Estimating Future Demand for Dental Prostheses and Workforce Needs in a Dental Care Setting: The Saudi Experience

Abstract

Introduction and aim

In line with global and national goals to improve healthcare access and quality, this study projected prosthetic needs in young adults to guide prevention, training, and staffing at KAUDH.

Methods

A cross-sectional study was conducted in 2025 among 1000 children for tooth loss and prosthetic need. Institutional demographic data projected population growth to 2035. Prosthesis demand, chairside time, and staffing capacity were estimated using prevalence rates, curriculum data, and surveys.

Results

Tooth loss prevalence was 9.5%, with first molars most affected (7.8%) due to caries (96.1%). 97.4% of missing teeth required one-unit prostheses. Projected annual cases rose from 3,588 in 2025 to 5,520 in 2035, requiring up 44,160 chairside hours. Estimated residents increased from 74 to 114.

Conclusions

Prosthetic demand will surpassing current staffing capacity by 2035.

Clinical Relevance

Urgent action is needed to strengthen prevention, expand prosthodontic training, and align workforce planning with future needs.

Introduction

Oral diseases are the fourth most expensive disease to treat worldwide, although they are preventable with timely and effective strategies.¹ These diseases are well known for causing discomfort, pain, anxiety, and impaired masticatory efficiency, which may lead to weight loss and other local or systemic disorders. Furthermore, oral diseases may damage psychosocial well-being and integration into society due to compromised speaking, poor appearance, and halitosis.

Dental caries remains the most prevalent worldwide, including Saudi Arabia. Despite the substantial reduction in their rate over the last decades, untreated dental caries of permanent teeth remain the primary cause of tooth loss, which is recognized as a public health challenge.2, 3, 4 Globally, tooth loss is the 36th most prevalent health condition. It contributes to a range of functional, aesthetic, and social issues and impacts overall health and quality of life.⁵

At any given age, an individual’s health condition, including oral health, is shaped not just by their present situation, but also by their prior living conditions.⁶ Young adults’ overall health is important as habits that form during this stage of life significantly impact future adult health and economic potential.^3,7 Despite this importance, epidemiological data on the prevalence of tooth loss among young adults in Saudi Arabia remain limited, and there has been a notable scarcity of longitudinal assessments.8, 9, 10

Given the irreversible nature and profound negative impact of tooth loss on well-being and quality of life, there is an urgent need for research to develop comprehensive prevention strategies, enhance public awareness, and improve availability and access to dental care services.¹¹ The current generation of young adults is the largest in history, with 1.8 billion between the ages of 10 and 24 years worldwide.¹² In Saudi Arabia, young adults constitute 15.25% of the total population, and Jeddah is the city with the second highest population.¹³ Approximately 41% of Jeddah’s residents are below 24 years of age, and half are younger than 30.¹⁴

Both the World Health Organization’s (WHO’s) global goal and Saudi Arabia's Vision 2030 prioritize equitable access to healthcare. The aim is to ensure that no individual is denied access due to economic, social, or geographic barriers or because of impediment or discrimination.^12,15 Oral health is often neglected despite evidence highlighting the significant unidirectional and bidirectional interaction between oral health and general health. Consequently, experts recommend incorporating dental care into public healthcare coverage to promote fair and equitable access.¹⁶

The 2022 WHO Global Strategy emphasizes the need for new workforce models and universal health coverage (UHC) for oral health by 2030.¹⁷ In alignment with these global objectives, Saudi Arabia is actively addressing challenges and opportunities in dental care by focusing on developing a highly skilled dental workforce that is capable of meeting national demands in clinical practice and education.¹⁸ Developing a well-trained prosthodontics workforce is essential for diagnosis, treatment planning, rehabilitation, and maintenance of the oral function, comfort, appearance, and health of patients with clinical conditions associated with missing or deficient teeth.¹⁹

Prosthodontics requires advanced training due to its multidisciplinary and technically demanding nature, which encompasses conventional removable and fixed dental prostheses, maxillofacial prosthetics, and implant support restorations.²⁰ In an educational settings with dual function, such as university hospitals, ensuring a sufficient number of well-trained dental students to provide prosthodontic services is important for effective patient care and student learning. Shortages in trained dental students could lead to gaps in prosthodontic care, which would adversely affect both patient access and student learning outcomes.

Thus, the aim of this study was to use predictive modelling to predict the future need for dental prosthetic treatment in early adulthood at King Abdulaziz University’s Faculty of Dentistry and University Dental Hospital (KAUFD and KAU-UDH) in Jeddah, Saudi Arabia. By assessing the prevalence of tooth loss at younger ages and its associated determinants, this research could help in strategic workforce planning and development of educational programs aligned with the WHO’s Global Oral Health Strategy and Saudi Vision 2030. The ultimate goal is to strengthen prosthodontic training, optimize patient care services, and contribute to the long-term sustainability of Saudi Arabia’s dental workforce.

