Prevalence of dental caries and its associated factors among individuals aged 6–18 years attending Governorate hospitals in Jizan, KSA: a cross‑sectional study

Abstract

Background

Dental caries is a major global oral health concern, with a high prevalence among studied population, particularly in the Kingdom of Saudi Arabia (KSA), where rates can reach up to 80%. This study aimed to determine the prevalence of dental caries and its associated factors among individuals aged 6–18 years in the Jizan region of KSA.

Methods

A cross-sectional study was conducted in 2024 among 568 individuals attending dental clinics of governorate hospitals in Jizan. A simple random sampling method was used to select hospitals and participants. Data on sociodemographic characteristics, dental caries, oral health behaviors, feeding practices, and dietary factors were collected through questionnaires and clinical examinations using the WHO diagnostic criteria for dental caries. The Statistical Package for the Social Sciences version 26 was used for data analysis. Adjusted odds ratio (aOR) was used as a measure of association, with 95% confidence interval (CI). P < 0.05 was considered statistically significant in multivariable regression.

Results

The median (interquartile range) age of the studied population was 13.0 years (9.0 and 17.0 years). The prevalence of dental caries among studied population in Jizan was 85.2%. Multivariable analysis revealed that several factors were statistically associated with the prevalence of dental caries: father’s education of high school level or below (aOR = 2.11, 95% CI: 1.14–3.93, p = 0.018), non-participation in a health program (aOR = 3.03, 95% CI: 1.68–5.46, p < 0.001), brushing teeth (aOR = 0.11, 95% CI: 0.04–0.28, p < 0.001), never or occasional consumption of fruits and vegetables (aOR = 3.69, 95% CI: 1.20–11.36, p = 0.023 and aOR = 14.29, 95% CI: 4.90–41.69, p < 0.001, respectively), and regular consumption of fast food (aOR = 40.13, 95% CI: 7.40–217.58, p < 0.001).

Conclusions

Dental caries prevalence is high among studied population in Jizan, KSA. Low paternal education, non-participation in health programs, absence of tooth brushing, irregular consumption of fruits and vegetables, and regular fast food intake are significantly associated with dental caries. Public health strategies focusing on oral health education for parents and individuals, promoting tooth brushing, and increase fruit and vegetable intake are recommended.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12903-026-07785-x.

Background

Globally, dental caries remains a widespread oral health concern [1–4]. The World Health Organization (WHO) estimates that between 60% and 90% of children worldwide experience this condition [3, 5]. Although individuals of all ages are affected by dental caries, younger populations are more severely affected than adults [5].

Untreated tooth decay can result in a range of negative consequences, including pain and infection [3, 6, 7]. Furthermore, it can weaken the structure of teeth, lead to absences from school, and cause difficulties with speech and language development [6, 8]. These issues can have enduring effects that reduce an individual’s overall quality of life [3, 6].

Dental caries arises from a complex interplay of biological, behavioral, and socioeconomic factors [6]. Frequent intake of sugary food and acidic foods or drinks has been reported as factors associated with dental caries [2, 5]. Additionally, poor oral hygiene behaviors, low socioeconomic status, and lack of access to dental care are related to dental caries [5].

The incidence and prevalence of dental caries in developed countries are linked to improved oral hygiene practices, the application of fissure sealants, and the use of fluoride products, all within the context of enhanced oral health care systems and programs [5].

The Kingdom of Saudi Arabia (KSA), a large and culturally diverse nation, exhibits varying rates of dental decay in its different urban and rural areas. Despite this variation, the prevalence of dental caries has increased in many districts and cities of KSA [9]. The widespread occurrence of dental caries across all age groups in KSA represents a significant public health issue for the healthcare system [1]. Notably, the prevalence of dental caries among the young population in KSA is high at nearly 80% [1, 3, 4, 10, 11].

