries prevalence was much higher than in the European countries since the implementation of the well-being framework. The prevalence of dental caries is high in Saudi populations, especially among young people [ 16 ]. Nationally, the prevalence of caries among children between the ages of 6 and 7 was 74–90 percent in the primary teeth with mean dmft varied between 2.7 and 7.1 while in permanent teeth, it was 59-80 percent [ 17 ]. The state of caries can be found in a research that examined the national prevalence of dental caries in SA school children. The primary national investigation that was done by Al-Shammery (1999) evaluated 1873 children at 12 to 13-year-olds in ten regulatory locales in SA. The article found that the prevalence of caries was 74% in urban areas and 67% in rural areas. The examination discovered a factually massive contrast between the metropolitan regions and the rural zones [ 18 ]. Studies showed different prevalence rates in various Kingdom areas, ranging between 60–87 percent [ 19 , 20 , 16 ]. A research was conducted in Riyadh's specified areas to assess dental caries among school children between ages 6 and 8. The results of the research investigation revealed that the prevalence of caries was 83%. The research finding is moderately high compared to the safe limit of the World Health Organization (WHO) [ 3 , 22 ]. In 2018, researchers of the Qassim area determined the general prevalence of caries in schoolchildren with an age range of 7 years. The outcomes were 80.80% in primary teeth and 29% in permanent teeth. In contrast, the mean DMFT scores were 3. 92 [ 21 ]. Another research conducted in Jeddah in 2000 considered 39,296 subjects. The research reported an 83.5% prevalence of caries in primary teeth [ 22 ]. Another Ph.D. thesis in the same area reported a similar result with a slight rise in caries prevalence (85.5%). In the eastern area of the Kingdom, female participants in school had dental caries in their permanent teeth. The prevalence was 73% [ 20 ]. The present figures show that the WHO 2000 expectations for dental caries are still not reached for SA children [ 21 ]. It is worth mentioning that since 1993, Saudi Arabia started applying different prevention measures in primary care centres. In 2005, the first national program that covers all primary schools was launched and ever since, the MOH has been providing oral health promotion activities in schools. Nevertheless, there is no research providing a true estimate regarding the prevalence of dental caries in all KSA regions to evaluate the efforts that have been made by the government. Therefore, the aim of this study is to assess the prevalence and trends of dental caries among school children in Saudi Arabia over the last 23 years. Methodology We reported and recorded this manuscript in accordance with MOOSE (Meta-analyses Of Observational Studies in Epidemiology) guidelines. Eligibility criteria: The inclusion criteria were as follows: a) participants between the age of 5 and 15 years (as WHO recommended) who are generally healthy without systemic disease; b) studies reporting the prevalence of dental caries using the WHO criteria for caries diagnosis; c) studies in English or Arabic and published between January 1996 and October 2019; d) population-based studies conducted in Saudi Arabia. We excluded all the relevant articles that did not completely comply with the inclusion criteria. Search strategy: The following databases were thoroughly searched for studies that met the inclusion criteria: Scopus, Google Scholar, ISI Web of Science, and MEDLINE via Ovid. For unpublished studies and theses, TA searched the local databases and journals through the Saudi Digital Library. Refer to Appendix A for detailed information about each database's search strategy. TA and GH reviewed the references of included studies to find relevant papers. The citations that have been identified through the search were imported into Endnote X8. Data extraction and assessment of the risk of bias. A data extraction form has been used to extract data from all included studies systematically. Two authors independently extracted the data from the selected studies (TA and GH). Any errors were settled by a third author (AH). Information extracted in the present review included the author's name, year of the examination, the age of participants study configuration, considered site, sample size, analytic measures, dental caries prevalence and severity of dental caries (dfmt/DMFT list). As per the Cochrane Reviewers' Handbook, the risk of bias inside investigations was evaluated freely by two writers (TA and GH). The Newcastle-Ottawa Scale for quality assessments for cross-sectional investigations assessed the methodology for the included examinations. The risk of bias tool comprises five items. Each investigation was ordered as having either a high (score < 3) or low (score 3–5) risk of bias [ 26 ]. Statistical methodology The heterogeneity between the studies was assessed using the I² test. A level of 75% or more indicates a high degree of heterogeneity. By using the random-effects model, the pooled prevalence with 95 percent confidence intervals was reported. The meta-analysis was done using tools for comprehensive meta-analysis (CMA). Significant variability among the studies was seen by this study (p < 0.005) Results Study Selection and Characteristics As outlined in Fig. 1 , The initial search identified 134 studies through the titles and abstracts of articles in the following electronic bibliographic databases: 36 studies from MEDLINE via Ovid, 27 from ISI Web of Science, nine from Scopus, 20 from the Saudi digital library, 18 from EMBASE and 24 from Google Scholar. After removing duplicates by utilization EndNote, 90 were excluded. Overall, twenty cross-sectional studies involving 56,154 children in six regions published between 1996 and 2019 reporting caries prevalence were included. No extra article was recognized through a manual search of the reference of the chose investigations. All the articles included were based on cross-sectional investigations and defined dental caries in the prescribed standardized manner, using the WHO's diagnostic criteria. Seven of the 20 articles (35%) were published in the Riyadh region, four (20%) in the Makkah region, three (15%) in the eastern region, three (15%) in the Medina region, and only one study conducted in Aseer region and Najran region (Table 1 ). Concerning study quality, 17 studies were at low risk of bias, and three were at high risk of bias (Table 2). Table 1 Characteristics of included studies Author and Year Study Location Age Group Gender Sample Size Dental caries measurement Mean dmft/DMFT Prevalence of dental caries Al-Tamimi, S., 1998 Medina 6, 12 Both 480 DMFT + dmft dmft 6.4 DMFT 2.9 87% in primary teeth 83% in permanent teeth Bhayat, A., 2014 Medina 12 Male 360 DMFT DMFT 1.53 57.2% in primary teeth Mahrous, M. S., 2016 Medina 6, 12 Both 316 DMFT + dmft dmft 4.9 DMFT 1.3 86% in primary teeth 67.6% in permanent teeth Abolfotouh, M. A., 2000 Abha 6, 12 Male 959 DMFT + dmft dmft 6.53 DMFT 1.23 93.3% in primary teeth 49.5 in permanent teeth Alkhunaizi, Y. M., 2018 Dhahran, Al-Khobar 6,12, 15 Female 895 DMFT + dmft dmft 5.94 DMFT 4.39 primary teeth 73% permanent teeth 82% Farooqi, F. A., 2015 Dammam 6,7, 12 Both 711 DMFT + dmft dmft 3.5 DMFT 2.82 In primary teeth 77.8% permanent teeth 68% Khan, N. B., 2001 Al-Ahsa 6–7 Both 457 dmft dmft 4.45 in primary teeth 82.9% Alamoudi, N., 1996 Jeddah 6,7 Not Reported 571 dmft dmft 5.54 primary teeth 73.5% Qutob, A. (2009) Jeddah 6, 12 Both 800 DMFT + dmft dmft 5.45 DMFT 2.89 in primary teeth 91% permanent teeth 71.7% Gandeh, M. B. S., (2000) Jeddah 6–7 Both 39,296 dmft Not Reported in primary teeth 83.4% Alkarimi, H. A., 2014 Jeddah mean age 6.8 Both 417 dmft dmft 5.7 in primary teeth 87.1% Elfaki, N. K., 2014 Najran 12,13 Female 96 DMFT DMFT 3.04 Not Reported Al-Rafee, M. A., 2019 Riyadh region 6, 12, 15 Both 1986 DMFT + dmft dft 1.4 DMFT 1.72 in primary teeth 85.77% permanent teeth 64.98% Aldosari, A. M., 2004 Riyadh and Qaseem 6–7 and 12–13 Both 1104 DMFT + dmft dmft 6.53 DMFT 5.06 in primary teeth 91.2% permanent teeth 90.5% Alamri, A. A., 2017 Riyadh 6 Male 672 dmft dmft 4.24 primary teeth 76.4% Alshiha, S. A., 2017 Riyadh 6–7 Female 6183 dmft dmft 5.47 primary teeth 85.5% Alhabdan, Y. A., 2018 Riyadh mean age 6.92 Male 578 dmft dmft 4.20 in primary teeth 83% Paul, T. R. 2003 Al-Kharj 5 Both 103 dmft dmft 7.1 in primary teeth 83.5% Paul, T. R. 1997 Alkharj 5 Both 103 dmft dfmt 7.12 In primary teeth 96.5% Al-Shammery, A. R., 1999 Saudi Arabia 12–13 both 1873 DMFT DMFT 2.69 rural areas were 67% urban areas were 74% Prevalence of dental caries in the primary dentition The general prevalence of dental caries among youngsters aged 5–7 was 84% (95% CI: 0.82–0.86%) because of the random-effects model. The highest and lowest prevalence of dental caries was observed in different regions of SA was seen in Al-Kharj (96.5%) and Eastern Province (73%), respectively (Fig. 2 ). Fourteen studies provided data on the mean dmft. The pooled mean dmft was 5.032 (95% CI: 3.876–6.189; I2 = 99%) (Fig. 3 ). Prevalence of dental caries in the permanent dentition. The general prevalence of dental caries among 12–15 youngsters was 74% (95% CI: 0.67–0.79%; I2 = 83%) based on the random-effects model. The maximum and minimum prevalence of dental caries was observed in Riyadh (92.3%) and Abha (52%), respectively (Fig. 4 ). Out of the nine studies, only seven provided data on the mean DMFT. The pooled mean DMFT was 2.84 (95% CI: 2.21–3.46). This analysis showed significant heterogeneity among the studies (p 0.005) (Fig. 5 ). Discussion This systematic review comprehensively describes the prevalence of dental caries in children living in SA regions based on data published from 1996 to 2019. In this process, the data of 20 studies (out of 134 published papers) were considered for quantitative analysis. This review found (1) high prevalence estimates of dental caries, (2) an increase of caries prevalence in the last decade, and (3) a high demand for effective intervention. Our results showed that dental caries' prevalence was 84 percent and 74 percent, respectively, in primary and permanent dentition. The mean dmft was 5.03 (95% CI: 3.876–6.189) at 5–6 years, and the mean DMFT was 2.84 (95% CI: 2.21–3.46) at 12–15 years. In concurrence