The principal outcome of this study was the geographic distribution of public dental services according to the child population demographics in Al Madinah, in comparison with that in Jeddah.
An uneven distribution of dental services was found, with services concentrated in certain districts with high-density populations in both Al Madinah and Jeddah. However, some highly populated districts had far fewer or no dental care services. This result aligns with the finding of a previous study that 38% of districts had limited access to dental services (9). This unequal distribution of dental services in relation to population density can also be observed in other countries worldwide (10, 11) .
The distribution of public dental care services according to the data analysed in this study is considered acceptable, with most children living within 5 km from a public dental service in both Al Madinah and Jeddah, but with relatively better access in Al Madinah than in Jeddah. However, these results should be interpreted with caution because many variables were not considered in the analysis. All the distances referred to in the findings were Euclidean distances, and the actual travel distance to a service might be farther than 5 km.
One factor to consider is that the dental services were not dedicated solely to children; they catered to both adults and children. Dental services focused on children, such as school dental services, which operate in other countries such as Australia, New Zealand and the United States, are lacking in SA (12, 13). Moreover, the dentist-to-population ratio in PPDS in Al Madinah (1:10,848) is higher than the ratio recommended by the World Health Organization (1:7,500) (9, 14). In addition, each primary healthcare centre serves a large proportion of the population. According to the annual statistics report in 2017, the average number of people served by each centre in SA was 13,813 persons (15).
In addition, barriers to access to dental care have been reported in SA including the lack of dentists in the community, and long waiting lists and times at clinics, which add to the perception that public dental care is of low quality compared with private dental care (16, 17).
The results are challenged by the inadequate transport facilities in SA. Private cars are the primary means of transport in SA and public transport systems are lacking in the cities which contributes to the burden of and barriers to low-income families.
Private dental services, which have been increasing in number in recent years, were not incorporated in the analysis. However, children from families of low socioeconomic status could not afford the high cost of private dental care compared with the free public dental care services delivered by the government.
The number of dentists per public dental service was not examined in the study; however, the shortage of dental workforce is expected to influence the results of this study. Public health policies to address the maldistribution of the workforce and dental health centers in cities and rural areas are recommended.