Aim: This is a systematic review that examines the evidence on dental caries prevalence, need and use of pediatric dental services in Saudi Arabia, critically analyzing the geographical differences, socioeconomic factors and barriers to the service.

Methods: A comprehensive synthesis of 34 total studies was conducted, of which 15 provided quantitative evidence derived from nationwide surveys, regional cross-sectional studies, and utilisation models. Data extraction was concerned with caries prevalence, dmft/DMFT indices, proportions of untreated decay and dental visit patterns and predictors of service utilization. Quantitative results were favored for comparison. Quality assessment was done using the Newcastle-Ottawa Scale.

Results: The prevalence of caries in Saudi children ranges from 61.7 to 76% in populations of preschool children and 65.6 to 93% in school children [1,4,9,10]. The nationwide mean dmft is 3.93 (+-3.60) for primary dentition and mean DMFT is 2.42 (+-2.52) for permanent teeth. 57.8% of children are affected by untreated decay and fissure sealant coverage is very negligible at 6.4%. The rates of dental visits are widely different: 38.4-70.6% of treatment needs remain unmet throughout the provinces, most of care seeking is problem-based and not preventive. Quantitative pooling shows that there is a permanent dentition caries prevalence of 72.62% (95% CI: 65.3-78.89%) with mean DMFT of 1.68 (95% CI: 0.55-2.80) and inverse relationship between treatment needs and geographic distribution of the dentist. Geographic analysis indicates that population density and workforce allocation account for 99% of the utilization variation.

Conclusions: Pediatric dental caries in Saudi Arabia is a major public health problem of high prevalence, high untreated disease and suboptimal patterns of utilization. Marked disparities are present across regions, age groups and socioeconomic strata. Results highlight the pressing needs of specific preventive programs, balanced workforce allocation and policies that should be used to overcome structural obstacles to dental care access.