Impact of Health System Structures on Caries Prevalence Among Schoolchildren in Germany and Saudi Arabia

Dental caries remains one of the most prevalent chronic conditions among children worldwide, with considerable variation in burden shaped by differences in health-system organization and preventive program implementation. Some countries have reported notable progress through coordinated school-based programs and supportive policy environments, while others continue to face challenges despite extensive public health efforts. This study aims to explore how selected structural and programmatic elements within national health systems may be associated with childhood caries outcomes, using Germany and Saudi Arabia as illustrative contexts.

A descriptive comparative secondary-data analysis combined with legal and policy mapping was conducted using published national oral health surveys, systematic reviews, and governmental reports. Caries indicators (dmft/DMFT) for children aged 6-7 and 12 years were extracted following WHO criteria. Health system organization, preventive program coverage, and policy enforcement mechanisms were mapped and critically reviewed. No new primary data were collected, and no inferential modeling was performed.

Germany has achieved substantial reductions in childhood caries prevalence through a legally mandated school-based prevention program, supported by individual prophylaxis covered by health insurance. This framework corresponds with low mean dmft (1.73) among 6-7-year-olds and mean DMFT (0.5) among 12-year-olds. By contrast, Saudi Arabia continues to report elevated caries rates despite substantial public-health investments, with mean dmft (5.0) and mean DMFT (3.5), with over 90% of children affected. Preventive initiatives in Saudi Arabia remain fragmented across sectors and lack a unified legal mandate.

The findings suggest that structured governance, coordinated prevention strategies, and reliable monitoring systems may be associated with more favorable oral health outcomes. In the context of Saudi Arabia, the persistently high caries burden suggests that strengthening national legislation, implementing an interoperable digital surveillance system, and improving the consistency of school-based preventive programs could support more equitable and effective oral health delivery.