The cost of dental caries in Saudi Arabia. Putting numbers into context.

A wellness is not easy to define, the World Health Organization (WHO) in 19481 defined health as “a complete state of physical, social, and mental well-being and not merely absence of disease”. This bio-psycho-social model changed the previous concept of health oriented merely by disease. Therefore, promoting oral health, and preventing dental caries is a dimension of being healthy. Tremendous monetary benefits are expected when primary prevention of dental caries especially in children is implemented. The aim of this report was to discuss primarily the monetary cost of treating dental caries for children in Saudi Arabia. Decayed, Missed, and Filled Teeth (DMFT) is an index classically utilized in epidemiological studies to anticipate dental caries history (treated and un-treated teeth). The WHO, Oral Health Database, has both a global and country specific DMFT estimates for 12-year-old children.2 Globally, over the past 31 years, DMFT showed a decreasing temporal trend of one unit. In 1980, the DMFT was 2.43. In 2001, it declined to 1.74, and then to 1.67 in 2011; further indication of a declining trend. Country specific DMFT estimates from Sweden, New Zealand, and Japan demonstrated great temporal reduction. In Sweden, the DMFT decreased from 6.3 in 1977, to 0.9 in 2008. The DMFT in New Zealand decreased from 5.1 in 1980, to 1.4 in 2009. Similarly, Japan showed reduction of DMFT from 4.9 in 1987, to 1.7 in 2005. On the contrary to the globally observed decline in DMFT trend, countries like Saudi Arabia, Jordan, Kuwait, Gambia, and Thailand were facing an upward trend in mean DMFT over time. The mean DMFT in Kuwait has increased from 2 in 1982, to 2.6 in 2000. In Saudi Arabia, the mean DMFT has substantially increased from 2 in 1979, to 5.9 in 2002; a 195% increase in approximately 23 years (around 4 additional teeth). Comparing the mean of DMFT in Saudi Arabia to the WHO Eastern Mediterranean region, which has 22 countries including Saudi Arabia, reveals that Saudi children have more dental caries experience relative to children from the surrounding countries, with a 4.6 DMFT difference. Moreover, within the WHO oral health database that includes more than 180 countries, the highest estimated DMFT was for Saudi Arabian children (DMFT=5.9 in 2002). No other country had such a high DMFT index in the new millennium. The prevalence of dental caries in Saudi Arabia was measured and presented by the National Campaign to Prevent Dental Caries (NCPDC).3 In 2008, they found that the minimum prevalence of dental caries among 6 to 7-year-old children was 74% in Hail, while the maximum prevalence was 93% in Asser. The median prevalence of dental caries was 86% in Jizan. A similar measure of DMFT score reported by WHO was also presented by a recent systematic review.4 As shown in Table 1, the estimated cost to treat all children aged 14 years or younger in Saudi Arabia is around 3.9 billion Saudi Riyals (SR), assuming each child had around 6 decayed teeth, and the prevalence of dental caries is approximately 84%. It should be noted that the large estimated cost relative to the population size (N=7,758,600) is reflective of the imperative need for immediate attention and comprehensive action. The allocated cost is derived from 3 main sources: salaries, general overhead expenses, and direct expenses. The estimated total cost for treating a decayed tooth by a general dentist in a governmental facility approximates SR100. The cost of the dental work force is SR80. General overhead (depreciation, utilities, rent, and cleaning) was assumed to cost approximately SR15 and direct expenses (materials and supplies) around SR5. These monetary costs may increase when treatment is provided by a specialized dentists or treatment center. The number of children in Saudi Arabia was extracted using the July 2010 population statistics from the Central Department of Statistics and Information, Saudi Arabia.5 Limitations include that the cost was estimated Brief Communication