Oral Health Interventions to Improve Access in Rural Areas of High-Income Countries: A Mixed Methods Systematic Review

Abstract

Objectives: The aim of this mixed methods systematic review was to identify oral health interventions in rural areas of high-income countries and synthesise the evidence on how access is addressed. Methods: Searches were conducted in Cochrane, CINAHL, Dentistry and Oral Sciences Source, PsycINFO and PubMed, with the last search in January–February 2025. All study types published in English since 2000 were included that reported oral health interventions aimed at addressing access to dental services. The Mixed Methods Appraisal Tool was used to assess study quality. The Penchansky and Thomas model of access, with Saurman's adaptation, guided the thematic synthesis. Results: The final dataset was 73 articles. Most authors reported small-scale interventions delivered by dental and primary health providers. Fluoride varnish application, treatments and health promotion were most reported in clinics, community settings and schools. Lack of service availability and accessibility caused by geographic distance required alternative service models, including telehealth. Free or minimal cost interventions were needed in low-income settings. Stakeholder partnerships and understanding of local context were critical. Evaluations of community acceptability and awareness were rare. There was a dearth of studies addressing the six dimensions of access, with wide variation in study quality. Conclusions: There is an absence of robust, well evaluated studies, with lack of homogeneity preventing meta-analysis. Rural oral health interventions should be informed by comprehensive frameworks of access, be grounded in equity, involve communities in design, development and evaluation, should reduce silos between oral and general healthcare, and should prioritise prevention. Access to high quality oral health is a fundamental human rights and equity issue for rural people.