{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,9]],"date-time":"2026-09-09T09:08:17Z","timestamp":1788944897857,"version":"build-2803163510"},"reference-count":34,"publisher":"MDPI AG","issue":"9","license":[{"start":{"date-parts":[[2026,9,9]],"date-time":"2026-09-09T00:00:00Z","timestamp":1788912000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Dent. J.","Dentistry Journal"],"abstract":"<jats:p>Background\/Objectives: Dental caries remains one of the most prevalent chronic diseases affecting children worldwide and continues to pose a substantial challenge to healthcare systems. Although the clinical consequences of paediatric dental caries are well documented, the associated economic burden has not been comprehensively synthesised. This systematic review aimed to evaluate and summarise the available evidence regarding the costs associated with dental caries in children and adolescents under 18 years of age. Methods: A systematic review was conducted in accordance with PRISMA 2020 guidelines and registered in PROSPERO (CRD420251138979). MEDLINE via PubMed, Scopus, and Dentistry &amp; Oral Sciences Source (EBSCOhost) were searched for studies published between January 2012 and July 2025. The MEDLINE and Scopus searches were conducted on 22 July 2025, and an additional search of Dentistry &amp; Oral Sciences Source (EBSCOhost) was conducted on 19 August 2026. Eligible studies included peer-reviewed cost-of-illness studies, economic evaluations, cost analyses, cross-sectional studies, retrospective studies, and randomised controlled trials reporting economic outcomes related to the prevention or management of dental caries in individuals under 18 years of age. Methodological quality was assessed using the Drummond 10-item checklist. Data were extracted on study characteristics, population demographics, cost components, study perspective, and key findings. Reported costs were categorised as direct, indirect, and intangible costs where applicable. Due to substantial methodological heterogeneity among studies, a narrative synthesis was performed. Results: Seventeen studies met the inclusion criteria. Most studies focused on direct medical costs associated with restorative treatment, hospital-based dental care, and emergency services. Direct costs were consistently substantial across different healthcare settings, particularly for cases requiring advanced treatment or general anaesthesia. Preventive interventions were generally reported to be more cost-effective than curative approaches. Indirect costs, including caregiver productivity losses, were infrequently assessed, while no study comprehensively evaluated intangible costs. Considerable variation in study design, costing perspective, and reporting methodology limited direct comparison across studies. Conclusions: Dental caries in individuals under 18 years of age imposes a considerable economic burden, driven primarily by direct treatment costs. Preventive oral health strategies appear to provide greater economic value than treatment-focused approaches. The limited assessment of indirect and intangible costs suggests that the overall societal burden of paediatric dental caries is likely underestimated. Future research should adopt standardised and comprehensive costing methodologies to better support policy development and resource allocation in paediatric oral healthcare.<\/jats:p>","DOI":"10.3390\/dj14090578","type":"journal-article","created":{"date-parts":[[2026,9,9]],"date-time":"2026-09-09T08:05:43Z","timestamp":1788941143000},"page":"578","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Direct, Indirect, and Intangible Costs in the Management of Dental Caries in Children Under 18: A Systematic Review"],"prefix":"10.3390","volume":"14","author":[{"given":"Darja","family":"Gostilo","sequence":"first","affiliation":[{"name":"Prof. Shaju Jacob Pulikkotil Group, Oral Health Research, Faculty of Dentistry, R\u012bga Stradi\u0146\u0161 University, LV-1007 Riga, Latvia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0001-7533-7439","authenticated-orcid":false,"given":"Xenia","family":"Teplitzky","sequence":"additional","affiliation":[{"name":"Prof. Shaju Jacob Pulikkotil Group, Oral Health Research, Faculty of Dentistry, R\u012bga Stradi\u0146\u0161 University, LV-1007 Riga, Latvia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0493-2553","authenticated-orcid":false,"given":"Blend","family":"Hamza","sequence":"additional","affiliation":[{"name":"Clinic of Orthodontics and Pediatric Dentistry, Center for Dental Medicine, University of Zurich, Plattenstrasse 11, 8032 Zurich, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5361-5840","authenticated-orcid":false,"given":"Georgios","family":"Tsilingaridis","sequence":"additional","affiliation":[{"name":"Division of Pediatric Dentistry, Department of Dental Medicine, Karolinska Institutet, 171 77 Stockholm, Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3075-3356","authenticated-orcid":false,"given":"Sivaprakash","family":"Rajasekharan","sequence":"additional","affiliation":[{"name":"ELOHA (Equal Lifelong Oral Health for All) Research Group, Paediatric Dentistry, Oral Health Sciences, Ghent University Hospital, 9000 Ghent, Belgium"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0003-2284-2591","authenticated-orcid":false,"given":"L\u012bna","family":"Petrova","sequence":"additional","affiliation":[{"name":"Prof. Shaju Jacob Pulikkotil Group, Oral Health Research, Faculty