In the KSA, many studies have demonstrated wide variability in the prevalence of dental caries, with reported rates ranging from 41.9% to 94.2%. Specifically, six studies carried out in Riyadh demonstrated different rates: 41.9%, 67.3%, 72.6%, 74.0%, 83%, and 83.7% [8, 10, 12–15]. In Eastern KSA, two investigations found prevalence levels of 73% and 75% [16, 17]. Additional research highlighted different prevalence rates in other regions, including 65.6% nationally, 52.5% in Jeddah, 85.1% in Al-Madinah, 72.9% in southern Asir, 78.9% in Hai’l, and 94.2% in a northern province [1, 9, 11, 18–20].

Furthermore, many studies conducted in the KSA have identified statistically significant correlations between the occurrence of dental caries and various factors, including gender [8, 11], maternal education [10], paternal occupation [13], family income [10], toothbrushing habits [16] frequency of daily toothbrushing [10, 21], consumption of snacks between meals [21], flavored milk intake [10], and soft drink consumption [10, 17].

Addressing the significant problem of dental caries requires evidence-based interventions. This evidence will enable the development of oral health programs and strategies that may contribute to improved oral health outcomes for children in the Jizan region. Therefore, this study aimed to estimate the prevalence of dental caries and its associated factors among individuals attending dental clinics of the governorate hospitals in Jizan, KSA.

Methods

Study design

A cross-sectional study design was conducted in Jizan, KSA, in 2024. It was carried out among studied population to assess the prevalence of dental caries and its association with sociodemographic, oral health behaviors, feeding practices, and dietary factors. This observational study conformed to the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) guidelines [22].

Study area and population

This study was conducted among individuals aged 6–18 years who were attending dental clinics of the governorate hospitals located in the east, west, north, and south of the Jizan region, KSA. It was conducted during the period from February to October 2024.

Sample size and sampling technique

Sample size (N = 568) was calculated using the Epi Info software (version 7.2.5.0), based on a 95% confidence level, an expected prevalence of 75.5% [2], acceptable margin of error of 5%, and design effect of 2.

A simple random sampling method was used. Eight governorate hospitals were randomly selected, and participants were then consecutively recruited from the dental clinics of these selected hospitals. Jizan has 19 governorate hospitals. Eight governorate hospitals were randomly selected from the four areas (the east, west, north, and south areas), with two hospitals selected from each area. Moreover, participants were randomly recruited from the outpatient dental clinics of each selected hospital during the study period.

Inclusion and exclusion criteria

Individuals of both genders, aged 6–18 years, were included in this study. Individuals and their parents attending the selected governorate hospitals during the study period and willing to participate were included in this study. However, individuals who were not within the age range of 6–18 years and who were attending non-selected governorate and private hospitals were excluded from this study. Individuals unwilling to participate were also excluded. Additionally, individuals with systemic conditions, disabilities, fixed orthodontic appliances, or teeth with fluorosis were excluded.

Data collection and clinical examination

The questionnaire was adapted from previous literature [3, 5, 6, 23, 24]. The questionnaire was translated from English to an Arabic version. The questionnaire comprised three parts (supplementary file). The first part contained questions to elicit data on the sociodemographic characteristics of studied population, including age, gender, nationality, and place of residence, as well as their parents’ educational status, occupation, family income, and health program attendance. The second part contained questions related to oral health behaviors, feeding practices, and dietary factors, such as toothbrushing, frequency of toothbrushing per day, number of times eating per day, number of snacks consumed between meals per day, flavored milk consumption, fruit and vegetable intake, fast food consumption, and soft drink consumption. The third part was used for the clinical examination of teeth. Face-to-face interviews were conducted with individuals and their parents or guardians, and oral examinations were used to collect data.

