Our Children's Teeth: Understanding Dental Caries in Saudi Arabia
Dental caries affects 96% of Saudi six-year-olds. Here's what the research tells us, why it matters, and what we as a dental community can do together — the first article in The Saudi Mouth series.
Research
Our Children's Teeth: Understanding Dental Caries in Saudi Arabia
There is a number that sits quietly in the background of almost every pediatric dental appointment in Saudi Arabia.
Ninety-six percent.
That is the figure the Ministry of Health reports for dental caries prevalence among six-year-old children in the Kingdom.¹ Nearly every child who walks into a first-grade classroom has already experienced tooth decay. Among twelve-year-olds, that figure is 93.7%.
If you've been in clinical practice for any length of time, this probably doesn't surprise you. You've seen it. The question most of us are beginning to ask — quietly, at conferences, between colleagues — is: what do we actually do about it?
This is the first article in The Saudi Mouth, a new SaudiDent series that looks at oral health through a specifically Saudi lens. Not to point fingers, not to alarm — but to understand. Because the more clearly we see the picture, the better equipped we are to make a difference, one patient, one family, one community at a time.
We begin with caries, because it is where most of our patients begin.
This is Part 1 of The Saudi Mouth.
Putting the Numbers in Perspective
Context always helps. Globally, the average caries prevalence among children aged 6–12 is around 60%.² Saudi Arabia's figure is higher — meaningfully so — and that gap is worth understanding, not because it reflects poorly on anyone, but because it tells us something important about where our attention and energy are most needed.
A 2026 study published in the Eastern Mediterranean Health Journal looked at 2,864 schoolchildren in rural areas of Riyadh Province and found caries prevalence of 76% among elementary-aged children.³ A 2025 study in the Journal of Clinical Pediatric Dentistry examined children in public primary schools in Riyadh and found that 91.2% had caries in primary or permanent teeth — and that 86.1% had decay that remained untreated at the time they were examined.⁴
That last figure is the one that stays with you. Not the prevalence — we've grown somewhat accustomed to seeing high prevalence — but the proportion who came in and left without treatment. It reminds us that the challenge isn't just clinical. It's behavioral, educational, and systemic all at once.
Why Is This So Common Here?
Caries is one of the most well-understood diseases in medicine. We know what causes it, we know how to prevent it, and we know how to treat it. So why does it remain so widespread?
In Saudi Arabia, as in many parts of the world, several factors tend to cluster together in a way that makes caries particularly persistent.
Diet and Sugar Exposure
Dietary patterns play a central role. A 2025 systematic review found that children who consumed sugary snacks or beverages three or more times a day had a 3.9-fold increased risk of developing caries (OR: 3.90; 95% CI: 2.79–5.45).⁵ Juices, carbonated drinks, sweetened milk — these are staples in many Saudi households, and for young teeth, frequent sugar exposure without adequate oral hygiene creates an environment where cariogenic bacteria thrive.
This isn't a judgement on families. Parents want what's best for their children. Many simply haven't been given the right information at the right time. That's where we come in.
Early Childhood Habits
For the very young, nighttime bottle-feeding with sweetened liquids remains one of the strongest risk factors for early childhood caries (ECC). A study looking at behavioral determinants of ECC in the Aseer region found that feeding behaviors and parental education were among the most predictive factors.⁶ The belief that primary teeth are temporary — that they'll fall out anyway — still leads many families to delay care until a child is in significant pain.
Every dentist reading this has had that conversation at the chair. It's a conversation worth having early and often.
Fluoride Access
Community water fluoridation is not widespread in Saudi Arabia, and fluoride toothpaste use in young children is inconsistent. In a context where sugar exposure is high, the absence of a reliable fluoride baseline matters. It doesn't mean families are doing something wrong — it means some of the protective factors that populations in other countries take for granted are simply less available here.
When Families Come to Us
Much of the time, families come to dental clinics when something hurts. That's human — it's true everywhere. But it means that by the time many children are seen, the disease has already progressed significantly. Shifting toward earlier, preventive visits requires a cultural shift that the dental community has a real role in driving.
Why This Matters Beyond the Mouth
Dental pain in children is not a minor inconvenience. It affects sleep, appetite, concentration, and mood. It is one of the leading causes of school absence globally, and there is no reason to think Saudi Arabia is an exception. Children with painful or missing teeth eat differently — often less well — with downstream effects on growth and development.