Materials and methods

KAU-UDH is a high-volume multi-disciplinary dental institution that has served the population of Makkah Province since 2013. A cross-sectional study was conducted at KAU-UDH to assess the projected need for one-unit prosthetic rehabilitation among young adults. The study protocol was approved by the Research Ethics Committee of the Faculty of Dentistry (REC-FD) at King Abdulaziz University.

The need for replacement of missing teeth is typically determined by a dentist during clinical oral examination, regardless of whether the patient is actively seeking care. Unmet need can be estimated and projected by analysing population trends and tooth-loss rates and by comparing total treatment need with the available supply of dental services. To forecast population growth up to the year 2035, a linear regression model was applied using institutional population data from 2020 to 2025 (Table 1). The model is expressed as:

$$Populationperyear=m\times year+b$$

where:

Table 1.

Annual number of children aged 8–16 years attending KAU-UDH (2020–2025)

Year	Total patients
2020	27,400
2021	29,516
2022	31,596
2023	33,855
2024	35,732
2025	37,767

m = slope of the line (the rate of increase in population per year)

b = y-intercept (the baseline level when at year 0)

The need-based forecasting method was adopted from Douglass et al. and used to estimate the annual number of missing teeth requiring implant-supported prosthetic rehabilitation.²¹ This approach assumes a constant prevalence derived from the 2025 sample and applies it to the projected population each year.

$$EstimatedNeed=ProjectedPopulation\times Prevalenceofneedforone-unitprothesis$$

Data on the average clinical time required to rehabilitate a single missing tooth with a one-unit prosthesis was obtained from prosthodontic residents and faculty in the Master Program in Prosthodontics at KAUFD via a structured survey. The number of clinical hours per week and working weeks per year were extracted from the official curriculum and verified with enrolled residents and supervising faculty. The total provider hours available per resident per year were calculated as:

$$AnnualProviderHours=AverageweeklyClinicalHours\times NumberofWorkingWeeksperYear$$

To estimate the annual clinical demand, the projected number of teeth requiring replacement with a one-unit prosthesis was multiplied by the average time needed per case. Finally, the required number of residents was calculated using the following:

$$NumberofResidentsRequired=\left(TotalChairsideHoursNeeded\right)/\left(AnnualClinicalHoursperResident\right)$$

Children aged between 8 and 16 years who attended UDH for screening between January and March 2025 were randomly selected for clinical examination using a simple random sampling technique. A computer-generated random number table was used biweekly to select participants from a master list of eligible children. Only individuals who were born and resided in Jeddah city and were classified as ASA I or ASA II according to the American Society of Anesthesiologists’ physical status classification were considered. Based on an observed prevalence of tooth loss of 5.4%, a sample size of 1000 children was considered more than sufficient to achieve a 95% confidence interval (CI) with a margin of error of ±5%, which would ensure that that the estimate would be within 5% of the true population value.⁴

Each selected participant completed a closed-ended questionnaire followed by a clinical examination. The questionnaire was designed by the principal investigator and included 2 parts: an introductory section with the study aim, an explanation, and informed consent, along with a section that gathered demographic details like age, gender, and address, as well as information about general and oral health. Only children whose guardians gave informed consent and who fully completed the questionnaire were included.

Clinical examinations were conducted by a single trained examiner using a mirror and explorer, and findings were digitally recorded chairside by an assistant in iPad-based direct entry software. The recorded data included the pattern of permanent tooth loss, reason for tooth loss if present, and future prosthetic need. Tooth loss was defined as missing teeth with remaining roots due to decay. Additionally, the participants’ radiographic records were reviewed to confirm clinical findings.

The reasons for tooth loss were categorized as caries, trauma, congenital absence, or periodontal disease. The need for dental prosthesis was assessed as “no prosthesis needed,” “need for one-unit prosthesis,” “need for multi-unit prosthesis,” “need for a combination of one-unit or multi-unit prostheses,” and “need for full prosthesis according to the WHO’s index.”²² Participants who were uncertain about the reasons for their tooth loss were excluded. All participants were offered oral health education and were encouraged to schedule an appointment for any necessary treatment or routine dental care.

Data were analysed using SPSS software (version 26; IBM). Categorical variables were presented as frequencies and percentages. The association between missing permanent central incisors, permanent lateral incisors, permanent first molars, and sociodemographic factors was evaluated using the chi-squared test. Binary logistic regression was performed to assess the predictive relationship between missing teeth and sociodemographic variables. The results were presented with odds ratios with 95% CIs. A p value of <.05 was used as an indication of statistical significance.

