Risk Factors of Dental Caries in Primary School Children: A Systematic Literature Review

Authors

DOI:

https://doi.org/10.37287/ijghr.v8i3.1433

Keywords:

dental caries, oral hygiene, primary school children, risk factors, socioeconomic status

Abstract

Dental caries is a chronic infectious disease with a high prevalence in elementary school-aged children (6–12 years) globally. This condition is influenced by the complex interaction of various determinants of health. This study aims to identify and synthesize the dominant risk factors for the occurrence of dental caries in elementary school-age children based on the latest scientific evidence. Systematic review was conducted following the PRISMA 2020 guidelines. A comprehensive literature search was conducted on the Scopus and PubMed databases for English-language articles published in the time range November 2022 to November 2025. Inclusion criteria include cross-sectional, cohort, case-control studies that analyze caries risk factors in elementary school-aged children of 6–12 years. Of the 1,422 articles identified from three databases, 11 studies met the eligibility criteria and were included in the final analysis. The main risk factors are categorized into behavioral and lifestyle aspects, socio-demographic, and socioeconomic. The findings suggest that high-sugar diet behaviors (sugary snacks and soft drinks) and poor oral hygiene (rarely brushing and not using dental floss) were the dominant factors. Socio-demographically, low parental education levels, low socioeconomic status, and male gender have a significant association with an increased risk of caries. In addition, the presence of dental plaque and tooth morphology (deep gaps) are important biological determinants. Dental caries in elementary school children is multifactorial, but lifestyle factors related to diet and oral hygiene, as well as family socioeconomic background are the main determinants. Effective prevention strategies require a holistic approach that focuses on modifying children's behavior and improving parental education.

 

References

Abbass, M. M. S., Mahmoud, S. A., El Moshy, S., Rady, D., AbuBakr, N., Radwan, I. A., Ahmed, A., Abdou, A., & Al Jawaldeh, A. (2019). The prevalence of dental caries among Egyptian children and adolescences and its association with age, socioeconomic status, dietary habits and other risk factors. A cross-sectional study. F1000Research, 8, 8. https://doi.org/10.12688/f1000research.17047.1

Alhabdan, Y. A., Albeshr, A. G., Yenugadhati, N., & Jradi, H. (2018). Prevalence of dental caries and associated factors among primary school children: A population-based cross-sectional study in Riyadh, Saudi Arabia. Environmental Health and Preventive Medicine, 23(1), 1–14. https://doi.org/10.1186/s12199-018-0750-z

Almubark, R., Basyouni, M., Alghanem, A., Althumairi, N., Alkhamis, D., Alharbi, L. S., Alammari, N., Algabbani, A., Alnofal, F., Alqahtani, A., & BinDhim, N. (2019). Health literacy in Saudi Arabia: Implications for public health and healthcare access. Pharmacology Research & Perspectives, 7(4), e00514. https://doi.org/10.1002/prp2.514

Alshayeb, L., & Dashash, M. (2025). Prevalence and clinical risk factors of dental caries in Syrian children: a cross-sectional study. Scientific Reports, 15(1), 1–9. https://doi.org/10.1038/s41598-025-95534-5

Arrica, M., Carta, G., Cocco, F., Cagetti, M. G., Campus, G., Ierardo, G., Ottolenghi, L., Sale, S., & Strohmenger, L. (2017). Does a social/behavioural gradient in dental health exist among adults? A cross-sectional study. The Journal of International Medical Research, 45(2), 451–461. https://doi.org/10.1177/0300060516675682

Bastani, P., Mohammadpour, M., Mehraliain, G., Delavari, S., & Edirippulige, S. (2021). What makes inequality in the area of dental and oral health in developing countries? A scoping review. Cost Effectiveness and Resource Allocation : C/E, 19(1), 54. https://doi.org/10.1186/s12962-021-00309-0

Campus, G., Cocco, F., Strohmenger, L., & Cagetti, M. G. (2020). Caries severity and socioeconomic inequalities in a nationwide setting: data from the Italian National pathfinder in 12-years children. Scientific Reports, 10(1), 15622. https://doi.org/10.1038/s41598-020-72403-x

Campus, G., Cocco, F., Strohmenger, L., Wolf, T. G., Balian, A., Arghittu, A., & Cagetti, M. G. (2022). Inequalities in caries among pre-school Italian children with different background. BMC Pediatrics, 22(1), 443. https://doi.org/10.1186/s12887-022-03470-4

Cheng, Y., Liao, Y., Chen, D., Wang, Y., & Wu, Y. (2019). Prevalence of dental caries and its association with body mass index among school-age children in Shenzhen, China. BMC Oral Health, 19(1), 270. https://doi.org/10.1186/s12903-019-0950-y

Conrads, G., & About, I. (2018). Pathophysiology of Dental Caries. Monographs in Oral Science, 1–10.