of Dentistry, R\u012bga Stradi\u0146\u0161 University, LV-1007 Riga, Latvia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0001-2172-1902","authenticated-orcid":false,"given":"Megija","family":"Florentine","sequence":"additional","affiliation":[{"name":"Prof. Shaju Jacob Pulikkotil Group, Oral Health Research, Faculty of Dentistry, R\u012bga Stradi\u0146\u0161 University, LV-1007 Riga, Latvia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5727-8255","authenticated-orcid":false,"given":"Shaju Jacob","family":"Pulikkotil","sequence":"additional","affiliation":[{"name":"Prof. Shaju Jacob Pulikkotil Group, Oral Health Research, Faculty of Dentistry, R\u012bga Stradi\u0146\u0161 University, LV-1007 Riga, Latvia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,9,9]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","unstructured":"Chen, X., Jia, L., Wang, Q., Wang, J.J., Tian, Y., Zhang, Z., and Xie, L. (2025). Global, regional, and national burden of caries in primary teeth from 1990 to 2021: Results from the Global Burden of Disease Study 2021. BMC Oral Health, 25.","DOI":"10.1186\/s12903-025-06691-y"},{"key":"ref_2","first-page":"215","article-title":"Childhood lead exposure and the risk of dental caries in permanent teeth: The Cincinnati Lead Study","volume":"11","author":"Amin","year":"2025","journal-title":"JDR Clin. Transl. Res."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"249","DOI":"10.1016\/S0140-6736(19)31146-8","article-title":"Oral diseases: A global public health challenge","volume":"394","author":"Peres","year":"2019","journal-title":"Lancet"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"261","DOI":"10.1186\/s12939-024-02279-0","article-title":"Every bite counts to achieve oral health: A scoping review on diet and oral health preventive practices","volume":"23","author":"Chamut","year":"2024","journal-title":"Int. J. Equity Health"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"201","DOI":"10.1111\/ipd.13224","article-title":"Caries status in 12-year-old children, geographical location and socioeconomic conditions across European countries: A systematic review and meta-analysis","volume":"35","author":"Vukovic","year":"2025","journal-title":"Int. J. Paediatr. Dent."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"214","DOI":"10.1111\/idj.12627","article-title":"Caries prevalence and severity for 12-year-old children in Latvia","volume":"71","author":"Maldupa","year":"2021","journal-title":"Int. Dent. J."},{"key":"ref_7","unstructured":"World Health Organization (2026, June 10). Oral Health Country Profile: Latvia. Available online: https:\/\/www.who.int\/publications\/m\/item\/oral-health-lva-2022-country-profile."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"5","DOI":"10.12688\/gatesopenres.12786.2","article-title":"Comparing the cost-per-QALYs gained and cost-per-DALYs averted literatures","volume":"2","author":"Neumann","year":"2018","journal-title":"Gates Open Res."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"e095832","DOI":"10.1136\/bmjopen-2024-095832","article-title":"Non-monetary burdens of out-of-pocket costs incurred by patients and caregivers for medical care: A scoping review","volume":"15","author":"Giombi","year":"2025","journal-title":"BMJ Open"},{"key":"ref_10","first-page":"e85185","article-title":"Role of the early detection and prevention of dental caries in children: A systematic review of clinical outcomes","volume":"17","author":"James","year":"2025","journal-title":"Cureus"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"n71","DOI":"10.1136\/bmj.n71","article-title":"The PRISMA 2020 statement: An updated guideline for reporting systematic reviews","volume":"372","author":"Page","year":"2021","journal-title":"BMJ"},{"key":"ref_12","unstructured":"Drummond, M.F., Sculpher, M.J., Claxton, K., Stoddart, G.L., and Torrance, G.W. (2015). Methods for the Economic Evaluation of Health Care Programmes, Oxford University Press. [4th ed.]."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"601","DOI":"10.1111\/cdoe.12958","article-title":"Economic evaluation of a water fluoridation scheme in Cumbria, UK","volume":"52","author":"Whittaker","year":"2024","journal-title":"Community Dent. Oral Epidemiol."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"e084776","DOI":"10.1136\/bmjopen-2024-084776","article-title":"Optimisation of services to prevent dental caries for school-aged children in China: A discrete choice experiment","volume":"14","author":"Wang","year":"2024","journal-title":"BMJ Open"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"431","DOI":"10.1007\/s40258-022-00720-5","article-title":"Cost-effectiveness analysis of the Dental RECUR pragmatic randomized controlled trial","volume":"20","author":"Victory","year":"2022","journal-title":"Appl. Health Econ. Health Policy"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"1","DOI":"10.17126\/joralres.2021.003","article-title":"Cost-benefit analysis of drinking water fluoridation in 12-year-old children in the Biob\u00edo Region, Chile","volume":"10","author":"Ulloa","year":"2021","journal-title":"J. Oral Res."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"136","DOI":"10.1111\/ipd.13214","article-title":"Modeling the cost-effectiveness of school-based supervised toothbrushing program in reducing the dental caries burden in India","volume":"35","author":"Sharda","year":"2025","journal-title":"Int. J. Paediatr. Dent."