Abstract
BACKGROUND: Untreated dental caries in permanent teeth is a widespread public health concern. These disparities arise from complex interactions between socioeconomic, healthcare, and dietary factors, despite advancements in dental care and prevention strategies. This study aims to analyze global geographical disparities in untreated dental caries of permanent teeth and identify key systemic factors influencing its prevalence, such as dental workforce density, affordability of fluoride toothpaste, sugar consumption, and healthcare expenditure. MATERIALS AND METHODS: An ecological study design was utilized, incorporating country-level data from the World Health Organization and related databases. Descriptive analyses, chi-square tests, and multiple linear regression models were employed to explore associations between untreated caries prevalence and independent variables. Sensitivity analyses addressed data outliers and regional variability. RESULTS: The prevalence of untreated caries ranged from 22.8% to 49.5%, with a mean of 32.4% ± 4.8%. Dental workforce density was a statistically significant predictor (P = 0.014), with higher density associated with increased caries prevalence, suggesting underlying systemic inefficiencies. Other factors, such as sugar consumption and affordability of fluoride toothpaste, showed weak or nonsignificant associations. Sensitivity analyses confirmed the robustness of these findings, highlighting notable regional disparities and indirect influences on caries outcomes. CONCLUSION: Geographical disparities in untreated caries prevalence are driven by systemic factors, with evidence pointing to inefficiencies in the distribution and accessibility of oral healthcare resources. These findings emphasize the need for targeted public health policies that address regional inequities, improve preventive care access, and account for broader socioeconomic determinants.