Four dental practitioners were trained and calibrated for examining dental caries by the researcher in the College of Dentistry, Jazan University. The trained examiners assessed studied population and performed dental examinations on the selected individuals attending the outpatient dental clinics of the selected governorate hospitals. During the examinations, the presence of dental caries was recorded according to the WHO diagnostic criteria for dental caries assessment [23]. Specifically, the decayed, missing, and filled teeth (DMFT) index for permanent dentition and the decayed, missing, and filled teeth (dmft) index for primary dentition were recorded for each participant. The number of decayed, missing and filled teeth due to dental caries was recorded separately. The final DMFT score was the sum of these three components (Decayed + Missing + Filled). Any missing teeth not caused by dental caries were excluded from the study. Participants were then categorized as having dental caries (a DMFT or dmft score greater than zero) or no dental caries (a DMFT or dmft score of zero). Tooth examinations were conducted in dental clinics by using a sterile disposable dental mirror and a blunt probe, and the findings were recorded on a standardized data collection form.

To ensure consistent application of diagnostic criteria by examiners throughout the study, we performed duplicate examinations at the beginning, middle, and end of the study period on 10% of the sample.

Inter-examiner reliability

Before the study, four examiners conducted clinical examinations on a pilot sample of 50 individuals from the four areas of Jizan (east, west, north, and south). To evaluate the consistency of clinical assessments among the examiners, we compared their recorded dmft and DMFT scores. Inter-examiner reliability was assessed by calculating Cohen’s kappa coefficient for the following six pairs of examiners (Examiners 1 and 2, Examiners 1 and 3, Examiners 1 and 4, Examiners 2 and 3, Examiners 2 and 4, and Examiners 3 and 4).

Statistical analysis

Statistical Package for the Social Sciences version 26 (IBM Corp., Armonk, NY, USA) was used for data analysis. Age was not normally distributed based on the Shapiro–Wilk test (p < 0.05). However, age was presented as the median, and interquartile range (IQR) was defined by quartile 1 and quartile 3. The frequency and percentage were used for categorical variables. The dental caries status was categorized into “yes” (caries present) and “no” (caries-free).

Univariable and multivariable analyses using binary logistic regression were performed to determine the associations between the dependent variable (dental caries status) and independent variables (sociodemographic, oral health behaviors, feeding practices, and dietary factors).

All variables that showed a statistically significant association (p < 0.05) on univariable analysis were included in the multivariable model. Multicollinearity among variables was assessed before performing multivariate analysis. Variables with multicollinearity were excluded from the multivariable model. Crude odds ratio (cOR) and adjusted odds ratio (aOR) were used as measures of association, with 95% confidence interval (CI). P < 0.05 was considered statistically significant in multivariable regression.

Results

Inter-examiner reliability

The Kappa values ranged from 0.80 to 0.95. Specifically, the reliability between Examiners 1 and 2 was 0.85, whereas Examiners 1 and 3 showed a Kappa of 0.85. The highest reliability was observed between Examiners 1 and 4, with a Kappa value of 0.95. Examiners 2 and 3 and Examiners 2 and 4 exhibited a Kappa of 0.80. Finally, the reliability between Examiners 3 and 4 was 0.81.

Sociodemographic characteristics

A total of 568 individuals participated in the study in Jizan, KSA, in 2024. The response rate was 100.0%. The median (IQR) age of individuals was 13.0 years (9.0 and 17.0 years). Gender and place of residence showed nearly equal distribution. The majority of individuals were of Saudi nationality (83.8%). Regarding parental occupation, 87.5% of fathers were employed by the government, and 62.9% of mothers were not working. In terms of parental education, the most frequent educational level for fathers and mothers was high school or below (66.5% and 80.3%, respectively). The majority of the families reported a monthly income of less than 10,000 Saudi Riyals (70.4%; Table 1).

Table 1.

Sociodemographic characteristics of individuals in Jizan, KSA (n = 568)

Characteristics	Category	Frequency	Percentage
Age	6–12 years	263	46.3
	13–18 years	305	53.7
	Median (IQR)	13.0 (9.0 and 17.0)
Gender	Male	279	49.1
	Female	289	50.9
Nationality	Saudi	476	83.8
	Non-Saudi	92	16.2
Place of residence	Urban	282	49.6
	Rural	286	50.4
Father’s occupation	Government employer	497	87.5
	NGO employer	0	0.0
	Personal business	71	12.5
Mother’s occupation	Government employer	211	37.1
	Not working	357	62.9
Father’s education	High school or below	378	66.5
	College or above	190	33.5
Mother’s education	High school or below	456	80.3
	College or above	112	19.7
Family income	< 10,000 SR	400	70.4
	≥ 10,000 SR	168	29.6
Health program attendance	Yes	219	38.6
	No	349	61.4

NGO Non-governmental organization, SR Saudi Riyal

The prevalence of dental caries among the studied population in Jizan, KSA, in 2024 was found to be 85.2% (Fig. 1).

