{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,24]],"date-time":"2026-03-24T11:01:51Z","timestamp":1774350111628,"version":"3.50.1"},"reference-count":67,"publisher":"MDPI AG","issue":"4","license":[{"start":{"date-parts":[[2026,3,24]],"date-time":"2026-03-24T00:00:00Z","timestamp":1774310400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Children"],"abstract":"<jats:p>Background and Objectives: Dental caries remains one of the most prevalent chronic conditions among children worldwide, with considerable variation in burden shaped by differences in health-system organization and preventive program implementation. Some countries have reported notable progress through coordinated school-based programs and supportive policy environments, while others continue to face challenges despite extensive public health efforts. This study aims to explore how selected structural and programmatic elements within national health systems may be associated with childhood caries outcomes, using Germany and Saudi Arabia as illustrative contexts. Materials and Methods: A descriptive comparative secondary-data analysis combined with legal and policy mapping was conducted using published national oral health surveys, systematic reviews, and governmental reports. Caries indicators (dmft\/DMFT) for children aged 6\u20137 and 12 years were extracted following WHO criteria. Health system organization, preventive program coverage, and policy enforcement mechanisms were mapped and critically reviewed. No new primary data were collected, and no inferential modeling was performed. Results: Germany has achieved substantial reductions in childhood caries prevalence through a legally mandated school-based prevention program, supported by individual prophylaxis covered by health insurance. This framework corresponds with low mean dmft (1.73) among 6\u20137-year-olds and mean DMFT (0.5) among 12-year-olds. By contrast, Saudi Arabia continues to report elevated caries rates despite substantial public-health investments, with mean dmft (5.0) and mean DMFT (3.5), with over 90% of children affected. Preventive initiatives in Saudi Arabia remain fragmented across sectors and lack a unified legal mandate. Conclusions: The findings suggest that structured governance, coordinated prevention strategies, and reliable monitoring systems may be associated with more favorable oral health outcomes. In the context of Saudi Arabia, the persistently high caries burden suggests that strengthening national legislation, implementing an interoperable digital surveillance system, and improving the consistency of school-based preventive programs could support more equitable and effective oral health delivery.<\/jats:p>","DOI":"10.3390\/children13040440","type":"journal-article","created":{"date-parts":[[2026,3,24]],"date-time":"2026-03-24T08:02:49Z","timestamp":1774339369000},"page":"440","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Impact of Health System Structures on Caries Prevalence Among Schoolchildren in Germany and Saudi Arabia"],"prefix":"10.3390","volume":"13","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0109-5211","authenticated-orcid":false,"given":"Yasser Mansour","family":"Aljafen","sequence":"first","affiliation":[{"name":"Zircon Dental Clinic, Buraidah 52387, Saudi Arabia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Christian Heinz","family":"Splieth","sequence":"additional","affiliation":[{"name":"Department of Pediatric Dentistry, University Medicine Greifswald, 17475 Greifswald, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2436-3001","authenticated-orcid":false,"given":"Julian","family":"Schmoeckel","sequence":"additional","affiliation":[{"name":"Department of Pediatric Dentistry, University Medicine Greifswald, 17475 Greifswald, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2026,3,24]]},"reference":[{"key":"ref_1","unstructured":"(2026, February 27). World Health Organization WHO|Oral Health. Available online: https:\/\/www.who.int\/health-topics\/oral-health."