Geographic Disparities in Oral Health Among Schoolchildren in Damascus, Syria, During the Prolonged Crisis: A Cross-Sectional Study.

Background The prolonged humanitarian crisis in Syria has severely impacted healthcare infrastructure and nutritional security, yet the geographic distribution of oral health outcomes among schoolchildren remains poorly understood. Objectives This study aimed to assess geographic disparities in the prevalence of dental caries and gingivitis among children aged six to 12 years in Damascus and to identify district-level variations in oral health status. Methods A cross-sectional study was conducted on 872 schoolchildren selected via multistage cluster sampling from nine administrative districts of urban Damascus. Clinical examinations assessed dental caries using DMFT (Decayed, Missing, and Filled Teeth (permanent dentition)) and dmft (decayed, missing, and filled teeth (primary dentition)) indices, gingival health using the Gingival Index (GI), and oral hygiene using the Plaque Index (PI). Data on sociodemographic factors and oral hygiene behaviors were collected via parental questionnaires. Chi-square tests and analysis of variance (ANOVA) were used to compare outcomes across districts, with statistical significance set at p<0.05. Results The overall prevalence of dental caries was 733 (84%), and gingivitis was 760 (87%). Significant geographic disparities were observed for the prevalence of dental caries. The highest mean DMFT was in Al‑Mazzeh district (2.62±1.67), while the lowest was in Al‑Qanawat district (1.61±1.44). For primary teeth (dmft), the highest mean was in Al‑Muhajireen district (3.50±2.64) and the lowest in Al‑Qusour district (2.29±2.07). Caries prevalence ranged from 71 (77%) in Al‑Qadam to 84 (90.3%) in Al‑Muhajireen. No statistically significant differences in gingivitis severity were observed across districts (p=0.566). Public schools consistently had worse oral health outcomes than private schools (p=0.01 for caries prevalence; p=0.035 for mean DMFT). Conclusion Significant geographic disparities in oral health exist among Damascus schoolchildren, with disadvantaged districts and public schools bearing the highest burden. These findings highlight the urgent need for targeted, area-specific preventive interventions in crisis-affected settings.