Fig. 1.

Prevalence of dental caries among individuals in Jizan, KSA (n = 568)

Factors associated with the prevalence of dental caries

Univariable logistic regression analysis revealed that the sociodemographic factors fathers’ and mothers’ education levels and health program attendance were significantly associated with the prevalence of dental caries (p < 0.001, p = 0.006, and p < 0.019, respectively; Table 2). Similarly, all behavioral, feeding, and dietary factors were significantly associated with the prevalence of dental caries (all p < 0.05), except flavored milk consumption and soft drink consumption (all p > 0.05; Table 3).

Table 2.

Sociodemographic factors associated with dental caries prevalence among individuals, Jizan

Variables	Category	Dental caries status				cOR (95% CI)	P value
		Yes (n = 484)		No (n = 84)
		n	%	n	%
Age	6–12 years	220	83.7	43	16.3	Ref
	13–18 years	264	86.6	41	13.4	1.26 (0.79–2.00)	0.331
Gender	Male	244	87.5	35	12.5	Ref
	Female	240	83.0	49	17.0	0.70 (0.44–1.12)	0.140
Nationality	Saudi	410	86.1	66	13.9	1.51 (0.85–2.69)	0.161
	Non-Saudi	74	80.4	18	19.9	Ref
Place of residence	Urban	234	83.0	48	17.0	Ref
	Rural	250	87.4	36	12.6	1.43 (0.89–2.27)	0.138
Father’s occupation	Government employer	424	85.3	73	14.7	1.07 (0.54–2.12)	0.858
	Personal business	60	84.5	11	15.5	Ref
Mother’s occupation	Government employer	176	83.4	35	16.6	0.80 (0.49–1.28)	0.354
	Not working	308	86.3	49	13.7	Ref
Father’s education	High school and below	338	89.9	38	10.1	2.55 (1.60–4.08)	< 0.001
	College or above	146	76.8	44	23.2	Ref
Mother’s education	High school and below	398	87.3	58	12.7	2.08 (1.24–3.48)	0.006
	College or above	86	76.8	26	23.2	Ref
Family income	< 10,000 SR	342	85.5	58	14.5	1.08 (0.65–1.78)	0.765
	≥ 10,000 SR	142	84.5	26	15.5	Ref
Health program attendance	Yes	165	75.3	54	24.7	Ref
	No	319	91.4	30	8.6	3.48 (2.14–5.65)	< 0.001

cOR Crude odds ratio, NGO Non-governmental organization, SR Saudi Riyal

Table 3.

Behaviors, feeding, and dietary factors associated with dental caries prevalence among individuals, Jizan