Dahlan, R., Bohlouli, B., Saltaji, H., Salami, B., & Amin, M. (2024). Sociocultural determinants of children’s oral health among immigrants in Canada. Community Dentistry and Oral Epidemiology, 52(5), 739–748. https://doi.org/10.1111/cdoe.12972

Dahroug, A. E., Heen, E. K., Hussein, M. A., & Madar, A. A. (2024). Dental caries status and related factors among 12-year-old Somali school children in Hargeisa. Community Dentistry and Oral Epidemiology, 52(6), 861–870. https://doi.org/10.1111/cdoe.12990

de Oliveira, K. M. H., Nemezio, M. A., Romualdo, P. C., da Silva, R. A. B., de Paula E Silva, F. W. G., & Küchler, E. C. (2017). Dental Flossing and Proximal Caries in the Primary Dentition: A Systematic Review. Oral Health & Preventive Dentistry, 15(5), 427–434. https://doi.org/10.3290/j.ohpd.a38780

De Sousa, F. S. de O., Dos Santos, A. P. P., Nadanovsky, P., Hujoel, P., Cunha-Cruz, J., & De Oliveira, B. H. (2019). Fluoride Varnish and Dental Caries in Preschoolers: A Systematic Review and Meta-Analysis. Caries Research, 53(5), 502–513. https://doi.org/10.1159/000499639

Escoffié-Ramirez, M., Ávila-Burgos, L., Baena-Santillan, E. S., Aguilar-Ayala, F., Lara-Carrillo, E., Minaya-Sánchez, M., Mendoza-Rodríguez, M., Márquez-Corona, M. de L., & Medina-Solís, C. E. (2017). Factors Associated with Dental Pain in Mexican Schoolchildren Aged 6 to 12 Years. BioMed Research International, 2017, 1–10. https://doi.org/10.1155/2017/7431301

Farsi, D. J. (2024). BMI, Dental Caries, and Risk Factors among Elementary School Children: A Cross-Sectional Study. Children, 11(9). https://doi.org/10.3390/children11091145

Fejerskov, O., Nyvad, B., & Kidd, E. (2015). Dental Caries: The Disease and Its Clinical Management. Wiley Blackwell. Wiley Blackwell.

Freire, M. do C. M., Reis, S. C. G. B., Gonçalves, M. M., Balbo, P. L., & Leles, C. R. (2010). Oral health in 12 year-old students from public and private schools in the city of Goiânia, Brazil. Revista panamericana de salud publica = Pan American journal of public health, 28(2), 86–91. https://doi.org/10.1590/s1020-49892010000800003

Ha, D. H., Crocombe, L. A., & Khan, S. (2021). The impact of different determinants on the dental caries experience of children living in Australia rural and urban areas. Community Dentistry and Oral Epidemiology, 49(4), 337–345.

Ha, D. H., Spencer, A. J., Moynihan, P., Thomson, W. M., & Do, L. G. (2021). Excess Risk of Dental Caries from Higher Free Sugars Intake Combined with Low Exposure to Water Fluoridation. Journal of Dental Research, 100(11), 1243–1250. https://doi.org/10.1177/00220345211007747

Harper, S., Lynch, J., Meersman, S. C., Breen, N., Davis, W. W., & Reichman, M. E. (2008). An overview of methods for monitoring social disparities in cancer with an example using trends in lung cancer incidence by area-socioeconomic position and race-ethnicity, 1992-2004. American Journal of Epidemiology, 167(8), 889–899. https://doi.org/10.1093/aje/kwn016

Hoa, L. T. T., Tue, P. X., Vinh, H. T., Duong, T. T. T., & Dung, L. T. K. (2025). Determinants of dental caries among primary schoolchildren in a mountainous region of Northern Vietnam. Frontiers in Oral Health, 6(October), 1–9. https://doi.org/10.3389/froh.2025.1675274