},{"key":"ref_2","doi-asserted-by":"crossref","unstructured":"Tudoroniu, C., Popa, M., Iacob, S.M., Pop, A.L., and N\u0103sui, B.A. (2020). Correlation of Caries Prevalence, Oral Health Behavior and Sweets Nutritional Habits among 10 to 19-Year-Old Cluj-Napoca Romanian Adolescents. Int. J. Environ. Res. Public Health, 17.","DOI":"10.3390\/ijerph17186923"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"3","DOI":"10.1016\/j.sdentj.2012.10.002","article-title":"A Systematic Review of Population-Based Dental Caries Studies among Children in Saudi Arabia","volume":"25","year":"2013","journal-title":"Saudi Dent. J."},{"key":"ref_4","unstructured":"Ministry of Health, and Saudi Arabia (2026, February 27). Dental Caries: Facts and Guidelines, Available online: https:\/\/www.moh.gov.sa\/en\/awarenessplateform\/OralHealth\/Pages\/DentalCaries.aspx."},{"key":"ref_5","unstructured":"Chen, M., Andersen, R., and Barmes, D. (1997). Comparing Oral Health Care Systems: A Second International Collaborative Study, University of Chicago Center for Health Administration Studies."},{"key":"ref_6","unstructured":"Petersen, P.E., Baez, R.J., and World Health Organization (2013). Oral Health Surveys\u2014Basic Methods, World Health Organization. [5th ed.]."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"3","DOI":"10.1046\/j..2003.com122.x","article-title":"The World Oral Health Report 2003: Continuous Improvement of Oral Health in the 21st Century\u2014The Approach of the WHO Global Oral Health Programme","volume":"31","author":"Petersen","year":"2003","journal-title":"Community Dent. Oral Epidemiol."},{"key":"ref_8","first-page":"68","article-title":"The WHO Global Oral Health Action Plan 2023\u20132030","volume":"40","author":"Eaton","year":"2023","journal-title":"Community Dent. Health"},{"key":"ref_9","first-page":"686","article-title":"Oral Health Information Systems\u2014Towards Measuring Progress in Oral Health Promotion and Disease Prevention","volume":"83","author":"Petersen","year":"2005","journal-title":"Bull. World Health Organ."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"784","DOI":"10.26719\/2011.17.10.784","article-title":"Health Care System in Saudi Arabia: An Overview","volume":"17","author":"Almalki","year":"2011","journal-title":"East. Mediterr. Health J."},{"key":"ref_11","unstructured":"Team DAJ (2017). Epidemiologische Begleituntersuchungen Zur Gruppenprophylaxe 2016, Deutsche Arbeitsgemeinschaft f\u00fcr Jugendzahnpflege e.V. (DAJ)."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"609","DOI":"10.1159\/000501263","article-title":"40-Year Longitudinal Caries Development in German Adolescents in the Light of New Caries Measures","volume":"53","author":"Splieth","year":"2019","journal-title":"Caries Res."},{"key":"ref_13","doi-asserted-by":"crossref","unstructured":"Schmoeckel, J., Wahl, G., Santamar\u00eda, R.M., Basner, R., Schankath, E., and Splieth, C.H. (2024). Influence of School Type and Class Level on Mean Caries Experience in 12-Year-Olds in Serial Cross-Sectional National Oral Health Survey in Germany\u2014Proposal to Adjust for Selection Bias. Int. J. Environ. Res. Public Health, 21.","DOI":"10.3390\/ijerph21040467"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"527","DOI":"10.1159\/000496932","article-title":"Introducing a Specific Term to Present Caries Experience in Populations with Low Caries Prevalence: Specific Affected Caries Index (SaC)","volume":"53","author":"Schmoeckel","year":"2019","journal-title":"Caries Res."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"74","DOI":"10.1111\/j.1600-0528.1982.tb00366.x","article-title":"Dental Caries Prevalence in Intermediate Saudi Schoolchildren in Riyad","volume":"10","author":"Younes","year":"1982","journal-title":"Community Dent. Oral Epidemiol."