with our outcomes, a public report led in all SA areas. Nevertheless, Central Province showed that dental caries' predominance was most noteworthy in the 6–7-year age gathering, contrasted with that 12-year age gathering [ 17 ]. These findings are worrisome in the efforts made by the Ministry of Health (MOH) to reduce these figures. The results have shown that dental caries is still a significant issue in SA despite the government’s and dental healthcare workers' attempts to improve oral health in children and increase people's awareness of oral health over the years. In Riyadh, the capital of SA, the present review showed improvement in caries' status in school children compared to the results of the cross-section study conducted in Central Province in 2004 [ 26 ]. The situation of caries among children aged 5–7 years in Jeddah has deteriorated in recent years compared to the previous survey in 1996 [ 27 ]. A sizeable number of publications to determine the prevalence of caries in schoolchildren were performed. In a previous review, Al-Ansari et al. concluded that most studies found that caries has a high prevalence among SA regions [ 28 ]. However, some of these papers did not evaluate caries in general populations. Instead, they attempted to estimate the prevalence of caries in participants with systemic diseases or special needs. These diseases may have a significant influence on oral health. Regardless, we excluded the articles that evaluated caries in a specific population because participants with the systemic disease have a much higher chance of having caries, which does not reflect the disease's true prevalence. Numerous preventive measures to reduce the caries burden in SA have been put in place. The World Dental Federation, the WHO, and the International Dental Research Association have worked to plan the Global Oral Health Goals for 2020. One aim was to reduce dental caries' impact on individuals and society and develop an early diagnosis, prevention, and effective management strategies for dental caries [ 29 ]. Unfortunately, most epidemiological studies have shown that dental caries remains prevalent among school children in SA. Also, untreated caries in young children is still a significant health burden in SA, suggesting that more extraordinary efforts and different preventive measures are needed if this goal is to be achieved. In 2007, the Saudi Arabian Standards Organization (SASO) had adopted the MOH recommendations regarding fluoride ions to the primary drinking water networks in the major cities aiming to reduce caries prevalence from 90% to 50–60% [ 30 ]. However, the findings of this meta-analysis showed that the MOH’s goal was not yet met. Our review found a decrease in dental caries among 5-7-year-old children over time (Fig. 6). While modest, this decrease is notable given efforts by the SASO and MOH to improve dental health. The identified trend may reflect the community’s increased awareness of dental caries. Unfortunately, the results have not met the WHO and FDI World Dental Federation goals that aim to achieve 50% of children aged 5–6 years to be caries-free [ 29 ]. The prevalence of dental caries in primary teeth has been decreasing in SA, with 1999 seeing dental caries decreased by ten percent. Since 1999, there’s been a year-on-year decline every year besides 2004 and 2018 (Fig. 7) This review found that caries’ prevalence in 6-year-old children was higher than in 12-year-old children. A 2019 study was done in Riyadh to estimate the dental caries prevalence in primary and permanent teeth. The study found that caries prevalence in primary and permanent teeth was 86% and 65%, respectively [ 31 ]. Another study conducted in the same age group but in Jeddah found a similar result, 83.5% for primary teeth and 72% for permanent teeth [ 32 ]. These findings are similar to a 2018 study, which showed that caries prevalence remains high among six-year-old children [ 3 ]. The increase in the prevalence of caries is consistent with previous findings. A review showed that the prevalence of caries increased between 1985 and 2010 [ 28 ]. Although most of the previous studies mentioned the importance of school programs and improving the practitioners' quality of care, the MOH has done many campaigns and programs to reduce the prevalence and severity of caries. One of these programs is the National Initiative to prevent dental caries, launched in 2018, which is the largest and most comprehensive campaign. The MOH aims to promote oral and dental health for primary school students by: raising health awareness among students, fluoride application to protect teeth from caries, providing the students with the skills of preventing dental diseases, and involving the family in inculcating healthy behavior among children. According to MOH, the initiative's number of beneficiaries reached nearly one million children in 2018 [ 33 ]. Nevertheless, there is no study to evaluate the effectiveness of these programs. Despite this, caries' prevalence is significantly higher than those recorded in Europe and America [ 34 , 35 ]. The proportions of caries reported in the review indicate that while there appears to be some decrease in the overall prevalence relative to previous national surveys, the changes are not marked as shown in European and American populations. It is likely due to the nature of dental caries; there are multiple factors that play a role in the increase of caries, including lack of awareness, poor oral hygiene, insufficient preventive dental services, and underutilization of dental services [ 31 , 36 ]. SA is the only country in the world that is providing free access to dental health care in primary, secondary, and tertiary dental clinics of the government sector to all citizens [ 37 ]. As for the residents (non-Saudis), the employer must provide health insurance that covers dental services, which include all emergency dental treatment, checks up, and scaling teeth (teeth cleaning) [ 38 ]. However, caries proportions among school children are high. Limited studies have been done in limited regions in SA to investigate the utilization of dental services to assess the influencing factors. The Saudi Health Information Surveyed over 10.000 participants to determine the use of oral health services in SA. The survey showed that only 11.5% of Saudi Arabia's population aged fifteen and above visited dentists for check-ups [ 39 ]. In the 2010 survey conducted among school children in Jeddah to investigate the utilization of dental services, only 8.6% visited dentists for a regular check-up. Simultaneously, almost half of the students visited the dentist when they feel pain or have dental problems [ 40 ]. A literature review conducted by Orfali et al. reported a correlation between the utilization of dental services and educational status. People who have a better education were more likely to have regular dental appointments [ 41 ]. Moreover, since the schools provide a unique setting to develop healthy habits, the researchers of these studies recommended improving children and parents' and teachers' awareness of the importance of dental care [ 39 , 40 , 42 , 43 ]. Our meta-analysis results should be interpreted considering certain limitations. First, there was considerable heterogeneity between studies, although we have set strict including and excluding criteria. High heterogeneity between studies requires cautious interpretation of the results. The significant heterogeneity of the results could be because of the geographical variation, ethnic backgrounds. Second, most of the studies did not adequately control confounding factors such as fluoride exposure, socioeconomic level, and parents' educational level. Finally, because most of the included studies were conducted in the Central Province of SA, the results cannot be generalized to the total population. The current review's discoveries propose that dental caries influences a noteworthy part of younger students in SA. Given the multifactorial idea of dental caries, various methodologies should be taken next to each other to roll out an exceptional improvement. Creating a national oral health policy that highlights the promotion and prevention of oral health would be most beneficial in addressing oral health problems in school children in Saudi Arabia and would support established curative programs. In schools, oral health education should be combined with the school curriculum and the dental sealant and fluoride application to admission conditions to the primary school should be added. This review may help public health managers, policymakers, and stakeholders evaluate such projects and may serve as a baseline for future national studies. Conclusion In this systematic review, the summary estimate of dental caries' prevalence among 5-7-year-old and 12 -15-year-old children were 84% and 74%, respectively. The pooled mean dmft/DMFT was 5.03 and 2.84 among 5–7 and 12–15 years. We conclude that dental caries status among school children is high in SA. Further research is required to identify approaches for the prevention and treatment of dental caries in schoolchildren. Declarations Ethics approval and consent to participate: Not applicable Consent for publication: Not applicable Availability of data and materials: All data generated or analysed during this study are included in this published article [and its supplementary information files]. Competing interests: The authors declare that they have no competing interests Funding: This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors. Authors' contributions: TA, SN, GAS contributed to the conception and design of the study. AH, DD, AAA contributed substantially to the acquisition and interpretation of data. TA drafted the manuscript. All the authors contributed to its critical revision, approval of the final version submitted for publication, and take responsibility for the statements made in the published article. Acknowledgements: Authors are thankful to the deanship of Scientific Research, King Saud University for funding through Vice Deanship of Scientific Research Chairs. References Frencken JE, Sharma P, Stenhouse L, Green D, Laverty D, Dietrich T (2017) Global epidemiology of dental caries and severe periodontitis - a comprehensive review. J Clin Periodontol. 