SYSTEMATIC REVIEW: CONSEQUENCES OF UNTREATED DENTAL CARIES IN SAUDI ARABIAN CHILDREN

Abstract

Dental caries remains one of the most prevalent chronic conditions affecting children in Saudi Arabia, with recent meta-analyses documenting prevalence rates of 75.43% in primary dentition and 67.7% in permanent dentition. The clinical sequelae of untreated disease including pulpal involvement, ulceration, fistula, and abscess formation (measured by the PUFA/pufa index) impose substantial burdens on oral health-related quality of life (OHRQoL), dietary adequacy, and school attendance. This systematic review synthesises evidence from randomised controlled trials, systematic reviews, and observational studies conducted in Saudi Arabia between 2010 and 2025, examining the clinical, functional, and psychosocial consequences of untreated dental caries in children. The review identified 19 eligible studies, predominantly cross-sectional designs (n=7), alongside five randomised controlled trials and meta-analyses (n=3). Key findings demonstrate a significant positive association between untreated caries and impaired OHRQoL (Rate Ratio 1.04, 95% CI 1.01–1.07), with untreated caries and age emerging as independent determinants of poor oral health outcomes. PUFA indices document clinical consequences in 40–72% of affected children, with mean scores ranging from 0.75 to 2.54 depending on age and sample characteristics. Evidence gaps persist regarding longitudinal impacts of pulpal disease on systemic health, sleep disruption attributable to caries-related pain, and the cost-effectiveness of interventions targeting untreated disease consequences. This review underscores the urgent need for targeted prevention and early treatment strategies to mitigate the substantial downstream impacts of untreated disease on Saudi Arabian children's health and development.