Results

A total of 1000 children participated in the study, and the majority were males (51.50%). Regarding nationality, a substantial proportion (96.40%) identified as Arab and most participants were between 8 and 12 years old (68.80%), while the remaining 31.20% were aged 13 to 16 years. The clinical examination revealed that the majority of participants had no missing permanent central incisors (99.70% of the sample). Only 0.30% reported at least missing one central incisors. Among those, 66.70% were missing a single central incisor, and the causes equally distributed between congenital absence, trauma, and syndromic conditions (each accounting for 33.30%).

For lateral incisors, 98.40% of participants had none missing, while 1.60% were missing at least one. Among these cases, 56.30% were missing both lateral incisors, and congenital causes accounted for 80.00% of the losses. Regarding first molars, 92.20% of participants had first molars present, while 7.80% were missing at least one. Of these, 61.50% had lost as single first molar. Decay was the primary cause of missing first molars (96.10% of cases; Table 2).

Table 2.

Missing permanent central incisors, lateral incisors, and 1st molar at a young age (n = 1000)

Parameter	Category	N	%
Missing central	No	997	99.70%
	Yes	3	0.30%
Number of missing central Need for replacement	1 central	2	66.70%
	2 centrals	0	0.00%
	3 centrals	1	33.30%
	4 centrals	0	0.00%
	One-unit prosthesis	3	0.30%
	No prosthesis is needed	0	0.00%
Cause	Congenital	1	33.30%
	Trauma	1	33.30%
	Syndromic	1	33.30%
Missing lateral	No	984	98.40%
	Yes	16	1.60%
Number of missing lateral Need for replacement	1 lateral	4	25.00%
	2 laterals	9	56.30%
	3 laterals	0	0.00%
	4 laterals	3	18.80%
	One- unit prosthesis	16	1.60%
	No prosthesis needed	0	0.00%
Cause	Congenital	12	80.00%
	Decay	1	6.70%
	Syndromic	2	13.30%
Missing 1st molar	No	922	92.20%
	Yes	78	7.80%
Number of missing 1st molar Need for replacement	1 molar	48	61.50%
	2 molars	23	29.50%
	3 molars	4	5.10%
	4 molars	3	3.80%
	One-unit prosthesis	76	7.60%
	No prosthesis needed	2	2.00%
Cause	Decay	74	96.10%
	Ameloblastoma	1	1.30%
	Orthodontic (Carious)	1	1.30%
	Resection of left mandible due to lesion	1	1.30%

As presented in Tables 3 there was no significant association between sociodemographic factors (age, gender, and nationality) and missing permanent central and lateral incisors. However, analysis of missing permanent first molars revealed significant variations based on gender and age. Among males, 6.30% reported missing first molars compared to 10.00% of females (p = .038). A notable age-related difference was observed: 3.90% of children aged 8–12 years had missing first molars compared to 16.30% in those aged 13 to 16 years (p < .001). Nationality was not significantly associated with permanent first molar loss.

Table 3.

Association between sociodemographic data and missing permanent teeth

Parameter	Category	No		Yes		P value
		N	%	N	%
a. Central incisor
Gender	Male	474	99.60%	2	0.40%	.598
	Female	448	99.80%	1	0.20%
Nationality	Arab	960	99.70%	3	0.30%	.737
	Non-Arab	36	100.00%	0	0.00%
Age	8–12	685	99.60%	3	0.40%	.243
	13–16	312	100.00%	0	0.00%
b. Lateral incisor
Gender	Male	473	99.40%	3	0.60%	.065
	Female	440	98.00%	9	2.00%
Nationality	Arab	948	98.40%	15	1.60%	.567
	Non-Arab	35	97.20%	1	2.80%
Age	8–12	677	98.40%	11	1.60%	.997
	13–16	307	98.40%	5	1.60%
c. 1st molars
Gender	Male	446	93.70%	30	6.30%	.038
	Female	404	90.00%	45	10.00%
Nationality	Arab	886	92.00%	77	8.00%	.252
	Non-Arab	35	97.20%	1	2.80%
Age	8–12	661	96.10%	27	3.90%	<.001
	13–16	261	83.70%	51	16.30%

In the logistic regression (Table 4), age was a significant predictor of first molar loss. Children aged 13 to 16 years were 4.462 times more likely to have missing first molars compared to those aged 8 to 12 years (odds ratio = 4.462, 95% CI: 2.718-7.325, p < .001). As shown in Table 2, all cases of missing permanent central and lateral incisors were identified as needing a one-unit prosthesis. Of the 78 missing first molars, 76 required a one-unit prosthesis. Two cases were identified as “no prosthesis needed”: one due to planned orthodontic space closure and another due to mandibular bone resection. Table 5 shows the estimated numbers of missing teeth needing one-unit prosthetic replacement for each year based on a 2025 prevalence rate of 9.5% (95 out of 1000 children).