10.1111/jcpe.12677 Centers for Disease Control and Prevention. Hygiene-related Diseases Dental Caries (2016) https://www.cdc.gov/healthywater/hygiene/disease/dental_caries.html . Accessed 21 Sept 2019 Alhabdan Y et al (2018) Prevalence of dental caries and associated factors among primary school children: a population-based cross-sectional study in Riyadh, Saudi Arabia. Environ Health Prev Med 23:1 Lamont RJ, Egland PG (2015) In: YW T (ed) Dental Caries: Molecular Medical Microbiology. Academic, Boston, pp 945–955 American dental association: Caries Risk Assessment and Management. www.ada.org (2018) Accessed 7 Apr 2020 Organization WH (2013) Oral health surveys: basic methods. World Health Organization Organization WH (2000) Global data on dental caries prevalence (DMFT) in children aged 12 years. Global Oral Data Bank ; 11 Khushbu Y (2016) Dental caries: A review. Asian J Biomedical Pharm Sci 6:53 Abanto J, Tsakos G, Paiva SM, Carvalho TS, Raggio DP, Bönecker M (2014) Impact of dental caries and trauma on quality of life among 5-to 6‐year‐old children: perceptions of parents and children. Commun Dent Oral Epidemiol. 10.1111/cdoe.12099 Paul TR (2003) Dental health status and caries pattern of preschool children in Al-Kharj, Saudi Arabia. Saudi Med J 24:12 Pitts NB, Domenick T, Phil D, Ekstrand K, Jane A, Francisco R et al (2017) Dental caries. Nat Reviews Disease Primers. ; 3 Bratthall D, Hänsel-Petersson G, Sundberg H (1996) Reasons for the caries decline: what do the experts believe? Eur J Oral Sci 104:4 Petersen PE, Ogawa H (2016) Prevention of dental caries through the use of fluoride–the WHO approach. Community Dent Health 33:2 Murray JJ, Vernazza CR, Holmes RD (2015) Forty years of national surveys: An overview of children's dental health from 1973–2013. Br Dent J 219:6 Schuller AA, Dommelen PV, Poorterman JHG (2014) Trends in oral health in young people in the N etherlands over the past 20 years: a study in a changing context. Commun Dent Oral Epidemiol 42:2 Alzahrani AA, Alhassan EM, Albanghali M (2018) The Oral Health Status and Attitudes of Saudi Adolescent Male Students in Albaha Province. Adv dentistry oral health 10:1 AlDosari AM, Akpata ES, Khan N (2010) Associations among dental caries experience, fluorosis, and fluoride exposure from drinking water sources in Saudi Arabia. J Public Health Dent 70:3 Al-Shammery AR (1999) Caries experience of urban and rural children in Saudi Arabia. J Public Health Dent 59:1 Faraz A, Khabeer A, Imran A, Soban Q, Imran F, ArRejaie AS (2015) Prevalence of dental caries in primary and permanent teeth and its relation with tooth brushing habits among schoolchildren in Eastern Saudi Arabia. Saudi Med J 36:6 Alkhunaizi YM, Alshahrani SM, Elshewahy KM, Moaf AI, Wyne AH, PREVALENCE, SEVERITY AND PATTERN OF DENTAL CARIES AMONG FEMALE SCHOOLCHILDREN IN EASTERN PROVINCE (2018) Pakistan Oral Dent J 38:2 GokulK (2018) Prevalence of Dental Caries Among Girl Students of Primary School in Buraydah City. Int J Cur Res Rev 10:7 Gandeh MBS, Milaat WA (2000) Dental caries among schoolchildren: report of a health education campaign in Jeddah, Saudi Arabia. EMHJ-Eastern Mediterranean Health J 6:2 Moher D, Altman DG, Liberati A, Tetzlaff J (2011) PRISMA statement. Epidemiology. 10.1097/EDE.0b013e3181fe7825 McGowan J (2016) PRESS peer review of electronic search strategies: 2015 guideline statement. J Clin Epidemiol. ;75 Stang A (2010) Critical evaluation of the Newcastle-Ottawa scale for the assessment of the quality of nonrandomized studies in meta-analyses. Eur J Epidemiol 25:9 AlDosari AM, Wyne AH, Akpata ES, Khan NB (2004) Caries prevalence and its relation to water fluoride levels among schoolchildren in Central Province of Saudi Arabia. Int Dent J 54:6 Alamoudi NN, Salako, Massoud I (1996) Caries experience of children aged 6–9 years in Jeddah, Saudi Arabia. Int J Pediatr Dent 6:2 Al-Ansari AA (2014) Prevalence, severity, and secular trends of dental caries among various Saudi populations: A literature review. Saudi J Med Med Sci 2:3 Martin H, Poul EP, John C, Newell J (2003) Global goals for oral health 2020. Int Dent J 53:5 Ministry of health (2007) MOH Recommends more Fluoride in Drinking Water Networks. https://www.moh.gov.sa Accessed 20 Apr 2020 AlRafee MA, AlShammery AR, AlRumikan AS, Pani SC (2019) A Comparison of Dental Caries in Urban and Rural Children of the Riyadh Region of Saudi Arabia. Front Public Health. ;7 Qutob A (2009) A needs-based approach for health human resources planning for dentistry in Jeddah. Saudi Arabia. 10.2147/AMEP.S41173 Ministry of health: National Initiative for the Prevention of Dental Caries (2019) https://www.moh.gov.sa Accessed 20 Apr 2020 Dye BA (2017) Trends in dental caries in children and adolescents according to poverty status in the United States from 1999 through 2004 and from 2011 through 2014. J Am Dent Association 148:8 Davies GM, Neville J, Jones K, White S (2017) Why are caries levels reducing in five-year-olds in England? Br Dent J 223:7 Togoo RA, AlRafee MA, Kandyala R, Luqam M, AlBulowey MA (2012) Dentists’ opinion and knowledge about preventive dental care in Saudi Arabia: a nationwide cross-sectional study. J Contemp Dent Pract 13:3 Bureau of experts at the council of ministers: The health system In KSA. www.boe.gov.sa (2002) Accessed 25 Apr 2020 Council of Cooperative Health Insurance: Cooperative Health Insurance Policy. www.cchi.gov.sa (2019) Accessed 23 Apr 2020 Bcheraoui CE, Tuffaha M, Daoud F, Kravitz H, AlMazroa MA, AlSaeedi M et al (2016) Use of dental clinics and oral hygiene practices in the Kingdom of Saudi Arabia, 2013. Int Dent J. 10.1111/idj.12210 Farsi J (2010) Dental visit patterns and periodontal treatment needs among Saudi students. EMHJ-Eastern Mediterranean Health J 16:7 Orfali SM, Aldossary MS (2020) Utilization of Dental Services in Saudi Arabia: A Review of the Associated Factors. Saudi J Oral Dent Res. 10.36348/sjodr.2020.v05i03.002 Almutlaqah MA (2018) Factors affecting access to oral health care among adults in Abha City, Saudi Arabia. J Int Soc Prev Community Dentistry 8:5 Curi DSC, Figueiredo ACL (2018) Jamelli SR Factors associated with the utilization of dental health services by the pediatric population: an integrative review. Ciencia saude coletiva. ;23 Additional Material Table 2 and Appendix A are not available with this version. Additional Declarations The authors declare no competing interests. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. 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Adekunle","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAABFklEQVRIiWNgGAWjYFCCBGYgYQFiMT5IqLCRA7EOPCCsRYKBh4GB2eDDmTRjsJYEIrWwSc5sO5zYABbEo4G/PfmwMe8OCTl79u4EaR425vT5YYcfAm2xk9NtwK5F4syz5GTeMxLGPDxnNwAJttyNt9MMgFqSjc0O4LDmRo7xYd42icQeidwNyTwSPLkbZyeAtBxI3IZDi/yN/M8gLfU98m83HOYxkEg3nJ3+Aa8Wgxs5zMlALQk8ErwbG2ckGCTIS+fgt8XwzDNjw7ltEoY9Z3I3MwCNN9wgnVNwIMEAt1/kjic/lnjbZiPP3n52+4/Ef//l5Wenb/7wocJODqf3MZ0KVmlArHIQkG8gRfUoGAWjYBSMBAAADYViMTa44XQAAAAASUVORK5CYII=","orcid":"https://orcid.org/0009-0008-3525-3821","institution":"Georgia State University, Atlanta, GA 30303","correspondingAuthor":true,"prefix":"","firstName":"Hakeem","middleName":"","lastName":"Adekunle","suffix":""}],"badges":[],"createdAt":"2025-08-08 02:40:24","currentVersionCode":1,"declarations":{"humanSubjects":false,"vertebrateSubjects":true,"conflictsOfInterestStatement":false,"humanSubjectEthicalGuidelines":false,"humanSubjectConsent":false,"humanSubjectClinicalTrial":false,"humanSubjectCaseReport":false,"vertebrateSubjectEthicalGuidelines":true},"doi":"10.21203/rs.3.rs-7322781/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-7322781/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":89861352,"identity":"8820a277-ac6d-4962-8352-550400e0006e","added_by":"auto","created_at":"2025-08-25 21:02:20","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":307781,"visible":true,"origin":"","legend":"\u003cp\u003eFlow diagram for identifying studies.\u003c/p\u003e","description":"","filename":"image1.png","url":"https://assets-eu.researchsquare.com/files/rs-7322781/v1/1b904670bf644db73a962ac2.png"},{"id":89861348,"identity":"04ab2428-f490-4cb4-ad0f-3d1dfc7ff915","added_by":"auto","created_at":"2025-08-25 21:02:20","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":86579,"visible":true,"origin":"","legend":"\u003cp\u003ePooled prevalence of dental caries among 5-7-year children\u003c/p\u003e","description":"","filename":"image2.png","url":"https://assets-eu.researchsquare.com/files/rs-7322781/v1/dbfd705b259824d361f096b9.png"},{"id":89861819,"identity":"8026df31-36e1-4d71-87a4-b07c16eb21f7","added_by":"auto","created_at":"2025-08-25 21:10:20","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":118914,"visible":true,"origin":"","legend":"\u003cp\u003eMeta-analysis of the mean dmft\u003c/p\u003e","description":"","filename":"image3.png","url":"https://assets-eu.researchsquare.com/files/rs-7322781/v1/2593226f468b8b39166c9392.png"},{"id":89861350,"identity":"5488bf5a-2b86-4a53-a2bb-97fe69bbed1b","added_by":"auto","created_at":"2025-08-25 21:02:20","extension":"png","order_by":4,"title":"Figure 4","display":"","copyAsset":false,"role":"figure","size":55428,"visible":true,"origin":"","legend":"\u003cp\u003ePooled prevalence of dental caries among 12-15-year children\u003c/p\u003e","description":"","filename":"image4.png","url":"https://assets-eu.researchsquare.com/files/rs-7322781/v1/ffb12b44cf071ebb5ac24993.png"},{"id":89861822,"identity":"3dadb26f-4506-4282-9a33-65a20ef5fefa","added_by":"auto","created_at":"2025-08-25 21:10:20","extension":"png","order_by":5,"title":"Figure 5","display":"","copyAsset":false,"role":"figure","size":108663,"visible":true,"origin":"","legend":"\u003cp\u003eMeta-analysis of the mean DMFT\u003c/p\u003e","description":"","filename":"image5.png","url":"https://assets-eu.researchsquare.com/files/rs-7322781/v1/185b67b47df439dec11d9de4.png"},{"id":89861993,"identity":"366482ee-e72f-4896-8341-0ccf8461c016","added_by":"auto","created_at":"2025-08-25 21:18:20","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1317753,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7322781/v1/015beff0-2aff-4fc5-a143-ad73fda4f7a6.pdf"}],"financialInterests":"The authors declare no competing interests.","formattedTitle":"\u003cp\u003e\u003cstrong\u003ePrevalence of Dental Caries–An Ongoing Public Health Crisis: A Meta-Analysis\u003c/strong\u003e\u003c/p\u003e","fulltext":[{"header":"Introduction","content":"\u003cp\u003eDental caries is one of the oldest and