Oral Health Literacy and Persistent Oral Health Inequalities in Older Adults: A Conceptual Model

Background: Oral health inequalities in older adults persist despite the availability of effective preventive and clinical interventions, representing a significant public health challenge in ageing societies. Objective: This narrative review examines how oral health literacy (OHL) and structural barriers interact to sustain these inequalities and proposes a conceptual framework to guide future research and intervention design. Methods: A narrative synthesis of peer-reviewed literature and authoritative policy documents published between January 2015 and October 2025 was conducted across PubMed, Scopus, Web of Science and Google Scholar. Older foundational studies were included where conceptually relevant. Findings were organised thematically into three categories: oral health literacy, structural barriers and their interaction within a social–ecological framework. Results: Low OHL constrains self-care capacity, symptom recognition and navigation of dental and medical systems. Structural barriers including inadequate insurance coverage, workforce shortages, geographic inaccessibility and fragmented care models restrict access independently of individual knowledge or motivation. The two factors interact in a mutually reinforcing manner: low OHL amplifies the impact of structural constraints, while structural exclusion suppresses OHL development. This dynamic sustains a cycle of unmet need, preventable disease, systemic health complications and reduced quality of life. Promising intervention strategies include integration of oral health into primary and long-term care, teledentistry, targeted literacy programmes, and policy reform expanding dental insurance coverage. Conclusions: Reversing oral health inequalities in older adults requires a shift from reactive, treatment-centred models toward proactive, integrated, and equity-oriented approaches that address individual capacity and structural conditions simultaneously.