Oral Health Interventions for People Living With Diabetes From a Public Health Perspective: A Mapping Review.

Abstract

Objectives: Despite growing concerns about the oral health-diabetes link, there is a lack of dental health interventions focused on people with diabetes. This mapping review synthesised the current landscape of oral health interventions for people with diabetes and identified future opportunities.

Methods: A systematic search of electronic databases (Embase, PubMed, Scopus, Web of Science, and the Cochrane Library) and grey literature was conducted without language or publication-year restrictions. Eligible evidence was restricted to review-level studies, including systematic reviews (with or without meta-analysis), network meta-analyses, and umbrella reviews, that focused on populations living with diabetes (type 1, type 2, or gestational) and reported at least one WHO core oral health outcome. Paired reviewers screened studies, extracted data, and assessed methodological quality using AMSTAR 2. A thematic map categorised interventions based on WHO-defined core oral health outcomes (periodontitis, dental caries, tooth loss, and oral cancer). Network maps were developed at three levels of action (patient, population, and policymaker), and the findings were stratified by World Bank income classification (2024-2025).

Results: A total of 3527 records were identified. After screening titles and abstracts and assessing 107 full texts, 76 reviews were included (62 systematic reviews, seven umbrella reviews, six network meta-analyses, and one meta-epidemiological study), with the majority originating from high-income countries (54.5%). Most interventions were conducted in clinical settings (n = 50), followed by community (n = 14) and institutional settings (n = 12). Follow-up periods ranged from two weeks to 20 years. At the patient level, interventions predominantly focused on non-surgical periodontal therapy and scaling and root planing (71 studies, 89.0%), often combined with adjunctive antimicrobial or anti-inflammatory therapies (39 studies, 51.3%), and oral hygiene or lifestyle education (25 studies, 32.9%). Population-level strategies were less frequently reported and included community oral health education, fluoride-based prevention, and primary care integration (26 studies, 34.2%). Policymaker-level evidence was limited (one study, 1.3%), emphasising the integration of periodontal care into diabetes management pathways and interdisciplinary healthcare models. The studies from low- and lower-middle income countries were underrepresented (9 of 44 countries, 20.5%).

Conclusions: Despite growing evidence, gaps persist in population-level and policy-oriented interventions, particularly within primary care and in low- and lower-middle-income country contexts. Future priorities include integrating oral health into diabetes care pathways, strengthening interdisciplinary care models, and expanding preventive strategies in low- and middle-income countries.