BackgroundUnderstanding factors influencing dental service utilization and dental caries assists dental professionals in addressing challenges within their field.ObjectivesAssess the prevalence of dental caries, the actual pattern of dental service utilization, and factors affecting them, such as parents' 1dental fear, demographic, and socio-demographic variables among primary school children.MethodsThis cross-sectional study included 1075 participants aged 6 to 12 years old, recruited from primary schools in Mansoura city, Egypt. This study was carried out in two stages; first, a well-structured questionnaire was used to collect data on socio-demographic variables and parental fear. Second, clinical examination was performed to measure dental caries according to the World Health Organization (WHO) diagnostic criteria and to record the dental services utilized. A multi-stage cluster random sampling technique was used to select the study sample. Data was analyzed statistically using regression analysis, Chi-square, and Fisher's exact tests.ResultsThe prevalence of dental caries was higher in primary teeth than in permanent teeth (59.3% vs. 35.8%). Likewise, a higher percentage of children had fillings in their primary dentition (14.1%) than in their permanent dentition (5.1%). 6-8 yearss age, of 6-8 years, significantly impacted dental caries prevalence and service utilization. Being in private schools significantly reduced dental caries in both types of dentitions (DMFT: Regression Coefficient (B) =-0.160, P-value (P) = 0.032), (deft: B=-0.459, P = 0.007). Children whose fathers had a higher educational level demonstrated lower dental caries scores in both dentitions (DMFT: B=-0.300, P = 0.023), (deft: B= -0.429, P = 0.035). A higher utilization rate of dental services was noted among children from families with higher incomes (Odds Ratio (OR) = 2.607, P = 0.006). Parental fear was significantly correlated to an increased dental caries prevalence and reduced preventive services (P <= 0.05).ConclusionDespite the relatively high prevalence of dental caries among study participants, the utilization of dental services was low. Age, number of children, and parental-related factors were predictors of caries prevalence and dental service utilization. This underscores the importance of implementing nationwide educational initiatives aimed at schoolchildren's parents to improve their understanding of accessible dental care options.Clinical trial numberNot applicable.