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To report on the dental caries experience in schoolchildren from a region with a needs-based dental service compared with a region with a demand-led dental service.Cross-sectional study with clustered sampling.Urban primary schools in Dublin (Ireland) and Freiburg (Germany).12-year-old schoolchildren.A trained and calibrated dentist examined a representative, random sample of schoolchildren under the same standardised conditions. Social class was recorded using the 'Goldthorpe-Social-Class-Schema'. Dental caries was recorded using WHO criteria.Atotal of 567 schoolchildren were examined, 332 in Ireland and 249 in Germany. For Ireland the mean DMFT in SC-1 (highest social class) was 0.28, in SC-2 (middle social class) it was 1.1 and in SC-3 (lowest social class) it was 0.94. For Germany the mean DMFT in SC-1 was 0.31, in SC-2 it was 0.61 and in SC-3 it was 1.33.This study demonstrated the existence of social gradients in dental caries levels in both samples but the magnitude of the difference varied across the two populations and appeared to be smaller in the needs-based dental service.

SUMMARY Background: It has been observed that the prevalence of dental caries among children has declined in the last decade in Germany. However, despite of these improvements there is still a proportion of children suffering from dental decay. Aims: The aims of this study were to evaluate if a social gradient in the prevalence of dental caries exists and, based on those findings, to develop a strategy to target those children with heightened risk to develop dental caries in order to assist oral health care professionals to refocus the current uniform school-based dental health programme to a caries preventive strategy based on a directed population approach. Design: A representative, random sample of 12-year olds in Freiburg (Germany) was examined and dental caries was recorded using WHO criteria. Educational attainment of the child’s parents was used as an indicator of socio-economic status and classified by use of the CASMIN Educational Classification. Results: A total of 322 children participated. An examination of dental caries score revealed that its distribution was positively skewed. For this reason this study provides summary analyses based on medians and a non-parametric rank-sum test. The Kruskal-Wallis H-test showed a significant difference between median scores across the different educational levels (p-value=0.015) which was due to lower dental caries levels in children with non-deprived social background. Conclusions: In order to reduce current social inequalities in child oral health the current uniform school-based dental health programme at secondary school level should be developed to a targeted school-based screening and prevention programme.