Variables	Category	Dental caries status				cOR (95% CI)	P value
		Yes (n = 484)		No (n = 84)
		n	%	n	%
Toothbrushing	No	196	71.5	78	28.5	Ref
	Yes	288	98.0	6	2.0	0.05 (0.02–0.12)	< 0.001
Frequency of toothbrushing per day	Twice or more	68	60.7	44	39.3	Ref
	Once	126	78.7	34	21.3	2.40 (1.40–4.10)	0.001
	Rarely or never	290	98.0	6	2.0	31.28 (12.81–76.38)	< 0.001
Times eating during the day	1–2 times	147	74.2	51	25.8	Ref
	3–5 times	157	84.0	30	16.0	1.82 (1.10–3.01)	0.020
	> 5 times	180	98.4	3	1.6	20.82 (6.37–68.06)	< 0.001
Snacks consumed between the meal per day	Once	80	62.0	49	38.0	Ref
	Twice	218	87.6	31	12.4	4.31 (2.57–7.23)	< 0.001
	≥ three	186	97.9	4	2.1	28.48 (9.94–81.58)	< 0.001
Flavored milk consumption	No	136	82.4	48	17.6	Ref
	Yes	348	86.4	55	13.6	1.35 (0.83–2.21)	0.232
Fruit and vegetable intake	Regularly	24	55.8	19	44.2	Ref
	Occasionally	392	90.3	42	9.7	7.39 (3.74–14.60)	< 0.001
	Never	68	74.7	23	25.3	2.34 (1.09–5.03)	0.029
Fast food consumption	Never	16	64.0	9	36.0	Ref
	Occasionally	395	84.6	72	15.4	3.09 (1.31–7.25)	0.010
	Regularly	73	96.1	3	3.9	13.69 (3.33–56.30)	< 0.001
Soft drink consumption	Never	74	100.0	0	0.0	Ref
	Occasionally	393	83.6	77	16.4	NC	0.997
	Regularly	17	70.8	7	29.2	NC	0.997

cOR Crude odds ratio, NC Not calculated because one of cell is zero

In multivariable analysis, fathers’ education, toothbrushing, fruit and vegetable intake, and fast food consumption remained significantly associated with dental caries. Individuals whose fathers had a high school education or below had 2,11 times the odds of having dental caries compared with those whose fathers had a college education or above (aOR = 2.11, 95% CI: 1.14–3.93, p = 0.018). Individuals who did not attend a health program had significantly higher odds of having dental caries compared with those who did (aOR = 3.03, 95% CI: 1.68–5.46, p < 0.001). Moreover, individuals who reported brushing their teeth had significantly lower odds of having dental caries compared with those who did not brush their teeth (aOR = 0.11, 95% CI: 0.04–0.28, p < 0.001). Individuals who ate fruits and vegetables occasionally had 14.29 times the odds of having dental caries compared with those who ate fruits and vegetables regularly (aOR = 14.29, 95% CI: 4.90–41.69, p < 0.001). Similarly, individuals who never ate fruits and vegetables had 3.69 times the odds of having dental caries compared with those who ate fruits and vegetables regularly (aOR = 3.69, 95% CI: 1.20–11.36, p = 0.023). Furthermore, individuals who consumed fast food regularly had 40.13 times the odds of having dental caries compared with those who never consumed fast food (aOR = 40.13, 95% CI: 7.40–217.58, p < 0.001), as shown in Table 4.

Table 4.

Multivariable analysis for factors associated with dental caries prevalence among individuals, Jizan

Variables	Category	Dental caries status				aOR (95% CI)	P value
		Yes (n = 484)		No (n = 84)
		n	%	n	%
Father’s education	College or above	146	76.8	44	23.2	Ref
	High school and below	338	89.9	38	10.1	2.11 (1.14–3.93)	0.0180
Mother’s education	College or above	86	76.8	26	23.2	Ref
	High school and below	398	87.3	58	12.7	1.04 (0.53–2.04)	0.904
Health program attendance	Yes	165	75.3	54	24.7	Ref
	No	319	91.4	30	8.6	3.03 (1.68–5.46)	< 0.001
Toothbrushing	No	196	71.5	78	28.5	Ref
	Yes	288	98.0	6	2.0	0.11 (0.04–0.28)	< 0.001
Fruit and vegetable intake	Regularly	24	55.8	19	44.2	Ref
	Occasionally	392	90.3	42	9.7	14.29 (4.90–41.69)	< 0.001
	Never	68	74.7	23	25.3	3.69 (1.20–11.36)	0.023
Fast food consumption	Never	16	64.0	9	36.0	Ref
	Occasionally	395	84.6	72	15.4	2.12 (0.65–6.99)	0.215
	Regularly	73	96.1	3	3.9	40.13 (7.40–217.58)	< 0.001

aOR Adjusted odds ratio

Discussion

This study aimed to estimate the prevalence of dental caries and its factors among studied population in Jizan, KSA. Multivariable logistic regression analysis identified factors significantly associated with the prevalence of dental caries. Specifically, these factors were father’s education, health program attendance, toothbrushing, fruit and vegetable intake, and fast food consumption. These findings highlight the crucial role of parental education, oral hygiene practices, and dietary patterns in influencing the prevalence of dental caries among studied population in Jizan, KSA.

