Financial Burden in Dental Care: Global Determinants, Policy Interventions and Access Inequities-A Scoping Review.

Abstract

Objective: Access to dental care is often limited by financial, structural and social factors, contributing to persistent oral health inequalities globally. This scoping review systematically maps and synthesizes how financial pressures influence access, service utilization and oral health outcomes, particularly among underserved and vulnerable populations.

Methods: Following PRISMA-ScR guidelines, 73 peer-reviewed studies published between 2004 and 2024 were included. The included studies spanned high-income countries (the USA, Canada, Japan, South Korea and Australia) and low- and middle-income countries (Iran, Tanzania, Uganda, Lesotho and Pakistan). Key outcomes were out-of-pocket expenditures, catastrophic health expenditure, delayed or foregone care, unmet needs, insurance gaps and utilization patterns.

Results: Study populations included adults, children, older adults and vulnerable groups such as racial and ethnic minorities and individuals with special needs. Between 17% and 63% of participants reported delaying or foregoing dental care due to cost, reflecting variation across populations and study contexts. Structural barriers, such as transportation limitations, provider shortages and clinic accessibility, further restrict care in low-resource areas. Social and cultural factors, such as discrimination, language barriers and mistrust, also reduced care-seeking among marginalized groups. These findings indicate the need for policies that address both financial and non-financial barriers to dental care.

Conclusions: Reducing financial barriers requires more than expanding coverage alone. Policies should aim to provide comprehensive benefits, affordable essential services, adequate provider availability and strategies that address structural and social barriers to promote equitable oral health outcomes.