Social inequalities are strongly associated with disparities in oral health, particularly in the development of childhood caries. This 4-year cohort study analyzed the impact of socioeconomic status (SES)- defined on the basis of the health insurance type- on the prevalence, treatment, and recurrence of dental caries in children. A total of 198 children (21 with social insurance, 177 with private insurance) were included. Caries prevalence at baseline was significantly higher in children with social insurance (95 % with >4 caries) compared to those with private insurance (29 % with >4 caries). No children with social insurance were caries-free, whereas 35 % of those with private insurance were caries-free. Pulpotomy and extraction needs were higher in the socially insured group, with 43 % requiring pulpotomies and 62 % requiring extractions, compared to 12 % and 10 %, respectively, in the privately insured group. General anesthesia (GA) use was more frequent in the socially insured group (72 % vs. 13 %), especially among younger children (100 % of 2-4 years old vs. 25 % in the private insurance group). In contrast, conventional anesthesia was more frequently used in the private insurance group (31 % vs. 14 %). Recall appointments were less frequent in the socially insured group, with 24% having no follow-up, compared to 12 % in the privately insured group. Caries recurrence was higher in the socially insured group (62 % had >3 new carious lesions) compared to the privately insured group, where 38 % of children had no new caries at follow-up. These findings highlight the impact of SES on caries burden, treatment modalities, and the importance of preventive measures for disadvantaged groups.