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"60","DOI":"10.1111\/j.1752-7325.1999.tb03236.x","article-title":"Caries Experience of Urban and Rural Children in Saudi Arabia","volume":"59","year":"1999","journal-title":"J. Public Health Dent."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"220","DOI":"10.1111\/j.1752-7325.2010.00169.x","article-title":"Associations among Dental Caries Experience, Fluorosis, and Fluoride Exposure from Drinking Water Sources in Saudi Arabia","volume":"70","author":"Aldosari","year":"2010","journal-title":"J. Public Health Dent."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"737","DOI":"10.15537\/smj.2015.6.10888","article-title":"Prevalence of Dental Caries in Primary and Permanent Teeth and Its Relation with Tooth Brushing Habits among Schoolchildren in Eastern Saudi Arabia","volume":"36","author":"Farooqi","year":"2015","journal-title":"Saudi Med. J."},{"key":"ref_19","first-page":"69","article-title":"Caries Increment Over A 3-Year Period in Adolescent Children in Riyadh, Saudi Arabia","volume":"8","author":"Saeed","year":"1996","journal-title":"Saudi Dent. J."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"29","DOI":"10.5005\/jp-journals-10062-0007","article-title":"Prevalence of Dental Caries among Elementary School Girls in Riyadh, Kingdom of Saudi Arabia: A Cross-Sectional Survey","volume":"11","author":"Alshiha","year":"2017","journal-title":"J. Oral Health Community Dent."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"14","DOI":"10.4103\/sjos.SJOralSci_30_20","article-title":"Oral Health Status and Use of Sugary Products among Adolescents in Urban and Rural Schools in Al-Ahsa, Saudi Arabia","volume":"8","author":"Alwabari","year":"2021","journal-title":"Saudi J. Oral Sci."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"424","DOI":"10.1111\/j.1875-595X.2004.tb00299.x","article-title":"Caries Prevalence and Its Relation to Water Fluoride Levels among Schoolchildren in Central Province of Saudi Arabia","volume":"54","author":"AlDosari","year":"2004","journal-title":"Int. Dent. J."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"60","DOI":"10.1186\/s12199-018-0750-z","article-title":"Prevalence of Dental Caries and Associated Factors among Primary School Children: A Population-Based Cross-Sectional Study in Riyadh, Saudi Arabia","volume":"23","author":"Alhabdan","year":"2018","journal-title":"Environ. Health Prev. Med."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"16","DOI":"10.5005\/jcdp-9-3-16","article-title":"Dental Caries in Relation to Salivary Factors in Saudi Population Groups","volume":"9","author":"Farsi","year":"2008","journal-title":"J. Contemp. Dent. Pract."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"37","DOI":"10.9790\/0853-131153741","article-title":"Prevalence of Dental Caries among Primary School Attendees in Najran-Saudi Arabia","volume":"13","author":"Elfaki","year":"2014","journal-title":"IOSR J. Dent. Med. Sci."},{"key":"ref_26","first-page":"54","article-title":"Dental Caries Prevalence in 6\u20137 Year-Old Schoolchildren in Riyadh Region: A Comparative Study with the 1987 Oral Health Survey of Saudi Arabia Phase I","volume":"16","year":"2004","journal-title":"Saudi Dent. J."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"10","DOI":"10.19080\/ADOH.2018.10.555779","article-title":"The Oral Health Status and Attitudes of Saudi Adolescent Male Students in Albaha Province: A Cross-Sectional Study","volume":"10","author":"Alzahrani","year":"2018","journal-title":"Adv. Dent. Oral Health"},{"key":"ref_28","first-page":"5447723","article-title":"Dietary Determinants of Dental Caries Prevalence and Experience in Saudi Schoolchildren: Frequency versus Quantity","volume":"2022","author":"Bakhurji","year":"2022","journal-title":"Sci. World J."