Direct, Indirect, and Intangible Costs in the Management of Dental Caries in Children Under 18: A Systematic Review.

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 & 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 & 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.