Understanding underutilization of oral health care in high-income countries: a scoping review

Aim<br/>Underutilization of oral healthcare can exacerbate health disparities by allowing preventable oral health problems to go untreated. This scoping review provides an overview of underutilization of oral healthcare, aiming to provide insight into populations at risk for underutilization and which individual and systemic barriers contribute.<br/><br/>Subject and Methods<br/>Searches were conducted in PubMed and Embase, focusing on studies published between 2018–2025 in high-income countries and populations aged 0–65 years. Studies addressing underutilization of oral healthcare were considered for inclusion.<br/><br/>Results<br/>Seventy-nine studies were included. Populations at risk for underutilization included individuals with chronic illnesses, rural residents, migrants, children, pregnant women and ethnic minorities. Individual barriers included financial constraints, low health literacy, dental anxiety, and competing health priorities, while systemic barriers to utilization of oral healthcare involved high treatment costs, lack of insurance, limited provider availability, and discrimination. Overarching determinants of underutilization commonly included low income, lack of education, and rural residence.<br/><br/>Conclusions<br/>Underutilization of oral healthcare is rarely driven by a single individual or systemic factor but instead results from a combination of multiple barriers. Financial constraints, low health literacy, and dental anxiety often intersect with systemic challenges such as lack of insurance and provider shortages. Addressing underutilization requires targeted, multi-level interventions that consider both individual and structural determinants to improve access to oral healthcare.