Hoffmann, R. H. S., Cypriano, S., Sousa, M. da L. R. de, & Wada, R. S. (2004). Dental caries experience in children at public and private schools from a city with fluoridated water. Cadernos de saude publica, 20(2), 522–528. https://doi.org/10.1590/s0102-311x2004000200020

Hong, J., Whelton, H., Douglas, G., & Kang, J. (2018). Consumption frequency of added sugars and UK children’s dental caries. Community Dentistry and Oral Epidemiology, 46(5), 457–464. https://doi.org/10.1111/cdoe.12413

Hu, X., Fan, M., Mulder, J., & Frencken, J. (2015). Caries experience in the primary dentition and presence of plaque in 7-year-old Chinese children: A 4-year time-lag study. Journal of International Society of Preventive and Community Dentistry, 5(3), 205. https://doi.org/10.4103/2231-0762.159958

Jurakova, V., Farková, V., Kucera, J., Dadakova, K., Zapletalova, M., Paskova, K., Reminek, R., Glatz, Z., Holla, L. I., Ruzicka, F., Lochman, J., & Linhartova, P. B. (2023). Gene expression and metabolic activity of Streptococcus mutans during exposure to dietary carbohydrates glucose, sucrose, lactose, and xylitol. Molecular Oral Microbiology, 38(5), 424–441. https://doi.org/10.1111/omi.12428

Kassebaum, N. J., Bernabé, E., Dahiya, M., Bhandari, B., Murray, C. J. L., & Marcenes, W. (2015). Global burden of untreated caries: A systematic review and metaregression. Journal of Dental Research, 94(5), 650–658. https://doi.org/10.1177/0022034515573272

Kazeminia, M., Abdi, A., Shohaimi, S., Jalali, R., Vaisi-Raygani, A., Salari, N., & Mohammadi, M. (2020). Dental caries in primary and permanent teeth in children’s worldwide, 1995 to 2019: a systematic review and meta-analysis. Head & Face Medicine, 16(1), 22. https://doi.org/10.1186/s13005-020-00237-z

Keppel, K., Pamuk, E., Lynch, J., Carter-Pokras, O., Insun, K., Mays, V., Pearcy, J., Schoenbach, V., & Weissman, J. S. (2005). Methodological issues in measuring health disparities. Vital and Health Statistics. Series 2, Data Evaluation and Methods Research, 141, 1–16.

Kim, S.-J., Lee, J.-Y., Kim, S.-H., & Cho, H.-J. (2022). Effect of interdental cleaning devices on proximal caries. Community Dentistry and Oral Epidemiology, 50(5), 414–420. https://doi.org/10.1111/cdoe.12690

Li, H., Liu, X., Xu, J., Li, S., & Li, X. (2024). The Prevalence of Dental Carious Lesions and Associated Risk Factors in Chinese Children Aged 7-9 Years. Oral Health & Preventive Dentistry, 22(146), 349–356. https://doi.org/10.3290/j.ohpd.b5628793

Li, T., Ma, L., Yan, Y., Liu, R., Sun, X., Yang, Y., Luo, G., Tan, S., Zhang, X., Yang, Y., Zhang, B., & Wang, X. (2025). Dental Caries and Associated Factors in Tibetan School-Age Children in Gannan, China. International Dental Journal, 75(2), 643–651. https://doi.org/10.1016/j.identj.2024.09.036

Liu, J., Zhang, S. S., Zheng, S. G., Xu, T., & Si, Y. (2016). Oral Health Status and Oral Health Care Model in China. The Chinese Journal of Dental Research, 19(4), 207–215. https://doi.org/10.3290/j.cjdr.a37145

Manton, D. J. (2018). Child Dental Caries – A Global Problem of Inequality. EClinicalMedicine, 1, 3–4. https://doi.org/10.1016/j.eclinm.2018.06.006

Masaebi, F., Ghorbani, Z., Azizmohammad Looha, M., Deghatipour, M., Mohammadzadeh, M., Ahsaie, M. G., Asadi, F., & Zayeri, F. (2024). Identifying early permanent teeth caries factors in children using random forest algorithm. Frontiers in Dental Medicine, 5(April), 1–9. https://doi.org/10.3389/fdmed.2024.1359379

Murnane, Richard J, & Reardon, Sean F. (2018). Long-Term Trends in Private School Enrollments by Family Income. AERA Open, 4(1), 2332858417751355. https://doi.org/10.1177/2332858417751355

N. Naveenaa, D. (2025). Association of Gender and Dental Caries—A Retrospective Analysis in Advances in Sports Science and Technology (5th ed.). CRC Press.