The current study showed a high prevalence of dental caries (85.2%) among individuals surveyed in Jizan, KSA, in 2024. Although this high prevalence might be attributed to the sample selection setting, where individuals attending dental clinics of the governorate hospitals were included, it still highlights dental caries as a significant public health issue in the Jizan region, demanding urgent attention and intervention.

Globally, many previous studies reported that the prevalence of dental caries ranges from 22% to 89%; for example, 60% [7] in India; 44% [25], 52.8% [26], 53.6% [27], and 74.5% [28] in China; 21.8% [29], 34.1% [30], and 46.9% [31] in Ethiopia; 27% [32], 54.6% [33], 57.5% [34], 20% [35], and 55.8% [36] in Nepal; 22.7% in Nigeria [37]; 33.6% in Uganda [38]; 43.9% in Tunisia [39]; 55% in Vietnam [40]; 55.1% in Pakistan [41]; 57.6% in Brazil [42]; 71% in Indonesia [43]; 76.5% in Thailand [44] and Turkey [45]; 82.7% in Bangladesh [46]; 83% in Uzbekistan [47]; 85.24% in Romania [48]; and 89.8% in Iran [49]. Moreover, five systematic reviews and meta-analyses in the world reported the prevalence of dental caries among individuals, such as 38.7% in low- and middle-income countries [50], 35% [51] and 40.9% [52] in Ethiopia, 23.0% in Nigeria [53], and between 17.2% and 88.8% in the Middle East and North Africa region [54].

Many previous studies in the KSA reported that the prevalence of dental caries ranged from 41.9% to 94.2%. For example, six studies in Riyadh reported that the prevalence rates of dental caries were 41.9% [8], 83% [10], 67.3% [12], 72.6% [13], 74.0% [14], and 83.7% [15]. Two studies in Eastern KSA found that the prevalence rates of dental caries were 73% [16] and 75% [17]. Other studies reported prevalence rates of dental caries of 65.6% in KSA [1], 52.5% in Jeddah [9], 85.1% in Al-Madinah [11], 72.9% in southern Asir [18], 78.9% in Hai’l [19], and 94.2% in a northern province [20]. Two systematic reviews in the KSA indicated prevalence rates for permanent teeth ranging from 5% to 99% and for primary teeth ranging from 21% to 100% [4], with one review reporting rates of 84% in 5–7-year-old children and 72% in 12–15-year-old children [55]. A meta-analysis across Gulf Cooperation Council states indicated a 64.7% prevalence in schoolchildren [56].

Several factors may contribute to the discrepancies observed in reported dental caries prevalence within and across countries. These include differences in study setting, sample selection (dental clinics and/or schools), age of the participants studied (primary and/or secondary school age children), and type of dentition examined (primary and/or permanent teeth). Furthermore, differences in socioeconomic conditions, dietary habits, access to dental care, and oral hygiene practices likely contribute to these discrepancies.

Regarding the factors associated with the prevalence of dental caries, this study indicated that the father’s educational level showed a statistically significant association with the prevalence of dental caries (p = 0.018). Individuals whose fathers had a high school education or below were 2.11 times more likely to have dental caries compared with those whose fathers had a college education or above. Thus, fathers with higher educational levels may possess greater health literacy, enabling them to thoroughly understand the importance of oral hygiene for their children. They might be more proactive in seeking and implementing preventative measures compared with their counterparts.

This result agreed with findings from previous studies that reported a statistically significant association between the father’s education level and the prevalence of dental caries, such as studies in China [27], Tunisia [39], Romania [48], and USA [57]. However, it contradicted earlier studies conducted in Riyadh [10, 13] and further studies in China [25, 26], Ethiopia [30], and Iran [49].