most common human infections. As showed by the American Dental Association, dental caries can be characterized as a \"biofilm-interceded, sugar-driven, multifactorial, powerful sickness that outcomes in the phasic demineralization and demineralization of dental hard tissues\". Over the most recent couple of decades, various measures have been executed to prevent dental caries and other oral health problems in many populations over the world. Despite the tremendous endeavors made, it is still a worldwide public health problem and influences an enormous piece of the total population [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. Although dental caries is preventable, the prevalence remains high in school-age children [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. In 2010, this infection influenced 2.43\u0026nbsp;billion individuals (35.3% of the population) worldwide [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eDifferent steps to avoid dental caries and other oral health conditions in various communities worldwide have been adopted over the last couple of decades, and true to nature, many people have benefited from these initiatives. However, there are still people who are still affected immensely by this health problem. Therefore, it is important to have additional measures in place to address this, based on the severity of the condition in each community. A useful resource that can be of incredible help is the dmft index. The dmft index can calculate the severity of dental caries; dmft refers to decayed, damaged caries, and filled teeth in the primary dentition. The DMFT corresponds to the permanent dentition number of decayed, absent because of caries, and Filled Teeth [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. Centered on the global decayed, incomplete, filled (DMFT / dmft) index of oral health status predictor, the incidence of dental caries is rated as very moderate (0.0 -1.1), moderate (0.0 -1.1) low (1.2\u0026ndash;2.6), moderate (2.7\u0026ndash;4.4), high (4.5\u0026ndash;6.5), and very high (\u0026gt;\u0026thinsp;6.6) [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eAccording to WHO, poor oral hygiene may profoundly influence the overall hygiene of children's and adolescents' lives [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. Therefore, caries may negatively affect the oral health-related quality of life (OHRQoL) of children and their parents during adolescence [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. Caries is very popular among 5-year-old children in Saudi Arabia (SA), with a prevalence of 83.5 percent [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eUntreated caries is often associated with pain, which influences weight gain, health, quality of life, and preschoolers' cognitive performance. Besides growth and development, caries can have a detrimental effect on education. Children with poor oral health are more likely to have a higher chance of exclusion from school and have lower school performance relative to children with better oral health [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eA decrease in caries\u0026rsquo; prevalence is mostly seen in nations that have built up public health programs using school health programs and school sealant programs for preventing dental caries. The United Kingdom (UK) used to witness high rates of dental caries. Nevertheless, by applying the oral health framework, the rates started to significantly change oral health prevalence in general and dental caries in particular. [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]. A British study of 69,318 children between the ages of 5\u0026ndash;15 years uncovered a 31\u0026ndash;51% decrease of caries over the last 40 years (1973\u0026ndash;2013) [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]. It appears that these figures have improved with time. In 2019, a study conducted in the UK reported that the dental caries\u0026rsquo; prevalence ranged from 25\u0026ndash;26% among five-year-old children [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]. Additionally, a Dutch examination reported that the caries\u0026rsquo; rate decreased in 1990\u0026ndash;2009 among 8\u0026ndash;21-year-olds.\u003c/p\u003e\u003cp\u003eAmong SA regions, the dental caries prevalence was much higher than in the European countries since the implementation of the well-being framework. The prevalence of dental caries is high in Saudi populations, especially among young people [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]. Nationally, the prevalence of caries among children between the ages of 6 and 7 was 74\u0026ndash;90 percent in the primary teeth with mean dmft varied between 2.7 and 7.1 while in permanent teeth, it was 59-80 percent [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]. The state of caries can be found in a research that examined the national prevalence of dental caries in SA school children. The primary national investigation that was done by Al-Shammery (1999) evaluated 1873 children at 12 to 13-year-olds in ten regulatory locales in SA. The article found that the prevalence of caries was 74% in urban areas and 67% in rural areas. The examination discovered a factually massive contrast between the metropolitan regions and the rural zones [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eStudies showed different prevalence rates in various Kingdom areas, ranging between 60\u0026ndash;87 percent [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e, \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e, \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]. A research was conducted in Riyadh's specified areas to assess dental caries among school children between ages 6 and 8. The results of the research investigation revealed that the prevalence of caries was 83%. The research finding is moderately high compared to the safe limit of the World Health Organization (WHO) [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e]. In 2018, researchers of the Qassim area determined the general prevalence of caries in schoolchildren with an age range of 7 years. The outcomes were 80.80% in primary teeth and 29% in permanent teeth. In contrast, the mean DMFT scores were 3. 92 [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e]. Another research conducted in Jeddah in 2000 considered 39,296 subjects. The research reported an 83.5% prevalence of caries in primary teeth [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e]. Another Ph.D. thesis in the same area reported a similar result with a slight rise in caries prevalence (85.5%). In the eastern area of the Kingdom, female participants in school had dental caries in their permanent teeth. The prevalence was 73% [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]. The present figures show that the WHO 2000 expectations for dental caries are still not reached for SA children [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eIt is worth mentioning that since 1993, Saudi Arabia started applying different prevention measures in primary care centres. In 2005, the first national program that covers all primary schools was launched and ever since, the MOH has been providing oral health promotion activities in schools. Nevertheless, there is no research providing a true estimate regarding the prevalence of dental caries in all KSA regions to evaluate the efforts that have been made by the government. Therefore, the aim of this study is to assess the prevalence and trends of dental caries among school children in Saudi Arabia over the last 23 years.\u003c/p\u003e"},{"header":"Methodology","content":"\u003cp\u003eWe reported and recorded this manuscript in accordance with MOOSE (Meta-analyses Of Observational Studies in Epidemiology) guidelines.\u003c/p\u003e\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e\u003ch2\u003eEligibility criteria:\u003c/h2\u003e\u003cp\u003eThe inclusion criteria were as follows: \u003cb\u003ea)\u003c/b\u003e participants between the age of 5 and 15 years (as WHO recommended) who are generally healthy without systemic disease; \u003cb\u003eb)\u003c/b\u003e studies reporting the prevalence of dental caries using the WHO criteria for caries diagnosis; \u003cb\u003ec)\u003c/b\u003e studies in English or Arabic and published between January 1996 and October 2019; \u003cb\u003ed)\u003c/b\u003e population-based studies conducted in Saudi Arabia. We excluded all the relevant articles that did not completely comply with the inclusion criteria.\u003c/p\u003e\u003c/div\u003e\n\u003ch3\u003eSearch strategy:\u003c/h3\u003e\n\u003cp\u003eThe following databases were thoroughly searched for studies that met the inclusion criteria: Scopus, Google Scholar, ISI Web of Science, and MEDLINE via Ovid. For unpublished studies and theses, TA searched the local databases and journals through the Saudi Digital Library. Refer to Appendix A for detailed information about each database's search strategy. TA and GH reviewed the references of included studies to find relevant papers. The citations that have been identified through the search were imported into Endnote X8.\u003c/p\u003e\u003cp\u003e\u003cb\u003eData extraction and assessment of the risk of bias.\u003c/b\u003e\u003c/p\u003e\u003cp\u003eA data extraction form has been used to extract data from all included studies systematically. Two authors independently extracted the data from the selected studies (TA and GH). Any errors were settled by a third author (AH). Information extracted in the present review included the author's name, year of the examination, the age of participants study configuration, considered site, sample size, analytic measures, dental caries prevalence and severity of dental caries (dfmt/DMFT list). As per the Cochrane Reviewers' Handbook, the risk of bias inside investigations was evaluated freely by two writers (TA and GH). The Newcastle-Ottawa Scale for quality assessments for cross-sectional investigations assessed the methodology for the included examinations. The risk of bias tool comprises five items. Each investigation was ordered as having either a high (score\u0026thinsp;\u0026lt;\u0026thinsp;3) or low (score 3\u0026ndash;5) risk of bias [\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e].