According to the results of the current study, fourth-year students show a significantly greater prevalence of dental caries than first-year students. In agreement with our findings, a 2013 study reported that the prevalence of caries was 72.1% in primary teeth and 61.7% in permanent teeth [17]. Another study involving participants aged four to 14 years identified ten-year-olds as the most affected age group and four-year-olds as the least affected [1]. On the other hand, the opposite results were found in a study of 730 s- to fourth-grade children. Of the participants, 53.7% of Grade Two children and 14.4% of Grade Four children had caries, whereas Grade Four children had fewer caries than Grade Two children [18].

In our study, we found that the prevalence of caries was greater among children enrolled in public schools than among those enrolled in private schools. This finding aligns with similar findings in a study conducted in Brazil, which reported caries prevalence rates of 74.50% and 61.20% among public schoolchildren and private schoolchildren, respectively [19]. Comparable results were also noted in a study among 12- to 15-year-old schoolchildren in Jordan, where public schoolchildren exhibited higher prevalence rates than did their private school counterparts [20].

Moreover, a study involving 604 children revealed a significantly greater percentage of children in public schools with poor oral hygiene status. Generally, the prevalence of oral diseases is lower among children in private schools than among those in public schools [21]. The type of school was consistently linked to the oral health condition of children in various studies, such as one where the DMFT index was higher in children from public schools [22].

However, it is worth noting a contradictory finding in a separate study in which students in public schools had a significantly lower prevalence of caries (37.36%) than did those in private schools (47.96%) [23]. Therefore, in the present study, the majority of the study subjects from public schools belonged to the medium- to high-risk category, and private school subjects belonged to the low-risk category, which suggested that private school students have more opportunity to prevent dental caries than do public school students.

Public schools typically serve a higher proportion of low-income and less educated families compared to private schools [24, 25]. Public schools are state-funded institutions that provide education at no cost to families, which is why many low- to middle-income families choose these schools for their children. This economic factor is crucial, as several factors contribute to the observed differences in dental caries prevalence between students in public and private schools. This socioeconomic disparity is significant because lower income and education levels are often associated with limited access to dental care services, poor health literacy, poor oral hygiene, and less nutritious diets, all of which increase the risk of dental caries [26, 27]. Consequently, the type of school a student attends can serve as an effective indicator of socioeconomic status in dental health surveys [28], particularly in SA, where collecting detailed individual socioeconomic data can be impractical.

In our study, we observed that 42% of schoolchildren exhibited moderate to severe caries, while 58% had no dental caries. This finding diverges from several studies conducted in SA. In a systematic review comprising 27 published studies on caries among children in SA, the national prevalence of dental caries was estimated to be approximately 80% for primary dentition and approximately 70% for children’s permanent dentition [1]. Another meta-analysis revealed that the estimated prevalence of dental caries among children aged 5–7 years was 84%, while for those aged 12–15 years, it was 72% [29]. Additionally, another study reported a general prevalence of dental caries of almost 73%, with specific rates of approximately 78% for six- to nine-year-old and approximately 68% for ten- to 12-year-olds [11].

However, international studies on dental caries showed equivalent results to our study. A study conducted in Pakistan reported a caries incidence of 40.5% in preschool children aged three to five years [11]. In addition, the overall prevalence of caries in the Timor-Leste group was 64% [30]. China reported results comparable to the prevalence of dental caries. In one study, it was 41.15% for school-age children aged six to 20 years [23]. In another study in the same country, the overall prevalence of caries was 52.0% in China [31]. Similar findings were observed in a study of 730 s- to fourth-grade children. Among the participants, 53.7% and 14.4% had caries in the primary and permanent dentition, respectively [18]. Moreover, a study of data from eight- to 12-year-old Brazilian children showed that the prevalence of dental caries was only 32.4% [32].

Although the prevalence of caries is still considered high among Saudi schoolchildren, this percentage is significantly lower than that reported in previous studies within the same community. This improvement is likely attributed to various enhancements and changes implemented in the last two years following the introduction of the 2030 Vision by the MOH school health program. The contributing factors include staff training courses, educational workshops for health councils in schools, collaborative efforts of the Ministry of Education and MOH, and awareness health campaigns conducted in schools and on social media channels. However, further studies are necessary to elucidate these positive changes.

This study can assist policymakers and public health officials in developing targeted interventions to address oral health inequalities among schoolchildren from different socioeconomic backgrounds. Furthermore, it will aid them in determining which school types require more attention in terms of oral health initiatives.

The interpretation of the current study results should consider specific limitations. The data utilised in the study were provided by the Saudi MOH, introducing uncertainties in the procedures for examination and data collection. Moreover, the datasets lack information on crucial factors such as family income, parental education, dietary habits, oral hygiene, and details regarding the number of examiners involved in the initiative and whether the examiners adhered to the initiative protocol. Furthermore, the available data do not provide clarity on whether the school visit was an initial assessment or a follow-up visit during the examination, which holds significance. Follow-up visits may have been influenced by the awareness programme and fluoride application, potentially impacting our study results.

Moreover, there are some challenges faced by the screening team. Firstly, since the team requested to examine all children in certain grades, absenteeism emerged as a significant obstacle for the screening team. Additionally, due to the large target number, the screening teams had to visit the school multiple times, leading to concerns from school authorities about the program interfering with their regular academic calendar. Moreover, a shortage of dentists involved in this initiative further exacerbated the situation. These issues collectively impacted the data collection process.