This study showed that health program attendance had a statistically significant association with the prevalence of dental caries (p < 0.001). Individuals who did not attend a health program were 3.03 times more likely to have dental caries compared with those who did. This highlighted the importance of health education and awareness campaigns in promoting good oral hygiene. Individuals participating in such programs are likely exposed to information and practices that contribute to enhanced oral health. Our findings differed from those of a study in Ethiopia [30], which found no statistically significant association between health program attendance and the prevalence of dental caries.

This study demonstrated that toothbrushing had a statistically significant association with the prevalence of dental caries (p < 0.001). Individuals who brushed their teeth were 89% less likely to have dental caries compared with those who did not brush their teeth. This highlights the critical role of toothbrushing in preventing the buildup of biofilm on all dental surfaces, which leads to the prevention of dental caries among individuals.

This result was similar to findings of previous studies in Eastern KSA [16], India [32], Nepal [36], Nigeria [58], and Ethiopia [29, 51]. A systematic review and meta-analysis of low- and middle-income countries [50] found a statistically significant association between toothbrushing and the prevalence of dental caries. However, it contradicted earlier studies carried out in China [27] and Ethiopia [31].

The current study demonstrated that fruit and vegetable intake showed a statistically significant association with the prevalence of dental caries (p < 0.05). Fruits and vegetables are rich in fiber, which can help clean teeth and stimulate saliva flow, thereby neutralizing acids and re-mineralizing enamel. They also contain essential vitamins and minerals that contribute to overall oral health. The significantly elevated odds of caries among individuals who “never” or “occasionally” consume fruits and vegetables highlight the protective role of these foods and underscore the importance of promoting their regular intake. This result agreed with the findings of previous studies conducted in Riyadh, KSA [10], and Romania [48], which found a statistically significant association between fruit and vegetable intake and the prevalence of dental caries.

The association between regular fast food consumption and dental caries was also in line with a previous study in Riyadh [10]. Fast foods generally contain significant amounts of refined carbohydrates, sugars, and unhealthy fats. These components offer a readily available food source for acid-producing bacteria in the mouth. The prolonged adherence of these foods to tooth surfaces, coupled with their often-low nutritional value, creates an ideal environment for demineralization and caries progression.

Our results were similar to previous studies conducted in Riyadh [13], Gizan [21], China [25], Ethiopia [30], India [32], Nepal [35], Bangladesh [46], and Iran [49], which found no statistically significant association between mother’s education and the prevalence of dental caries. Conversely, other previous studies in Riyadh, KSA [10], China [26, 28], and Romania [48], as well as a systematic review in the Middle East and North Africa region [54], identified a statistically significant association between mother’s education and the prevalence of dental caries.

Furthermore, our study agreed with many previous studies in the KSA, which reported no statistically significant associations between the prevalence of dental caries and age [8, 10, 11, 13, 20, 21], gender [9, 13, 14, 19–21], parental occupations [10, 13], family income [10, 11], place of residence [14], frequency of toothbrushing per day [13, 20], times eating during the day [10], flavored milk consumption [17, 59], and soft drink consumption [13, 59]. Similarly, numerous previous studies globally have found no statistically significant associations between the prevalence of dental caries and age [21, 29, 31, 37, 38, 46, 57], gender [7, 21, 28, 29, 32, 35, 37, 38, 40, 43, 46, 57], place of residence [28, 38], father’s occupation [35, 40, 46], mother’s occupation [40, 46, 49], family income [29], frequency of toothbrushing per day [13, 25, 30, 35, 37, 46], flavored milk consumption [46], and soft drink consumption [29, 46].

By contrast, our study diverged from many previous studies in the KSA, which found statistically significant associations between the prevalence of dental caries and gender [8, 11], father’s occupation [13], family income [10], frequency of toothbrushing per day [10, 21], snacks consumed between the meal per day [21], flavored milk consumption [10], and soft drink consumption [10, 17]. Numerous previous studies globally have found statistically significant associations between the prevalence of dental caries and age [7, 25, 27, 33, 35, 42, 44, 45, 49, 58, 60], gender [25, 26, 27, 33, 31, 58, 60], place of residence [46, 54], family income [46], frequency of toothbrushing per day [26, 28, 39, 47, 54], soft drink consumption [26], and snacks consumed between the meal per day [58].