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"897","DOI":"10.1016\/j.sdentj.2021.09.008","article-title":"Caries Prevalence and Severity in Association with Sociodemographic Characteristics of 9-to-12-Year-Old School Children in Al-Madinah, Saudi Arabia","volume":"33","author":"Aqeeli","year":"2021","journal-title":"Saudi Dent. J."},{"key":"ref_30","first-page":"15","article-title":"Prevalence of Dental Caries among Children in Jeddah-Saudi Arabia-2015","volume":"8","year":"2017","journal-title":"EC Dent. Sci."},{"key":"ref_31","first-page":"10400","article-title":"Prevalence of Dental Caries Among Girl Students of Primary School in Buraydah City","volume":"9","author":"Gokul","year":"2018","journal-title":"Int. J. Contemp. Res. Rev."},{"key":"ref_32","first-page":"71","article-title":"Caries in Primary School Children: Prevalence, Severity and Pattern in Al-Ahsa, Saudi Arabia","volume":"13","author":"Khan","year":"2001","journal-title":"Saudi Dent. J."},{"key":"ref_33","doi-asserted-by":"crossref","unstructured":"Kotha, S.B., Terkawi, S.A., Mubaraki, S.A., Al Saffan, A.D., Kotha, S.L., and Mallineni, S.K. (2022). Association between Body Mass Index (BMI) and Dental Caries among 6\u201312-Year-Old School Children. Children, 9.","DOI":"10.3390\/children9050608"},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"396","DOI":"10.26719\/2000.6.2-3.396","article-title":"Dental Caries among Schoolchildren: Report of a Health Education Campaign in Jeddah, Saudi Arabia","volume":"6","author":"Gandeh","year":"2000","journal-title":"East. Mediterr. Health J."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"42","DOI":"10.4103\/njbcs.njbcs_42_21","article-title":"Intelligence Quotient and Dental Caries: An Analytical Cross-Sectional Study among Saudi Arabian Children","volume":"18","author":"Madhan","year":"2021","journal-title":"Niger. J. Basic Clin. Sci."},{"key":"ref_36","first-page":"41","article-title":"Can the Prevalence of Dental Caries Be Used as an Indicator of the Quality of Dental Services? A Cross-Sectional Study among Children in Almadinah Almunawwarah, KSA","volume":"11","author":"Mahrous","year":"2016","journal-title":"J. Taibah Univ. Med. Sci."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"101","DOI":"10.1016\/j.jds.2012.12.009","article-title":"Dental Caries and Associated Factors in Mothers and Their Preschool and School Children\u2014A Cross-Sectional Study","volume":"8","author":"Mannaa","year":"2013","journal-title":"J. Dent. Sci."},{"key":"ref_38","first-page":"33","article-title":"Comparison of Caries in 6-7 Year Old Saudi Girls Attending Public and Armed Forces Schools in Riyadh, Saudi Arabia","volume":"12","author":"Magda","year":"2000","journal-title":"Saudi Dent. J."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"277","DOI":"10.5005\/jp-journals-10024-2031","article-title":"Relation between Dental Caries and Body Mass Index- for-Age among Schoolchildren of Jazan City, Kingdom of Saudi Arabia","volume":"18","author":"Quadri","year":"2017","journal-title":"J. Contemp. Dent. Pract."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"659","DOI":"10.1159\/000500854","article-title":"Caries Trends in the Primary Dentition of 6- to 7-Year-Old Schoolchildren in Germany from 1994 to 2016: Results from the German National Oral Health Surveys in Children","volume":"53","author":"Santamaria","year":"2019","journal-title":"Caries Res."},{"key":"ref_41","doi-asserted-by":"crossref","unstructured":"Santamar\u00eda, R.M., Splieth, C.H., Basner, R., Schankath, E., and Schmoeckel, J. (2024). Caries Level in 3-Year-Olds in Germany: National Caries Trends and Gaps in Primary Dental Care. Children, 11.","DOI":"10.3390\/children11121426"},{"key":"ref_42","unstructured":"(2025, August 03). Bundesministerium der Justiz Sozialgesetzbuch (SGB) F\u00fcnftes Buch (V)\u2014Gesetzliche Krankenversicherung\u2014(Artikel 1 Des Gesetzes v. 20. Dezember 1988, BGBl. I S. 2477) \u00a7 21 Verh\u00fctung von Zahnerkrankungen (Gruppenprophylaxe). Available online: https:\/\/www.gesetze-im-internet.de\/sgb_5\/__21.html."