\u003c/p\u003e\n\u003ch3\u003eStatistical methodology\u003c/h3\u003e\n\u003cp\u003eThe heterogeneity between the studies was assessed using the I\u0026sup2; test. A level of 75% or more indicates a high degree of heterogeneity. By using the random-effects model, the pooled prevalence with 95 percent confidence intervals was reported. The meta-analysis was done using tools for comprehensive meta-analysis (CMA). Significant variability among the studies was seen by this study (p\u0026thinsp;\u0026lt;\u0026thinsp;0.005)\u003c/p\u003e"},{"header":"Results","content":"\u003cdiv id=\"Sec7\" class=\"Section2\"\u003e\u003ch2\u003eStudy Selection and Characteristics\u003c/h2\u003e\u003cp\u003eAs outlined in Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e, The initial search identified 134 studies through the titles and abstracts of articles in the following electronic bibliographic databases: 36 studies from MEDLINE via Ovid, 27 from ISI Web of Science, nine from Scopus, 20 from the Saudi digital library, 18 from EMBASE and 24 from Google Scholar. After removing duplicates by utilization EndNote, 90 were excluded. Overall, twenty cross-sectional studies involving 56,154 children in six regions published between 1996 and 2019 reporting caries prevalence were included. No extra article was recognized through a manual search of the reference of the chose investigations.\u003c/p\u003e\u003cp\u003eAll the articles included were based on cross-sectional investigations and defined dental caries in the prescribed standardized manner, using the WHO's diagnostic criteria. Seven of the 20 articles (35%) were published in the Riyadh region, four (20%) in the Makkah region, three (15%) in the eastern region, three (15%) in the Medina region, and only one study conducted in Aseer region and Najran region (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). Concerning study quality, 17 studies were at low risk of bias, and three were at high risk of bias (Table\u0026nbsp;2).\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eCharacteristics of included studies\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"8\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAuthor and Year\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eStudy Location\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eAge Group\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eGender\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003eSample Size\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\"\u003e\u003cp\u003eDental caries measurement\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c7\"\u003e\u003cp\u003eMean dmft/DMFT\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c8\"\u003e\u003cp\u003ePrevalence of dental caries\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAl-Tamimi, S., 1998\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eMedina\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e6, 12\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eBoth\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e480\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eDMFT\u0026thinsp;+\u0026thinsp;dmft\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003edmft 6.4 \u003c/p\u003e\u003cp\u003eDMFT 2.9\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e87% in primary teeth \u003c/p\u003e\u003cp\u003e 83% in permanent teeth\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eBhayat, A., 2014\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eMedina\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e12\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eMale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e360\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eDMFT\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003eDMFT 1.53\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e57.2% in primary teeth\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMahrous, M. S., 2016\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eMedina\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e6, 12\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eBoth\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e316\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eDMFT\u0026thinsp;+\u0026thinsp;dmft\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003edmft 4.9\u003c/p\u003e\u003cp\u003eDMFT 1.3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e86% in primary teeth\u003c/p\u003e\u003cp\u003e 67.6% in permanent teeth\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAbolfotouh, M. A., 2000\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eAbha\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e6, 12\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eMale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e959\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eDMFT\u0026thinsp;+\u0026thinsp;dmft\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003edmft 6.53\u003c/p\u003e\u003cp\u003eDMFT 1.23\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e93.3% in primary teeth\u003c/p\u003e\u003cp\u003e49.5 in permanent teeth\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAlkhunaizi, Y. M., 2018\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eDhahran, Al-Khobar\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e6,12, 15\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eFemale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e895\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eDMFT\u0026thinsp;+\u0026thinsp;dmft\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003edmft 5.94\u003c/p\u003e\u003cp\u003eDMFT 4.39\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003eprimary teeth 73%\u003c/p\u003e\u003cp\u003epermanent teeth 82%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eFarooqi, F. A., 2015\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eDammam\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e6,7, 12\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eBoth\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e711\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eDMFT\u0026thinsp;+\u0026thinsp;dmft\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003edmft 3.5\u003c/p\u003e\u003cp\u003eDMFT 2.82\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003eIn primary teeth 77.8%\u003c/p\u003e\u003cp\u003epermanent teeth 68%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eKhan, N. B., 2001\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eAl-Ahsa\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e6\u0026ndash;7\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eBoth\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e457\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003edmft\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003edmft 4.45\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003ein primary teeth 82.9%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAlamoudi, N., 1996\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eJeddah\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e6,7\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eNot Reported\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e571\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003edmft\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003edmft 5.54\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003eprimary teeth 73.5%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eQutob, A. (2009)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eJeddah\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e6, 12\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eBoth\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e800\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eDMFT\u0026thinsp;+\u0026thinsp;dmft\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003edmft 5.45 DMFT 2.89\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003ein primary teeth 91%\u003c/p\u003e\u003cp\u003epermanent teeth 71.7%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eGandeh, M. B. S., (2000)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eJeddah\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e6\u0026ndash;7\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eBoth\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e39,296\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003edmft\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003eNot Reported\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003ein primary teeth 83.4%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAlkarimi, H. A., 2014\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eJeddah\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003emean age 6.8\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eBoth\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e417\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003edmft\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003edmft 5.7\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003ein primary teeth 87.1%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eElfaki, N. K., 2014\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNajran\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e12,13\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eFemale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e96\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eDMFT\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003eDMFT 3.04\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003eNot Reported\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAl-Rafee, M. A., 2019\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eRiyadh region\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e6, 12, 15\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eBoth\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e1986\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eDMFT\u0026thinsp;+\u0026thinsp;dmft\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003edft 1.4\u003c/p\u003e\u003cp\u003eDMFT 1.72\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003ein primary teeth 85.77%\u003c/p\u003e\u003cp\u003epermanent teeth 64.98%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAldosari, A. M., 2004\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eRiyadh and Qaseem\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e6\u0026ndash;7 and 