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"1525","DOI":"10.1007\/s10198-025-01787-2","article-title":"Economic evaluation on dental caries preventive interventions for Australian children using a priority-setting approach","volume":"26","author":"Nguyen","year":"2025","journal-title":"Eur. J. Health Econ."},{"key":"ref_19","first-page":"52","article-title":"BRIGHT RCT: Behaviour change intervention to prevent dental caries in secondary school pupils: Process and economic evaluation","volume":"28","author":"Marshman","year":"2024","journal-title":"Health Technol. Assess."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"43","DOI":"10.1186\/s12955-020-01300-8","article-title":"Demonstration of high-value care to improve oral health of a remote Indigenous community in Australia","volume":"18","author":"Kularatna","year":"2020","journal-title":"Health Qual. Life Outcomes"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"560","DOI":"10.1111\/cdoe.12181","article-title":"Relative cost-effectiveness of home visits and telephone contacts in preventing early childhood caries","volume":"43","author":"Koh","year":"2015","journal-title":"Community Dent. Oral Epidemiol."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"30","DOI":"10.1922\/CDH_4115Owen07","article-title":"Cost-utility analysis of caries prevention interventions in a high-risk UK population","volume":"35","author":"Kay","year":"2018","journal-title":"Community Dent. Health"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"765","DOI":"10.1016\/j.acap.2024.02.006","article-title":"A cost-effectiveness analysis of population-level dental caries prevention strategies in US children","volume":"24","author":"Janusz","year":"2024","journal-title":"Acad. Pediatr."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"61","DOI":"10.1177\/0022034518799742","article-title":"Cost-effectiveness of the Hall Technique in a randomized trial","volume":"98","author":"Schwendicke","year":"2019","journal-title":"J. Dent. Res."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"e220269","DOI":"10.1001\/jamanetworkopen.2022.0269","article-title":"Cost-effectiveness of artificial intelligence as a decision-support system for melanoma, dental caries, and diabetic retinopathy detection","volume":"5","author":"Krois","year":"2022","journal-title":"JAMA Netw. Open"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"369","DOI":"10.1111\/j.1600-0528.2012.00684.x","article-title":"Cost-effectiveness of extending water fluoridation coverage in Australia","volume":"40","author":"Cobiac","year":"2012","journal-title":"Community Dent. Oral Epidemiol."},{"key":"ref_27","first-page":"207","article-title":"Economic evaluation of the Protecting Teeth @ 3 randomized controlled trial","volume":"7","author":"Anopa","year":"2022","journal-title":"JDR Clin. Transl. Res."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"202","DOI":"10.1111\/jphd.12088","article-title":"A population-based cost description study of oral treatment of hospitalized Western Australian children <15 years","volume":"75","author":"Alsharif","year":"2015","journal-title":"J. Public Health Dent."},{"key":"ref_29","doi-asserted-by":"crossref","unstructured":"Nguyen, T.M., Witton, R., Withers, L., and Paisi, M. (2024). Economic evaluation of a community dental care model for people experiencing homelessness. Br. Dent. J.","DOI":"10.1038\/s41415-024-8166-1"},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"845","DOI":"10.1177\/0022034517708315","article-title":"Global burden of sugar-related dental diseases in 168 countries and corresponding health care costs","volume":"96","author":"Meier","year":"2017","journal-title":"J. Dent. Res."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"125","DOI":"10.1016\/j.puhe.2019.02.010","article-title":"The caries-related cost and effects of a tax on sugar-sweetened beverages","volume":"169","author":"Jevdjevic","year":"2019","journal-title":"Public Health"},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"5","DOI":"10.1093\/bmb\/ldq033","article-title":"Health outcomes in economic evaluation: The QALY and utilities","volume":"96","author":"Whitehead","year":"2010","journal-title":"Br. Med. Bull."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"1868","DOI":"10.1136\/heartjnl-2015-308255","article-title":"QALYs in cost-effectiveness analysis: An overview for cardiologists","volume":"101","author":"Wouters","year":"2015","journal-title":"Heart"},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"2197","DOI":"10.1016\/S0140-6736(12)61689-4","article-title":"Disability-adjusted life years (DALYs) for 291 diseases and injuries in 21 regions, 1990\u20132010: A systematic analysis for the Global Burden of Disease Study 2010","volume":"380","author":"Murray","year":"2012","journal-title":"Lancet"}],"container-title":["Dentistry Journal"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2304-6767\/14\/9\/578\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,9]],"date-time":"2026-09-09T08:35:50Z","timestamp":1788942950000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2304-6767\/14\/9\/578"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,9,9]]},"references-count":34,"journal-issue":{"issue":"9","published-online":{"date-parts":[[2026,9]]}},"alternative-id":["dj14090578"],"URL":"https:\/\/doi.org\/10.3390\/dj14090578","relation":{},"ISSN":["2304-6767"],"issn-type":[{"value":"2304-6767","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,9,9]]}}}