Nazário, A. C., Traebert, J., & Traebert, E. (2024). Incidence of Dental Caries and Associated Factors in the School Period in a Municipality in Southern Brazil. Pesquisa Brasileira Em Odontopediatria e Clinica Integrada, 24, 1–10. https://doi.org/10.1590/pboci.2024.002

Nsabimana, U., Isyagi, M., Rutayisire, R., & Nyirazinyoye, L. (2023). Dental Caries Risk Assessment in Primary School Children Aged 11 to 12 years: Case of Nyarugenge District, Rwanda. Rwanda Journal of Medicine and Health Sciences, 6(2), 113–122. https://doi.org/10.4314/rjmhs.v6i2.2

Page, M. J., Moher, D., Bossuyt, P. M., Boutron, I., Hoffmann, T. C., Mulrow, C. D., Shamseer, L., Tetzlaff, J. M., Akl, E. A., Brennan, S. E., Chou, R., Glanville, J., Grimshaw, J. M., Hróbjartsson, A., Lalu, M. M., Li, T., Loder, E. W., Mayo-Wilson, E., Mcdonald, S., … Mckenzie, J. E. (2021). PRISMA 2020 explanation and elaboration: Updated guidance and exemplars for reporting systematic reviews. The BMJ, 372. https://doi.org/10.1136/bmj.n160

Peres, M. A., Macpherson, L. M. D., Weyant, R. J., Daly, B., Venturelli, R., Mathur, M. R., Listl, S., Celeste, R. K., Guarnizo-Herreño, C. C., Kearns, C., Benzian, H., Allison, P., & Watt, R. G. (2019). Oral diseases: a global public health challenge. The Lancet, 394(10194), 249–260. https://doi.org/10.1016/S0140-6736(19)31146-8

Peters, A., Brandt, K., Wienke, A., & Schaller, H.-G. (2022). Regional Disparities in Caries Experience and Associating Factors of Ghanaian Children Aged 3 to 13 Years in Urban Accra and Rural Kpando. International Journal of Environmental Research and Public Health, 19(9). https://doi.org/10.3390/ijerph19095771

Pitts, N. B., Zero, D. T., Marsh, P. D., Ekstrand, K., Weintraub, J. A., Ramos-Gomez, F., Tagami, J., Twetman, S., Tsakos, G., & Ismail, A. (2017). Dental caries. Nature Reviews Disease Primers, 3(1), 17030. https://doi.org/10.1038/nrdp.2017.30

Pizzo, G., Matranga, D., Maniscalco, L., Buttacavoli, F., Campus, G., & Giuliana, G. (2023). Caries Severity, Decayed First Permanent Molars and Associated Factors in 6–7 Years Old Schoolchildren Living in Palermo (Southern Italy). Journal of Clinical Medicine, 12(13), 1–13. https://doi.org/10.3390/jcm12134343

Rodriguez-Alvarez, E., Borrell, L. N., Marañon, E., & Lanborena, N. (2022). Immigrant Status and Ethnic Inequities in Dental Caries in Children: Bilbao, Spain. In International Journal of Environmental Research and Public Health (Vol. 19, Issue 8, p. 4487). https://doi.org/10.3390/ijerph19084487

Saber, A. M., Altoukhi, D. H., Horaib, M. F., El-Housseiny, A. A., Alamoudi, N. M., & Sabbagh, H. J. (2018). Consequences of early extraction of compromised first permanent molar: a systematic review. BMC Oral Health, 18(1), 59. https://doi.org/10.1186/s12903-018-0516-4

Sathiyakumar, T., Vasireddy, D., & Mondal, S. (2021). Impact of Sociodemographic Factors on Dental Caries in Children and Availing Fluoride Treatment : A Study Based on National Survey of Children ’ s Health ( NSCH ) Data 2016-2019. 13(9). https://doi.org/10.7759/cureus.18395

Schwendicke, F., Dörfer, C. E., Schlattmann, P., Page, L. F., Thomson, W. M., & Paris, S. (2015). Socioeconomic Inequality and Caries. Journal of Dental Research, 94(1), 10–18. https://doi.org/10.1177/0022034514557546