12\u0026ndash;13\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eBoth\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e1104\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eDMFT\u0026thinsp;+\u0026thinsp;dmft\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003edmft 6.53\u003c/p\u003e\u003cp\u003eDMFT 5.06\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003ein primary teeth 91.2% \u003c/p\u003e\u003cp\u003epermanent teeth 90.5%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAlamri, A. A., 2017\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eRiyadh\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e6\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eMale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e672\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003edmft\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003edmft 4.24\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003eprimary teeth 76.4%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAlshiha, S. A., 2017\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eRiyadh\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e6\u0026ndash;7\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eFemale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e6183\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003edmft\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003edmft 5.47\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003eprimary teeth 85.5%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAlhabdan, Y. A., 2018\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eRiyadh\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003emean age 6.92\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eMale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e578\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003edmft\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003edmft 4.20\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003ein primary teeth 83%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePaul, T. R. 2003\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eAl-Kharj\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eBoth\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e103\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003edmft\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003edmft 7.1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003ein primary teeth 83.5%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePaul, T. R. 1997\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eAlkharj\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eBoth\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e103\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003edmft\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003edfmt 7.12\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003eIn primary teeth 96.5%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAl-Shammery, A. R., 1999\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eSaudi Arabia\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e12\u0026ndash;13\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eboth\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e1873\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eDMFT\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003eDMFT 2.69\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003erural areas were 67%\u003c/p\u003e\u003cp\u003eurban areas were 74%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec8\" class=\"Section2\"\u003e\u003ch2\u003ePrevalence of dental caries in the primary dentition\u003c/h2\u003e\u003cp\u003eThe general prevalence of dental caries among youngsters aged 5\u0026ndash;7 was 84% (95% CI: 0.82\u0026ndash;0.86%) because of the random-effects model. The highest and lowest prevalence of dental caries was observed in different regions of SA was seen in Al-Kharj (96.5%) and Eastern Province (73%), respectively (Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e). Fourteen studies provided data on the mean dmft. The pooled mean dmft was 5.032 (95% CI: 3.876\u0026ndash;6.189; I2\u0026thinsp;=\u0026thinsp;99%) (Fig.\u0026nbsp;\u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e3\u003c/span\u003e).\u003c/p\u003e\u003cp\u003e\u003cb\u003ePrevalence of dental caries in the permanent dentition.\u003c/b\u003e\u003c/p\u003e\u003cp\u003eThe general prevalence of dental caries among 12\u0026ndash;15 youngsters was 74% (95% CI: 0.67\u0026ndash;0.79%; I2\u0026thinsp;=\u0026thinsp;83%) based on the random-effects model. The maximum and minimum prevalence of dental caries was observed in Riyadh (92.3%) and Abha (52%), respectively (Fig.\u0026nbsp;\u003cspan refid=\"Fig5\" class=\"InternalRef\"\u003e4\u003c/span\u003e). Out of the nine studies, only seven provided data on the mean DMFT. The pooled mean DMFT was 2.84 (95% CI: 2.21\u0026ndash;3.46). This analysis showed significant heterogeneity among the studies (p 0.005) (Fig.\u0026nbsp;\u003cspan refid=\"Fig4\" class=\"InternalRef\"\u003e5\u003c/span\u003e).\u003c/p\u003e\u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eThis systematic review comprehensively describes the prevalence of dental caries in children living in SA regions based on data published from 1996 to 2019. In this process, the data of 20 studies (out of 134 published papers) were considered for quantitative analysis. This review found (1) high prevalence estimates of dental caries, (2) an increase of caries prevalence in the last decade, and (3) a high demand for effective intervention.\u003c/p\u003e\u003cp\u003eOur results showed that dental caries' prevalence was 84 percent and 74 percent, respectively, in primary and permanent dentition. The mean dmft was 5.03 (95% CI: 3.876\u0026ndash;6.189) at 5\u0026ndash;6 years, and the mean DMFT was 2.84 (95% CI: 2.21\u0026ndash;3.46) at 12\u0026ndash;15 years. In concurrence with our outcomes, a public report led in all SA areas. Nevertheless, Central Province showed that dental caries' predominance was most noteworthy in the 6\u0026ndash;7-year age gathering, contrasted with that 12-year age gathering [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]. These findings are worrisome in the efforts made by the Ministry of Health (MOH) to reduce these figures.\u003c/p\u003e\u003cp\u003eThe results have shown that dental caries is still a significant issue in SA despite the government\u0026rsquo;s and dental healthcare workers' attempts to improve oral health in children and increase people's awareness of oral health over the years. In Riyadh, the capital of SA, the present review showed improvement in caries' status in school children compared to the results of the cross-section study conducted in Central Province in 2004 [\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e]. The situation of caries among children aged 5\u0026ndash;7 years in Jeddah has deteriorated in recent years compared to the previous survey in 1996 [\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eA sizeable number of publications to determine the prevalence of caries in schoolchildren were performed. In a previous review, Al-Ansari et al. concluded that most studies found that caries has a high prevalence among SA regions [\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e]. However, some of these papers did not evaluate caries in general populations. Instead, they attempted to estimate the prevalence of caries in participants with systemic diseases or special needs. These diseases may have a significant influence on oral health. Regardless, we excluded the articles that evaluated caries in a specific population because participants with the systemic disease have a much higher chance of having caries, which does not reflect the disease's true prevalence.\u003c/p\u003e\u003cp\u003eNumerous preventive measures to reduce the caries burden in SA have been put in place. The World Dental Federation, the WHO, and the International Dental Research Association have worked to plan the Global Oral Health Goals for 2020. One aim was to reduce dental caries' impact on individuals and society and develop an early diagnosis, prevention, and effective management strategies for dental caries [\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e]. Unfortunately, most epidemiological studies have shown that dental caries remains prevalent among school children in SA. Also, untreated caries in young children is still a significant health burden in SA, suggesting that more extraordinary efforts and different preventive measures are needed if this goal is to be achieved. In 2007, the Saudi Arabian Standards Organization (SASO) had adopted the MOH recommendations regarding fluoride ions to the primary drinking water networks in the major cities aiming to reduce caries prevalence from 90% to 50\u0026ndash;60% [\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e]. However, the findings of this meta-analysis showed that the MOH\u0026rsquo;s goal was not yet met.\u003c/p\u003e\u003cp\u003eOur review found a decrease in dental caries among 5-7-year-old children over time (Fig.\u0026nbsp;6). While modest, this decrease is notable given efforts by the SASO and MOH to improve dental health. The identified trend may reflect the community\u0026rsquo;s increased awareness of dental caries. Unfortunately, the results have not met the WHO and FDI World Dental Federation goals that aim to achieve 50% of children aged 5\u0026ndash;6 years to be caries-free [\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e]. The prevalence of dental caries in primary teeth has been decreasing in SA, with 1999 seeing dental caries decreased by ten percent. Since 1999, there\u0026rsquo;s been a year-on-year decline every year besides 2004 and 2018 (Fig.