These discrepancies may be attributed to several factors, such as differences in study setting, sample selection (dental clinics and/or schools), age of the studied population (primary and/or secondary school), and type of dentition examined (primary and/or permanent teeth). Additionally, differences in socioeconomic conditions, dietary habits, access to dental care, and oral hygiene practices likely contributed to these discrepancies.

Strengths of this study include an adequately calculated sample size based on statistical power, expected prevalence, and margin of error. The use of a random sampling method for selecting hospitals across the four areas of Jizan and for recruiting participants from the dental clinics enhanced the internal validity of the sample within the clinical setting.

However, the study’s findings should be interpreted with caution because of some limitations. First, a small number of individuals in the caries-free group, or the absence of participants in one subgroup, may have reduced the statistical power to detect a statistically significant difference. Second, the study’s reliance on self-reported and retrospective data on variables may have introduced recall bias. Third, the study did not calculate intra-examiner reliability because it prioritized assessing the inter-examiner reliability of clinical assessments among the four examiners in four areas of Jizan, as well as constraints related to logistics, the total time spent at the clinic for the individuals, and the burden associated with re-examining subjects. Fourth, the cross-sectional design of the study may prevent the establishment of a causal relationship between the variables and the prevalence of dental caries. Fifth, selection bias might arise because the study was conducted among individuals attending dental clinics of the governorate hospitals in Jizan. Consequently, these limitations restrict the generalizability of our findings to the entire population of the Jizan region.

Conclusions

The study found a high prevalence of dental caries (85.2%) among individuals seeking dental care at governorate dental clinics in Jizan, KSA. Low paternal education, lack of participation in health programs, absence of toothbrushing, never or irregular fruit and vegetable consumption, and regular fast food consumption significantly increased the likelihood of caries, so they were identified as key determinants of dental caries. To effectively address this high prevalence, targeted public health strategies are essential. These should include oral health education programs targeting population, promoting and reinforcing the habit of toothbrushing, increasing fruit and vegetable intake, and reducing fast food consumption. Future longitudinal studies employing robust methodologies are warranted to further explore the potential causal relationship between these identified factors and the prevalence of dental caries.

Abbreviations

aOR

Adjusted Odd Ratio

CI

Confidence interval

cOR

Crude odds ratio

dmft

Decayed, Missing, and Filled teeth

DMFT

Decayed, Missing, and Filled teeth

IQR

interquartile range

KSA

The Kingdom of Saudi Arabia

WHO

The World Health Organization

Authors’ contributions

**MAS** contributed to the conception, study design, interpretation of data, writing the original draft and revising it, and reviewing the final paper. **AAN** contributed to statistical analysis, data interpretation, writing the original draft and revising it, reviewing the final paper, and editing the final paper. **MMA** contributed to the study design, data interpretation, writing the original draft and revising it, and reviewing the final paper. **NHA, AA, ASA, BYA, DA, ** and **WE** contributed to data interpretation, writing the original draft and revising it, and reviewing the final paper. **NO, AA, OH, ** and **HHN** contributed to data collection and review of the final paper. The final manuscript was reviewed and approved by all authors.

Funding

None.

Data availability

All relevant data are presented in this paper. Additional information can be provided upon reasonable request from the corresponding author.

Declarations

Ethical approval and consent to participate

The study was approved by the Jazan Health Ethics Committee, Ministry of Health, Saudi Arabia (Approval no: 2296). The methods of this study were performed in accordance with the Declaration of Helsinki. Informed written consent was obtained from the parents or legal guardians of all participating individuals. Anonymity and confidentiality of the collected data were assured and ensured.

Consent for publication

Not applicable.

Competing interests

The authors declare no competing interests.