},{"key":"ref_43","unstructured":"(2025, July 27). Ministry of National Guard Health Affairs School Dental Prevention Programs. Available online: https:\/\/ngha.med.sa\/English\/MedicalCities\/AlRiyadh\/SDPP\/Pages\/sdpps.aspx."},{"key":"ref_44","unstructured":"Ministry of Health, and Saudi Press Agency (2025, July 27). National Initiative on Prevent Tooth Caries, Available online: https:\/\/www.moh.gov.sa\/en\/Ministry\/Projects\/tooth-decay\/Pages\/default.aspx."},{"key":"ref_45","unstructured":"Public Health Authority, and National Committee of Periodic Health Examination (2023). Saudi Clinical Preventive Guideline, Saudi Public Health Authority (Weqaya). [3rd ed.]."},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"103727","DOI":"10.1016\/j.jdent.2021.103727","article-title":"Ten-Year Trends in DMF-S and DMF-T in a Northeast German Adult Population","volume":"111","author":"Schmoeckel","year":"2021","journal-title":"J. Dent."},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"9","DOI":"10.1159\/000442713","article-title":"Caries Epidemiology and Community Dentistry: Chances for Future Improvements in Caries Risk Groups. Outcomes of the ORCA Saturday Afternoon Symposium, Greifswald, 2014. Part 1","volume":"50","author":"Splieth","year":"2016","journal-title":"Caries Res."},{"key":"ref_48","first-page":"38","article-title":"Oral Health Behaviour of Children and Adolescents in Germany Results of the Cross-Sectional KiGGS Wave 2 Study and Trends","volume":"3","author":"Krause","year":"2018","journal-title":"J. Health Monit."},{"key":"ref_49","unstructured":"Splieth, C.H. (2012). Gesunde Z\u00e4hne ein Leben Lang\u20148-Jahres-Evaluation 2012: Kariesintensivprophylaxe f\u00fcr Risikokinder in Mecklenburg-Vorpommern, Universit\u00e4t Greifswald."},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"e035999","DOI":"10.1136\/bmjopen-2019-035999","article-title":"Oral Health Improvement for Nursing Home Residents through Delegated Remotivation and Reinstruction (MundZaRR Study): Study Protocol of a Cluster-Randomised Controlled Trial","volume":"10","author":"Hertrampf","year":"2020","journal-title":"BMJ Open"},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"977","DOI":"10.1007\/s00103-021-03371-4","article-title":"Oral Health Literacy of Persons with Migration Background\u2014First Results of the MuMi Study","volume":"64","author":"Spinler","year":"2021","journal-title":"Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz"},{"key":"ref_52","doi-asserted-by":"crossref","first-page":"862","DOI":"10.1007\/s00103-021-03356-3","article-title":"Versorgungsforschung in Der Zahnmedizin in Deutschland","volume":"64","author":"Huettig","year":"2021","journal-title":"Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz"},{"key":"ref_53","unstructured":"Almohammadi, S.M. National Initiative for Pediatric Dental Caries (NIPDC): Overview and Data Presentation. Unpublished presentation."},{"key":"ref_54","doi-asserted-by":"crossref","first-page":"1293","DOI":"10.1177\/00220345231187828","article-title":"Evidence-Informed Oral Health Policy Making: Opportunities and Challenges","volume":"102","author":"Listl","year":"2023","journal-title":"J. Dent. Res."},{"key":"ref_55","doi-asserted-by":"crossref","first-page":"444","DOI":"10.1111\/j.1600-0722.1996.tb00111.x","article-title":"Factors for Changes of Caries Prevalence among Adolescents in Germany","volume":"104","author":"Splieth","year":"1996","journal-title":"Eur. J. Oral Sci."