Table 4.

Logistic regression showing the relation between statistically significant sociodemographic data and missing permanent 1^st molars

Parameter	Category	OR	95% CI		P value
			LB	UB
Gender	Male	Ref.	Ref.	Ref.	Ref.
	Female	1.593	0.974	2.605	.063
Age	8-12	Ref.	Ref.	Ref.	Ref.
	13-16	4.462	2.718	7.325	<.001

Table 5.

Estimated annual need for one-unit prothesis and corresponding number of prosthodontic residents required at KAU-UDH

Year	Projected population	Estimated teeth needing implants	Total chairside hours needed	Estimated residents required
2025	37,767	3588	28,704	74
2026	39,801	3781	30,248	78
2027	41,835	3974	31,792	82
2028	43,869	4168	33,344	86
2029	45,903	4361	34,888	90
2030	47,938	4554	36,432	94
2031	49,972	4747	37,976	98
2032	52,006	4941	39,528	102
2033	54,040	5134	41,072	106
2034	56,074	5327	42,616	110
2035	58,109	5520	44,160	114

Note: results were rounded up to the nearest whole number to ensure sufficient capacity.

The survey data from prosthodontic residents and instructors indicated that on average, each resident works 15 clinical hours per week for 26 weeks per year. This corresponds to a total of 390 hours of clinical service per resident annually. An average of 8 hours was required to fully rehabilitate a single missing tooth with a one-unit prosthesis, including diagnosis, treatment planning, surgical and prosthetic phases, and follow-up (n = 37, mean = 8 hours, standard deviation (SD) = 1.3).

Discussion

This is the first population-based study to use predictive modelling to project the future prosthodontic treatment needs among young adults at KAU-UDH in Jeddah, Saudi Arabia, between the years 2030 and 2035. The study aligns with Saudi Arabia’s Vision 2030 and the WHO Global Strategy on Oral Health, which emphasize equitable healthcare access. The findings highlight that anticipated demand is significant for dental prosthodontic treatment, particularly 1-unit prostheses, indicating that current and planned prosthodontic training capacities may be insufficient to meet the demand. Aligning with Saudi Arabia’s Vision 2030, the outcomes underscore the importance of strategic planning in dental education and healthcare delivery.

The findings indicated a significant predicted rise in prosthodontic treatment needs between 2030 and 2035, which reflects the combined impact of population growth and persistent oral health issues among young adults. Tooth loss predominantly affected first molars, which was primarily due to untreated dental caries, followed by congenital absences of lateral incisors. These findings support prior national and international studies demonstrating dental caries as the leading cause of tooth loss globally and emphasize the need for targeted preventive and interventional strategies, particularly among adolescents and young adults, who are in critical stages for lifelong oral health habits.^4,9,10

Interestingly, the association between sociodemographic factors and tooth loss varied significantly for permanent first molars. There was a higher prevalence among females than males and among adolescents aged 13 to 16 years compared to younger children aged 8 to 12 years. The increased odds ratio of tooth loss among older children (4.462) reflects prolonged exposure to risk factors for caries, such as poor dietary habits, insufficient oral hygiene practices, and limited preventive care.^17,23 This finding highlights the necessity for targeted and greater initiatives for early promotion of oral health.

Our predictive modelling indicated that there is unmet clinical demand for prosthodontic treatment that may surpass the current training capacity of prosthodontic residents at KAUFD. The model estimated that 74 residents would be required in 2025 to adequately fulfill the projected patient care demand, which will increase annually to 114 residents by 2035. These findings are methodologically and conceptually consistent with the foundational work of Douglass and Watson, who employed a population-based need assessment model to estimate future prosthodontic service demand in the United States. Douglass and Watson projected a significant increase in unmet prosthodontic needs despite declining trends in tooth loss in the United States, which was driven by aging populations and increasing demand for advanced prosthodontic treatments.²¹ Similarly, our approach aligns with modern prosthetic projections by Schwendicke et al., which emphasize that population growth is the primary driver of unmet dental need even in settings where oral disease prevalence is stabilizing or declining.²⁴

Likewise, Bernabé et al. employed a prevalence-based projection model using Global Burden of Disease data, in which age-specific tooth-loss prevalence was applied to population growth estimates to quantify future absolute treatment needs. Although age-standardized prevalence declined, their model demonstrated a sustained increase in the number of individuals requiring prosthodontic care due to population expansion and aging.²⁵ A comparable modelling framework underpins our analysis, in which a stable institutional prevalence of single-tooth loss was applied to projected population growth, resulting in a marked increase in absolute clinical demand over time. These international findings underscore that even with reduced tooth-loss rates, demand for prosthodontic services may still grow due to population dynamics and evolving treatment preferences.

