Integration of Oral Health Into Primary Care and Public Health Systems: A Systematic Review of Strategies, Outcomes, and Sustainability Determinants.

Abstract

Objectives: To evaluate the effectiveness and implementation of integrated oral health services within primary care and other health system settings.

Methods: A systematic review of electronic databases was conducted. Studies evaluating the integration of oral health services into primary care or related settings were eligible, including comparative and implementation studies of preventive interventions, screening, counseling, fluoride varnish delivery, referral pathways, and integrated care models. Risk of bias and methodological quality were assessed using design-appropriate tools. Where outcomes were sufficiently comparable, random-effects meta-analysis was performed, with pooled estimates reported as risk ratios (RR), hazard ratios (HR), or standardized mean differences (SMD) with 95% confidence intervals (CI).

Results: Twenty-seven studies met the inclusion criteria, including randomized trials, cohort studies, implementation evaluations, qualitative studies, and economic analyses. Integrated preventive oral health interventions were associated with reduced caries incidence (pooled RR/HR 0.19, 95% CI 0.09-0.43; two studies) and lower caries burden in children (pooled SMD -0.45, 95% CI -0.54 to -0.36; two studies). Several studies also reported improved delivery of preventive oral health services in primary care. Heterogeneity in study designs and outcome reporting limited quantitative synthesis.

Conclusions: Integration of preventive oral health services into primary care appears feasible and may improve oral health outcomes and service delivery. However, heterogeneity and the small number of studies contributing to pooled estimates limit confidence in the findings. Further well-designed controlled studies using standardized outcome measures are needed.

Trial registration: PROSPERO: CRD420251239041.