Objectives: Data on the oral health status in the Qinghai-Tibetan Plateau are limited. This study aimed to investigate the dental caries status and identify associated risk factors among 8- to 12-year-old children in Gannan, a Tibetan Autonomous Prefecture in Northwest China. Methods: The study population was recruited using a multistage stratified random sampling procedure. Caries status was assessed by clinical oral examination and indicated by the decayed, missing, and filled teeth (DMFT/dmft) index. Information on sociodemographic characteristics, oral hygiene behaviours, and dietary habits was collected using a comprehensive structured questionnaire. Statistical analyses, including the chi-square test and a two-level logistic regression model, were conducted to examine the risk factors associated with dental caries. Results: A total of 1024 Tibetan children were examined, revealing a dental caries prevalence rate of 89.55%, with a mean DMFT/dmft index of 4.25 3.27. The two-level logistic regression model showed that initiating tooth brushing at four to 5 years old (OR = 2.295, 95% CI 1.053-5.002) and frequent dessert and candy intake (OR = 2.655, 95% CI 1.216-5.794) were risk factors for dental caries. Conversely, being 11 years (OR = 0.399, 95% CI 0.1770.904) or 12 years old (OR = 0.396, 95% CI 0.163-0.961) and if the father's education level was high school or above (OR = 0.311, 95% CI 0.098-0.986) were indicated to be protective factors against dental caries. Conclusions: The prevalence of dental caries was high in Tibetan children aged 8 to 12yearold in Gannan. Therefore, it is imperative to prioritize comprehensive home- and schoolbased interventions to improve the oral health of this population. (c) 2024 The Authors. Published by Elsevier Inc. on behalf of FDI World Dental Federation. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/)