However, the calculations likely represent conservative estimates as they did not fully account for additional clinical responsibilities that are regularly performed by prosthodontic residents, such as treatment planning, surgical phases, and laboratory procedures. Additionally, curriculum officials and residents noted that only around 20% of the clinical workload during the 3-year residency program is typically allocated to 1-unit prostheses, which is a limitation that was not factored into the estimation of resident workforce requirements. Thus, even if prosthodontic residents devoted 100% of their clinical time exclusively to providing 1-unit prostheses, the need would not be met with the current available supply.

One-unit prostheses may be provided as either implant-supported restorations or fixed dental prostheses (ie, tooth-supported bridges). Implant-supported restorations are increasingly favoured and tend to have better long-term prognoses, particularly because they preserve adjacent teeth and avoid bridge-abutment preparation.26, 27, 28 Implant-supported prosthetic treatment involves complex multidisciplinary collaboration and substantial clinical commitments. Often, specialists spend 3 to 6 hours chairside across multiple appointments to replace a single missing tooth with an implant-supported crown.29, 30, 31 For example, recent clinical studies of single-unit implant crowns using full digital workflows reported mean chairside times of around 50 to 51 minutes per case at delivery.³² Therefore, this further emphasizes the potential for underestimation of actual workforce requirements.

Importantly, the gap identified between the supply of prosthodontic services and projected clinical demands highlights critical implications for healthcare planning and policy development. To address this gap, strategic interventions may include expanding prosthodontic residency programs, increasing clinical training hours and integrating advanced simulation technologies to optimize student education and clinical efficiency. Additionally, preventative strategies targeting caries management, particularly among adolescents, may significantly reduce future prosthetic needs and associated healthcare costs.

This study has several strengths, including its population-based design, standardized data-collection methods, and robust predictive modelling approach, which is aligned with international standards. Nonetheless, its limitations should be acknowledged. These include the reliance on a single-centre analysis, potential underestimation of resident workloads, and the normative categorization of treatment needs, which may not reflect actual clinical decision-making scenarios. Moreover, the WHO criteria used in the study consider all missing teeth as requiring prosthetic treatment, which may have led to an overestimation of clinical needs.²² Several studies have shown that not all missing teeth necessarily compromise chewing efficiency or overall quality of life.³³ Chisini et al. highlighted the importance of distinguishing between normative and subjective prosthodontic needs, given that not all individuals perceive a need for tooth replacement, particularly for posterior teeth.³⁴

Conversely, as early as 1983, Douglas A. Conrad predicted that the demand for dental services among older adults would increase despite improvements in overall health. This anticipated rise in demand was attributed in part to a higher perceived need for dental care fostered by decades of growing oral-health awareness and education among the general population.^35,36 Thus, future research should aim to integrate subjective measures such as patient-reported outcomes with functional assessments and clinical evaluations in order to provide a more precise estimation of true treatment needs.

Our findings underscore that an increase in prosthodontic treatment demand is anticipated among young adults in Jeddah. Forecasting analyses indicate that prosthetic service demand is projected to surpass current workforce capacity by 2035. This projected imbalance will necessitate strategic enhancements in dental education, workforce planning, and public health initiatives. Integrating preventive strategies and expanding prosthodontic training programs aligned with Saudi Arabia’s Vision 2030 objectives will be essential to sustainably meet these projected needs and ensure equitable access to high-quality dental care.

Funding

The study received no funding.

Ethical consideration

The study protocol was approved by the Research Ethics Committee of the Faculty of Dentistry (REC-FD) at King Abdulaziz University (067-03-23).

Authors’ contributions

GB contributed to the conceptualization of the study, interpretation of the results, and the drafting, writing, revising, and editing of the manuscript. AK performed the clinical examinations and collected and interpreted the data. AA coordinated the research project, contributed to the interpretation of the results, and revised the manuscript. LS managed the research project, contributed to the conceptualization of the study, and critically revised the manuscript. All authors have read and approved the final version of the manuscript.

Data availability

The datasets used in the current study are available from the corresponding author upon reasonable request.

Conflict of interest

None disclosed.