\u0026nbsp;7)\u003c/p\u003e\u003cp\u003eThis review found that caries\u0026rsquo; prevalence in 6-year-old children was higher than in 12-year-old children. A 2019 study was done in Riyadh to estimate the dental caries prevalence in primary and permanent teeth. The study found that caries prevalence in primary and permanent teeth was 86% and 65%, respectively [\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e]. Another study conducted in the same age group but in Jeddah found a similar result, 83.5% for primary teeth and 72% for permanent teeth [\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e]. These findings are similar to a 2018 study, which showed that caries prevalence remains high among six-year-old children [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. The increase in the prevalence of caries is consistent with previous findings. A review showed that the prevalence of caries increased between 1985 and 2010 [\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eAlthough most of the previous studies mentioned the importance of school programs and improving the practitioners' quality of care, the MOH has done many campaigns and programs to reduce the prevalence and severity of caries. One of these programs is the National Initiative to prevent dental caries, launched in 2018, which is the largest and most comprehensive campaign. The MOH aims to promote oral and dental health for primary school students by:\u003c/p\u003e\u003cp\u003e\u003col\u003e\u003cspan\u003e\u003cli\u003e\u003cp\u003eraising health awareness among students,\u003c/p\u003e\u003c/li\u003e\u003c/span\u003e\u003cspan\u003e\u003cli\u003e\u003cp\u003efluoride application to protect teeth from caries,\u003c/p\u003e\u003c/li\u003e\u003c/span\u003e\u003cspan\u003e\u003cli\u003e\u003cp\u003eproviding the students with the skills of preventing dental diseases, and\u003c/p\u003e\u003c/li\u003e\u003c/span\u003e\u003cspan\u003e\u003cli\u003e\u003cp\u003einvolving the family in inculcating healthy behavior among children.\u003c/p\u003e\u003c/li\u003e\u003c/span\u003e\u003c/ol\u003e\u003c/p\u003e\u003cp\u003eAccording to MOH, the initiative's number of beneficiaries reached nearly one million children in 2018 [\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e]. Nevertheless, there is no study to evaluate the effectiveness of these programs.\u003c/p\u003e\u003cp\u003eDespite this, caries' prevalence is significantly higher than those recorded in Europe and America [\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e, \u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e]. The proportions of caries reported in the review indicate that while there appears to be some decrease in the overall prevalence relative to previous national surveys, the changes are not marked as shown in European and American populations. It is likely due to the nature of dental caries; there are multiple factors that play a role in the increase of caries, including lack of awareness, poor oral hygiene, insufficient preventive dental services, and underutilization of dental services [\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e, \u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eSA is the only country in the world that is providing free access to dental health care in primary, secondary, and tertiary dental clinics of the government sector to all citizens [\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e]. As for the residents (non-Saudis), the employer must provide health insurance that covers dental services, which include all emergency dental treatment, checks up, and scaling teeth (teeth cleaning) [\u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e]. However, caries proportions among school children are high. Limited studies have been done in limited regions in SA to investigate the utilization of dental services to assess the influencing factors. The Saudi Health Information Surveyed over 10.000 participants to determine the use of oral health services in SA. The survey showed that only 11.5% of Saudi Arabia's population aged fifteen and above visited dentists for check-ups [\u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e]. In the 2010 survey conducted among school children in Jeddah to investigate the utilization of dental services, only 8.6% visited dentists for a regular check-up. Simultaneously, almost half of the students visited the dentist when they feel pain or have dental problems [\u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e]. A literature review conducted by Orfali et al. reported a correlation between the utilization of dental services and educational status. People who have a better education were more likely to have regular dental appointments [\u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e41\u003c/span\u003e]. Moreover, since the schools provide a unique setting to develop healthy habits, the researchers of these studies recommended improving children and parents' and teachers' awareness of the importance of dental care [\u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e, \u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e, \u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e42\u003c/span\u003e, \u003cspan citationid=\"CR43\" class=\"CitationRef\"\u003e43\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eOur meta-analysis results should be interpreted considering certain limitations. First, there was considerable heterogeneity between studies, although we have set strict including and excluding criteria. High heterogeneity between studies requires cautious interpretation of the results. The significant heterogeneity of the results could be because of the geographical variation, ethnic backgrounds. Second, most of the studies did not adequately control confounding factors such as fluoride exposure, socioeconomic level, and parents' educational level. Finally, because most of the included studies were conducted in the Central Province of SA, the results cannot be generalized to the total population.\u003c/p\u003e\u003cp\u003eThe current review's discoveries propose that dental caries influences a noteworthy part of younger students in SA. Given the multifactorial idea of dental caries, various methodologies should be taken next to each other to roll out an exceptional improvement.\u003c/p\u003e\u003cp\u003eCreating a national oral health policy that highlights the promotion and prevention of oral health would be most beneficial in addressing oral health problems in school children in Saudi Arabia and would support established curative programs. In schools, oral health education should be combined with the school curriculum and the dental sealant and fluoride application to admission conditions to the primary school should be added. This review may help public health managers, policymakers, and stakeholders evaluate such projects and may serve as a baseline for future national studies.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eIn this systematic review, the summary estimate of dental caries' prevalence among 5-7-year-old and 12 -15-year-old children were 84% and 74%, respectively. The pooled mean dmft/DMFT was 5.03 and 2.84 among 5\u0026ndash;7 and 12\u0026ndash;15 years. We conclude that dental caries status among school children is high in SA. Further research is required to identify approaches for the prevention and treatment of dental caries in schoolchildren.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll data generated or analysed during this study are included in this published article [and its supplementary information files].\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that they have no competing interests\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026apos; contributions:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eTA, SN, GAS contributed to the conception and design of the study. AH, DD, AAA contributed substantially to the acquisition and interpretation of data. TA drafted the manuscript. All the authors contributed to its critical revision, approval of the final version submitted for publication, and take responsibility for the statements made in the published article.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAuthors are thankful to the deanship of Scientific Research, King Saud University for funding through Vice Deanship of Scientific Research Chairs.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eFrencken JE, Sharma P, Stenhouse L, Green D, Laverty D, Dietrich T (2017) Global epidemiology of dental caries and severe periodontitis - a comprehensive review. J Clin Periodontol. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1111/jcpe.12677\u003c/span\u003e\u003cspan address=\"10.1111/jcpe.12677\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eCenters for Disease Control and Prevention. Hygiene-related Diseases Dental Caries (2016) \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.cdc.gov/healthywater/hygiene/disease/dental_caries.html\u003c/span\u003e\u003cspan address=\"https://www.cdc.gov/healthywater/hygiene/disease/dental_caries.html\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e. Accessed 21 Sept 2019\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eAlhabdan Y et al (2018) Prevalence of dental caries and associated factors among primary school children: a population-based cross-sectional study in Riyadh, Saudi Arabia. Environ Health Prev Med 23:1\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eLamont RJ, Egland PG (2015) In: YW T (ed) Dental Caries: Molecular Medical Microbiology. Academic, Boston, pp 945\u0026ndash;955\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eAmerican dental association: Caries Risk Assessment and Management. www.ada.org (2018) Accessed 7 Apr 2020\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eOrganization WH (2013) Oral health surveys: basic methods. World Health Organization\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eOrganization WH (2000) Global data on dental caries prevalence (DMFT) in children aged 12 years. Global Oral Data Bank ; 11\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eKhushbu Y (2016) Dental caries: A review. Asian J Biomedical Pharm Sci 6:53\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eAbanto J, Tsakos G, Paiva SM, Carvalho TS, Raggio DP, B\u0026ouml;necker M (2014) Impact of dental caries and trauma on quality of life among 5-to 6‐year‐old children: perceptions of parents and children. Commun Dent Oral Epidemiol. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1111/cdoe.12099\u003c/span\u003e\u003cspan address=\"10.1111/cdoe.12099\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003ePaul TR (2003) Dental health status and caries pattern of preschool children in Al-Kharj, Saudi Arabia. Saudi Med J 24:12\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003ePitts NB, Domenick T, Phil D, Ekstrand K, Jane A, Francisco R et al (2017) Dental caries. Nat Reviews Disease Primers. ; 3\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eBratthall D, H\u0026auml;nsel-Petersson G, Sundberg H (1996) Reasons for the caries decline: what do the experts believe? Eur J Oral Sci 104:4\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003ePetersen PE, Ogawa H (2016) Prevention of dental caries through the use of fluoride\u0026ndash;the WHO approach. Community Dent Health 33:2\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eMurray JJ, Vernazza CR, Holmes RD (2015) Forty years of national surveys: An overview of children's dental health from 1973\u0026ndash;2013. Br Dent J 219:6\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eSchuller AA, Dommelen PV, Poorterman JHG (2014) Trends in oral health in young people in the N etherlands over the past 20 years: a study in a changing context. Commun Dent Oral Epidemiol 42:2\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eAlzahrani AA, Alhassan EM, Albanghali M (2018) The Oral Health Status and Attitudes of Saudi Adolescent Male Students in Albaha Province. Adv dentistry oral health 10:1\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eAlDosari AM, Akpata ES, Khan N (2010) Associations among dental caries experience, fluorosis, and fluoride exposure from drinking water sources in Saudi Arabia. J Public Health Dent 70:3\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eAl-Shammery AR (1999) Caries experience of urban and rural children in Saudi Arabia. J Public Health Dent 59:1\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eFaraz A, Khabeer A, Imran A, Soban Q, Imran F, ArRejaie AS (2015) Prevalence of dental caries in primary and permanent teeth and its relation with tooth brushing habits among schoolchildren in Eastern Saudi Arabia. Saudi Med J 36:6\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eAlkhunaizi YM, Alshahrani SM, Elshewahy KM, Moaf AI, Wyne AH, PREVALENCE, SEVERITY AND PATTERN OF DENTAL CARIES AMONG FEMALE SCHOOLCHILDREN IN EASTERN PROVINCE (2018) Pakistan Oral Dent J 38:2\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eGokulK (2018) Prevalence of Dental Caries Among Girl Students of Primary School in Buraydah City. Int J Cur Res Rev 10:7\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eGandeh MBS, Milaat WA (2000) Dental caries among schoolchildren: report of a health education campaign in Jeddah, Saudi Arabia. EMHJ-Eastern Mediterranean Health J 6:2\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eMoher D, Altman DG, Liberati A, Tetzlaff J (2011) PRISMA statement. Epidemiology. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1097/EDE.0b013e3181fe7825\u003c/span\u003e\u003cspan address=\"10.1097/EDE.0b013e3181fe7825\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eMcGowan J (2016) PRESS peer review of electronic search strategies: 2015 guideline statement. J Clin Epidemiol. ;75\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eStang A (2010) Critical evaluation of the Newcastle-Ottawa scale for the assessment of the quality of nonrandomized studies in meta-analyses. Eur J Epidemiol 25:9\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eAlDosari AM, Wyne AH, Akpata ES, Khan NB (2004) Caries prevalence and its relation to water fluoride levels among schoolchildren in Central Province of Saudi Arabia. Int Dent J 54:6\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eAlamoudi NN, Salako, Massoud I (1996) Caries experience of children aged 6\u0026ndash;9 years in Jeddah, Saudi Arabia. Int J Pediatr Dent 6:2\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eAl-Ansari AA (2014) Prevalence, severity, and secular trends of dental caries among various Saudi populations: A literature review. Saudi J Med Med Sci 2:3\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eMartin H, Poul EP, John C, Newell J (2003) Global goals for oral health 2020. Int Dent J 53:5\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eMinistry of health (2007) MOH Recommends more Fluoride in Drinking Water Networks. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.moh.gov.sa\u003c/span\u003e\u003cspan address=\"https://www.moh.gov.sa\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e Accessed 20 Apr 2020\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eAlRafee MA, AlShammery AR, AlRumikan AS, Pani SC (2019) A Comparison of Dental Caries in Urban and Rural Children of the Riyadh Region of Saudi Arabia. Front Public Health. ;7\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eQutob A (2009) A needs-based approach for health human resources planning for dentistry in Jeddah. Saudi Arabia. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.2147/AMEP.S41173\u003c/span\u003e\u003cspan address=\"10.2147/AMEP.S41173\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eMinistry of health: National Initiative for the Prevention of Dental Caries (2019) \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.moh.gov.sa\u003c/span\u003e\u003cspan address=\"https://www.moh.gov.sa\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e Accessed 20 Apr 2020\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eDye BA (2017) Trends in dental caries in children and adolescents according to poverty status in the United States from 1999 through 2004 and from 2011 through 2014. J Am Dent Association 148:8\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eDavies GM, Neville J, Jones K, White S (2017) Why are caries levels reducing in five-year-olds in England? Br Dent J 223:7\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eTogoo RA, AlRafee MA, Kandyala R, Luqam M, AlBulowey MA (2012) Dentists\u0026rsquo; opinion and knowledge about preventive dental care in Saudi Arabia: a nationwide cross-sectional study. J Contemp Dent Pract 13:3\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eBureau of experts at the council of ministers: The health system In KSA. www.boe.gov.sa (2002) Accessed 25 Apr 2020\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eCouncil of Cooperative Health Insurance: Cooperative Health Insurance Policy. www.cchi.gov.sa (2019) Accessed 23 Apr 2020\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eBcheraoui CE, Tuffaha M, Daoud F, Kravitz H, AlMazroa MA, AlSaeedi M et al (2016) Use of dental clinics and oral hygiene practices in the Kingdom of Saudi Arabia, 2013. Int Dent J. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1111/idj.12210\u003c/span\u003e\u003cspan address=\"10.1111/idj.12210\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eFarsi J (2010) Dental visit patterns and periodontal treatment needs among Saudi students. EMHJ-Eastern Mediterranean Health J 16:7\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eOrfali SM, Aldossary MS (2020) Utilization of Dental Services in Saudi Arabia: A Review of the Associated Factors. Saudi J Oral Dent Res. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.36348/sjodr.2020.v05i03.002\u003c/span\u003e\u003cspan address=\"10.36348/sjodr.2020.v05i03.002\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eAlmutlaqah MA (2018) Factors affecting access to oral health care among adults in Abha City, Saudi Arabia. J Int Soc Prev Community Dentistry 8:5\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eCuri DSC, Figueiredo ACL (2018) Jamelli SR Factors associated with the utilization of dental health services by the pediatric population: an integrative review. Ciencia saude coletiva. ;23\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"},{"header":"Additional Material","content":"\u003cp\u003eTable 2 and Appendix A are not available with this version.\u003c/p\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":true,"hideJournal":true,"highlight":"","institution":"Georgia State University","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Dental, Caries, Prevalence, Children, Age","lastPublishedDoi":"10.21203/rs.3.rs-7322781/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7322781/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e\u003cp\u003eDental caries is one of the oldest and most prevalent infectious diseases affecting humans. According to the American Dental Association, it is a biofilm-mediated, sugar-driven, multifactorial disease characterized by the cyclical demineralization and remineralization of dental hard tissues. Despite numerous global efforts to reduce its burden, comprehensive assessments of its prevalence in specific populations remain limited.\u003c/p\u003e\u003ch2\u003eObjective\u003c/h2\u003e\u003cp\u003eThis study aimed to systematically review and analyze the prevalence and trends of dental caries among school-aged children in Saudi Arabia over the past 23 years.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e\u003cp\u003eA systematic search of Scopus, Google Scholar, ISI Web of Science, and MEDLINE via Ovid was conducted to identify relevant studies. A total of 20 eligible articles were included in the meta-analysis. Pooled prevalence estimates were calculated with 95% confidence intervals (CI), and heterogeneity was assessed using the I\u0026sup2; statistic.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e\u003cp\u003eThe pooled prevalence of dental caries among children aged 5\u0026ndash;7 years was 84% (95% CI: 0.82\u0026ndash;0.86). Among children aged 12\u0026ndash;15 years, the overall prevalence was 74% (95% CI: 0.67\u0026ndash;0.79) with significant heterogeneity observed (I\u0026sup2; = 83%).\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e\u003cp\u003eDental caries remains highly prevalent among school-aged children in Saudi Arabia, particularly in younger age groups. These findings underscore the need for enhanced preventive strategies and sustained public health interventions targeting oral health in this population.\u003c/p\u003e","manuscriptTitle":"Prevalence of Dental Caries–An Ongoing Public Health Crisis: A Meta-Analysis","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-08-25 21:02:15","doi":"10.21203/rs.3.rs-7322781/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"4d41c117-3b9f-4315-ab62-4a2ab3cec6dc","owner":[],"postedDate":"August 25th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[{"id":52841408,"name":"Biostatistics"}],"tags":[],"updatedAt":"2025-08-25T21:02:15+00:00","versionOfRecord":[],"versionCreatedAt":"2025-08-25 21:02:15","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-7322781","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7322781","identity":"rs-7322781","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}