},{"key":"ref_56","doi-asserted-by":"crossref","unstructured":"Jordan, R.A., Bodechtel, C., Hertrampf, K., Hoffmann, T., Kocher, T., Nitschke, I., Schiffner, U., Stark, H., Zimmer, S., and Micheelis, W. (2014). The Fifth German Oral Health Study (F\u00fcnfte Deutsche Mundgesundheitsstudie, DMS V)\u2014Rationale, Design, and Methods. BMC Oral Health, 14.","DOI":"10.1186\/1472-6831-14-161"},{"key":"ref_57","doi-asserted-by":"crossref","first-page":"772","DOI":"10.1007\/s00103-021-03341-w","article-title":"Oral Health Trends in Children: Results from the Epidemiological Surveys Accompanying Group Prophylaxis in Germany","volume":"64","author":"Schmoeckel","year":"2021","journal-title":"Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz"},{"key":"ref_58","doi-asserted-by":"crossref","first-page":"821","DOI":"10.1007\/s00103-021-03359-0","article-title":"Mundgesundheitsziele F\u00fcr Deutschland 2030: Karies Und Parodontitis Weiter Reduzieren Sowie Pr\u00e4vention Verbessern","volume":"64","author":"Ziller","year":"2021","journal-title":"Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz"},{"key":"ref_59","doi-asserted-by":"crossref","first-page":"39","DOI":"10.1046\/j.1365-263x.2000.00166.x","article-title":"Oral Health Survey of 5\u201312-Year-Old Children of National Guard Employees in Riyadh, Saudi Arabia","volume":"10","author":"Echeverri","year":"2000","journal-title":"Int. J. Paediatr. Dent."},{"key":"ref_60","doi-asserted-by":"crossref","unstructured":"Al-Rafee, M.A., Al Shammery, A.R., Al Rumikan, A.S., and Pani, S.C. (2019). A Comparison of Dental Caries in Urban and Rural Children of the Riyadh Region of Saudi Arabia. Front. Public Health, 7.","DOI":"10.3389\/fpubh.2019.00195"},{"key":"ref_61","unstructured":"WHO (2003). WHO Information Series on School Health. Oral Health Promotion: An Essential Element of a Health-Promoting School, World Health Organization."},{"key":"ref_62","doi-asserted-by":"crossref","first-page":"142","DOI":"10.4103\/1658-631X.142496","article-title":"Prevalence, Severity, and Secular Trends of Dental Caries among Various Saudi Populations: A Literature Review","volume":"2","year":"2014","journal-title":"Saudi J. Med. Med. Sci."},{"key":"ref_63","doi-asserted-by":"crossref","first-page":"3234970","DOI":"10.1155\/2018\/3234970","article-title":"Oral Hygiene Practices among Saudi Arabian Children and Its Relation to Their Dental Caries Status","volume":"2018","author":"Quadri","year":"2018","journal-title":"Int. J. Dent."},{"key":"ref_64","doi-asserted-by":"crossref","first-page":"35","DOI":"10.1159\/000526361","article-title":"Dental Governance and the Saudi Vision 2030: A Narrative Review","volume":"3","author":"Aldossary","year":"2022","journal-title":"Saudi J. Health Syst. Res."},{"key":"ref_65","doi-asserted-by":"crossref","unstructured":"Mani, Z.A., and Goniewicz, K. (2024). Transforming Healthcare in Saudi Arabia: A Comprehensive Evaluation of Vision 2030\u2019s Impact. Sustainability, 16.","DOI":"10.3390\/su16083277"},{"key":"ref_66","doi-asserted-by":"crossref","first-page":"e003070","DOI":"10.1136\/bmjoq-2024-003070","article-title":"Implementing the Child Oral Health Initiative (COHI): Improving Access to Preventive Dental Care to Achieve Saudi Vision 2030 Healthcare Goals","volume":"14","author":"Alkarimi","year":"2025","journal-title":"BMJ Open Qual."},{"key":"ref_67","doi-asserted-by":"crossref","unstructured":"Samietz, S., Borof, K., Hertrampf, K., Aarabi, G., Ciardo, A., Finke, H., Hagenfeld, D., K\u00fchnisch, J., R\u00fctters, M., and Baumeister, S.-E. (2025). Dental and Oral Health Assessments in the German National Cohort (NAKO). BMC Oral Health, 25.","DOI":"10.1186\/s12903-025-05454-z"}],"container-title":["Children"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2227-9067\/13\/4\/440\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,3,24]],"date-time":"2026-03-24T08:41:50Z","timestamp":1774341710000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2227-9067\/13\/4\/440"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,3,24]]},"references-count":67,"journal-issue":{"issue":"4","published-online":{"date-parts":[[2026,4]]}},"alternative-id":["children13040440"],"URL":"https:\/\/doi.org\/10.3390\/children13040440","relation":{},"ISSN":["2227-9067"],"issn-type":[{"value":"2227-9067","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,3,24]]}}}