Cascade of Care in Pediatric Oral Health: A Cross-sectional Study to Assess Care Utilization

Abstract

Introduction:

The cascade of care (COC) approach assesses key stages in care, including screening, diagnosis, treatment, and control. It has been applied to communicable and noncommunicable diseases but is yet to be used in oral health.

Objectives:

To adapt the COC framework for pediatric oral health and apply it in a cross-sectional study of schoolchildren in Jeddah, Saudi Arabia, to assess dental needs, diagnosis, treatment, and follow-up.

Methods:

A 2-stage process was used to first adapt the 4-step COC model for pediatric dental needs and to produce a survey questionnaire. Stratified random sampling was then used to recruit children in grades 4 to 6 in primary schools in Jeddah, Saudi Arabia, from October 2023 to January 2024. Parents completed COC questions, and children completed dental examinations. Descriptive statistics and multilevel logistic regression models were used to assess outcomes, including unmet dental needs in context.

Results:

A total of 783 schoolchildren from 11 primary schools were included in the cross-sectional study. The largest loss of care occurred at the treatment stage, where 41.3% of those who had visited a dentist and were diagnosed had completed their treatment. Children who had not visited a dentist in >12 mo were less likely to be diagnosed, complete treatment, or receive follow-up care when compared with those who had seen a dentist within 12 mo ( P < 0.05).

Conclusion:

This study is the first to adapt and apply the COC framework in pediatric oral health. The total unmet dental need was high, particularly for children visiting the dentist for symptomatic reasons (i.e., pain or extraction). This model lays the groundwork for more targeted assessments at national or subnational levels.

Knowledge Transfer Statement:

This is the first time that the cascade of care (COC) approach has been adapted and applied in a pediatric oral health case study in Jeddah, Saudi Arabia, to understand gaps in children’s dental care. It showed how the COC can highlight where systems might be underperforming and where additional data are needed. Introducing the COC framework in pediatric oral health could improve data collection across key stages of care, such as access, diagnosis, treatment, and follow-up.