Untreated primary caries can also affect the permanent teeth developing beneath them, through infection, pressure, or disrupted eruption. And periapical infections in young children, though preventable, can escalate quickly.
At the community level, the cost of treating preventable dental disease is real. Extractions, pulpotomies, space maintainers, sedation appointments — these add up. Resources invested in treatment are resources not available for prevention. That's a cycle worth interrupting.
What We Can Do — Together
Here is the genuinely hopeful part: we have excellent tools, and most of them are simple.
Silver Diamine Fluoride (SDF)
SDF has become one of the most important interventions in pediatric dentistry over the past decade. A 2025 evaluation confirmed it is highly effective at arresting active caries in preschool children, outperforming conventional fluoride-only approaches.⁷ The AAPD and the FDI World Dental Federation both support its use as part of a personalized caries management plan.⁸
For a busy clinic seeing children with multiple active lesions, SDF is a practical gift — a 38% solution applied in minutes, arresting lesions without drilling or anesthesia, and buying time for the behavioral and dietary counseling that changes long-term outcomes. SaudiDent published a full evidence review on SDF in March 2026: Read the SDF Evidence Review →
The Hall Technique and ART
The Hall Technique — placing a stainless steel crown over a carious primary molar without removing the decay — and Atraumatic Restorative Treatment (ART) using glass ionomer cement are both well-supported approaches that work well in high-volume pediatric settings. Less chair time, less anxiety, less anesthesia. More completed treatment.
The Conversation at the Chair
Perhaps the highest-yield intervention available to every one of us is a well-timed, empathetic conversation with a parent. Not a lecture — just accurate, accessible information about why primary teeth matter, when to bring children in for a first visit, and what happens when sweet drinks become part of a bedtime routine.
School-Based Programs
The 2026 EMHJ study specifically highlighted school-based screening and education as a priority intervention.³ This is an area where collective advocacy from the dental community — through professional societies, through SaudiDent, through connections with the Ministry of Health — can move things forward.
A Note to Our Community
Ninety-six percent is a number that calls for response, not resignation. And the response doesn't have to be dramatic. It is built slowly and steadily — in the way we talk to the next parent who brings in a toddler, in the fluoride varnish we apply before a child leaves the chair, in the conversation we have with a school principal about a semester screening visit.
The Saudi dental community is talented, motivated, and growing. SaudiDent exists because of that — because dentists here want to share what they know, learn from each other, and raise the standard of care together.
That's what this series is for. Not to diagnose a failure, but to map an opportunity.
Because the same data that tells us how common caries is also tells us how much room there is to change it.
Key Takeaways
- Saudi Arabia's caries prevalence among children is high — 96% at age 6, 93.7% at age 12. Understanding the contributing factors helps us respond more effectively.
- Diet, early childhood habits, fluoride access, and late presentation are the key drivers. All of them are addressable.
- Silver Diamine Fluoride is one of the most practical and evidence-based tools for managing active caries in children. Use it.
- The parental conversation is often the highest-yield intervention in the room.
- We are in this together — as a profession, as a community.
References
- Ministry of Health, Kingdom of Saudi Arabia. Dental Caries — Oral Health Awareness Platform. moh.gov.sa
- GBD 2019 Diseases and Injuries Collaborators. The Lancet. 2020;396(10258):1204–1222. doi:10.1016/S0140-6736(20)30992-930992-9)
- A'aqoulah A, et al. Prevalence of dental caries among schoolchildren in Saudi Arabia. East Mediterr Health J. 2026;32(2):86–92. doi:10.26719/2026.32.2.86
- Prevalence of dental caries among children in public primary schools in Riyadh. Journal of Clinical Pediatric Dentistry. 2025. jocpd.com
- Systematic review and meta-analysis: sugar consumption frequency and caries risk in children. PMC. 2025. PMC12628725
- Social and Behavioral Determinants of Early Childhood Caries in the Aseer Region of Saudi Arabia. Gavin Publishers. gavinpublishers.com
- Evaluation of Effectiveness of Silver Diamine Fluoride in Preschool Children. PMC. 2025. PMC12563730
- American Academy of Pediatric Dentistry. Use of Silver Diamine Fluoride for Dental Caries Management in Children and Adolescents. aapd.org
The Saudi Mouth is a SaudiDent original series by Dr. Mahmoud H. Al-Johani.