Barriers to and facilitators of access to geriatric oral healthcare in India: an ontological analysis

Oral health is a fundamental yet frequently neglected component of supportive and palliative care for older adults, directly influencing comfort, nutrition, and communication. Despite this, geriatric oral healthcare (GOHC) remains fragmented and poorly integrated into palliative care systems, especially in low- and middle-income countries such as India. This study applies an ontology-based approach to systematically examine barriers to and facilitators of access to GOHC and to identify neglected pathways relevant to supportive and palliative care. An ontology encompassing eight interrelated dimensions of access to GOHC was developed. A structured synthesis of peer-reviewed literature indexed in Scopus and PubMed was undertaken, and 100 eligible articles were mapped onto the ontology. Monad and theme maps were generated to assess patterns of research emphasis and gaps. The findings indicate a strong research focus on financial and temporal barriers to physical access and on dentist-led preventive care for edentulism and dental caries. In contrast, promotive, rehabilitative, and palliative oral healthcare, virtual and home-based care models, non-dental and community-based providers, and conditions highly relevant to palliative care, including oral cancer and symptom-focused oral management, are substantially underrepresented. The ontology highlights critical misalignment between current research and the oral health needs of ageing populations requiring supportive and palliative care and provides a framework to guide integrated and equitable oral healthcare strategies.