Sengupta, K., Bihrmann, K., Christensen, L. B., Mortensen, L. H., Andersen, I., & Ersbøll, A. K. (2023). Development of geographic inequality in dental caries and its association with socioeconomic factors over an 18-year period in Denmark. BMC Oral Health, 23(1), 662. https://doi.org/10.1186/s12903-023-03373-5

Soofi, M., Karami-Matin, B., Kazemi-Karyani, A., Soltani, S., Ameri, H., Moradi-Nazar, M., & Najafi, F. (2020). Socioeconomic inequality in dental caries experience expressed by the significant caries index: cross-sectional results from the RaNCD Cohort Study. International Dental Journal, 71(2), 153–159. https://doi.org/10.1111/idj.12612

Spatafora, G., Li, Y., He, X., Cowan, A., & Tanner, A. C. R. (2024). The Evolving Microbiome of Dental Caries. Microorganisms, 12(1). https://doi.org/10.3390/microorganisms12010121

Sukhabogi, J., Shekar, C., Hameed, I., Ramana, I., & Sandhu, G. (2014). Oral Health Status among 12 ‑ and 15 ‑ Year ‑ Old Children from Government and Private Schools in. Annals of Medical and Health Sciences Research, 4(3), 272–7.

Taani, D. Q. (2002). Relationship of socioeconomic background to oral hygiene, gingival status, and dental caries in children. EBSCOhost, 33(3), 195.

Theresia, T. T., Lestari, S., Kristanto, C. V., Winson, A., & Astoeti, T. E. (2025). Dental caries risk factors in West Jakarta Primary students: A cross-sectional study. Dental Journal, 58(3), 280–288. https://doi.org/10.20473/j.djmkg.v58.i3.p280-288

Tilton, E. E., Keels, M. A., Simancas-Pallares, M. A., Quiñonez, R. B., Roberts, M. W., Ferreira Zandona, A. G., & Divaris, K. (2021). Child Nutrition Patterns Are Associated with Primary Dentition Dental Caries. Pediatric Dentistry, 43(3), 205–210.

Tomczyk, J., Olczak-Kowalczy, D., Turska-Szybka, A., & Studnicki, M. (2025). Oral health behaviors and tooth decay at the age of 12 and 15-18 years in Poland. Dental and Medical Problems. https://doi.org/10.17219/dmp/184054

van Ligten, T. S., Duijster, D., Zaura, E., & Volgenant, C. M. C. (2025). Influence of Early and Regular Dental Visits on Dental Health Care Costs of Primary School Children in Amsterdam. International Dental Journal, 75(4), 100839. https://doi.org/10.1016/j.identj.2025.100839

Wang, X., Chen, H., Hou, R., Yang, T., Liu, J., Li, J., Shi, X., Zhao, B., & Liu, J. (2023). Effect of dietary patterns on dental caries among 12–15 years-old adolescents: a cross-sectional survey. BMC Oral Health, 23(1), 1–12. https://doi.org/10.1186/s12903-023-03566-y

Wilder, J. R., Kaste, L. M., Handler, A., Chapple‐McGruder, T., & Rankin, K. M. (2016). The association between sugar‐sweetened beverages and dental caries among third‐grade students in Georgia. Journal of Public Health Dentistry, 76(1), 76–84. https://doi.org/10.1111/jphd.12116

World Health Organization. (2022). Global oral health status report. In Who (Vol. 57, Issue 2). https://www.who.int/team/noncommunicable-diseases/global-status-report-on-oral-health-2022

Zhao, M., Wang, Z., Liu, M., Song, Z., Wang, R., & Yang, L. (2024). Eruption and caries status of first permanent molars in children aged 6–7 years in Shijingshan District, Beijing, China. BMC Oral Health, 24(1), 1–7. https://doi.org/10.1186/s12903-024-04915-1

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Published

2026-06-01

How to Cite

Aprillia, Z., Rahfiludin, M. Z., Susanto, H. S., & Mustofa, S. B. (2026). Risk Factors of Dental Caries in Primary School Children: A Systematic Literature Review. Indonesian Journal of Global Health Research, 8(3), 1193–1204. https://doi.org/10.37287/ijghr.v8i3.1433

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