Abstract Introduction Tooth decay is considered the fourth most important public health problem in the world. According to the latest studies, the prevalence of this disease is also important in school children. The interest of this work is to study the prevalence of dental caries and its influencing factors in primary school children in the city of Sousse (Tunisia) and to formulate recommendations for the prevention of this phenomenon. Methods It is a cross-sectional study conducted among pupils enrolled from 1st and 3rd grade of 3 primary schools in the city of Sousse in April 2022 through a questionnaire filled out by the pupils. Results A total of 376 participated in the study. Among them, 52,4% were male. The mean age was 7.4 ± 1.2 years. The prevalence of dental caries in our population was 43.9%. Many factors were associated with dental caries including pupils from public schools (p = 0.000), poor oral hygiene: [lack of tooth brushing (p = 0.000), tooth brushing only 1 time per day (p = 0.000), eating in the evening after brushing the teeth (p = 0.000), lack of changing the toothbrush (p = 0.000)] and unhealthy eating habits (p ≤ 0.05). Consequently, dental caries was significantly higher among children with overweight body mass index (BMI) (90.9%; p = 0.016). Conclusions The organization of awareness and information days in schools, the integration of an education program on preventive measures against this phenomenon and the generalization of screening campaigns to detect this disease are necessary measures that should be carried out according to a well determined strategy. Key messages • Dental caries prevalence among primary school children in Sousse is significant, highlighting the urgent need for preventive measures. • Factors such as poor oral hygiene, unhealthy eating habits, and attending public schools contribute to the prevalence of dental caries.