Every bite counts to achieve oral health: a scoping review on diet and oral health preventive practices

Abstract

Objective

To examine the landscape of preventive strategies and interventions directed to achieve oral health equity, with particular emphasis on the interplay between dental caries prevention, individual behaviors, and population-level strategies across various demographic and geographic regions.

Methods

This scoping review was guided by Peters et al.’s framework, which incorporates four key concepts aimed at reducing caries: education for individuals and healthcare providers, behavioral modifications, addressing broader social determinants of health, and extending oral health education programs beyond traditional dental settings. A systematic search was conducted across five databases, from 2011 to 2022.

Results

This review identified 107 studies highlighting three main themes: behavioral practices (N = 33), which focused on reducing the prevalence of caries, improving oral hygiene practices, and enhancing overall oral health knowledge; educational interventions (N = 39), which explored strategies to integrate oral health with broader public health initiatives; and dietary interventions (N = 35), which emphasized the critical relationship between diet and oral health.

Conclusion

This SR highlights the critical need for comprehensive multilevel approaches that address the complex interplay between nutrition, oral health, and sociodemographic factors, while emphasizing the critical relationship between societal factors and individual health behaviors. Multifaceted interventions that include behavioral change, education, and dietary modifications are crucial for improving oral and overall health outcomes across diverse populations. Comprehensive strategies should prioritize medical-dental integration and data-driven approaches to effectively reduce oral health disparities for vulnerable populations, promoting long-term health equity.

Introduction

Oral health is a frequently overlooked yet essential aspect of overall well-being. Described as a “silent epidemic,” poor oral health impacts nearly 4 billion people worldwide, resulting in substantial economic losses [1,2,3,4,5,6,7,8]. In the United States (U.S.), oral diseases, including both inflammatory and degenerative conditions, lead to an annual financial impact of approximately $136 billion, emphasizing the urgency of integrating oral health into broader health policy frameworks and enhancing accessible, cost-effective preventive measures, particularly among children, older adults, and underserved populations [1,2,3,4,5,6,7,8,9,10,11,12]. Oral diseases not only compromise masticatory function, which is essential for proper nutrition and quality of life (QoL), but are associated with increased risk for systemic conditions and noncommunicable chronic diseases (NCDs), such as diabetes and cardiovascular disease [4, 13,14,15,16,17,18,19]. Such systemic manifestations, often heightened by dietary deficiencies, further complicate the burden of oral diseases and potentially lead to severe and life-threatening health conditions [8, 12, 20,21,22,23,24].

A key objective for both public and private health entities in the U.S. is the reduction of health disparities, as underscored the 2000 Surgeon General's report, which highlighted oral health as essential to overall well-being and pointed out disparities in dental care access. Later, the 2011 Institute of Medicine (IOM) report acknowledged that efforts to date have been insufficient in eliminating these disparities. Recently, the 2021 NIDCR's “Oral Health in America: Advances and Challenges” report noted the minimal progress made, particularly for the most disadvantaged groups, reaffirming the urgent need for focused action [4, 6, 22, 23, 25, 26]. Whilst the World Health Organization (WHO) champions the concept of health as a holistic state encompassing physical, mental, and social well-being, wherein oral health is recognized as a crucial component [27, 28]. Building on this foundation, the WHO’s “Global Oral Health Action Plan 2023 – 2030” underscores the integration of oral health into overall health strategies [29,30,31]. Additionally, in 2022, the WHO, along with the Food and Agriculture Organization of the United Nations, the World Organization for Animal Health, and the United Nations Environment Programme, forged a collaborative agreement to propel the One Health initiative to the forefront of global health priorities, emphasizing the interconnectedness of human, animal, and environmental health [32]. Concurrently, the United Nations Agenda 2030 introduced the 17 Sustainable Development Goals (SDG) aimed at securing peace, prosperity, and well-being for all by 2030. Notably, SDG 3, which seeks to ensure good health and promote well-being for all ages, implicitly encompasses oral health, despite not targeting it explicitly [30, 33, 34]. Oral health extends beyond the mere condition of one’s teeth, influencing and being influenced by broader social, environmental, and economic factors. These strategic partnerships and action plans highlight the upstream and downstream social determinants of health that impact oral health outcomes, addressing factors from global policy initiatives to individual behaviors, also mirrored in the US where significant socioeconomic impacts and health disparities persist [4, 35].

Good oral health ensures the dignity of performing daily activities without pain or discomfort, which is paramount for maintaining QoL [20, 21, 36,37,38,39,40]. Tooth loss and other oral health problems can directly compromise QoL, dietary intake and nutritional quality, leading to broader health consequences. Most oral diseases are preventable, and factors involved in caries are highly modifiable with the right support [3, 41, 42]. Sustained neglect of oral health not only diminishes QoL, but also poses risks to micronutrient deficiencies and overall systemic health, highlighting the critical need for integrated approaches such as the One Health initiative [12, 24, 30, 32]. The prevailing dental restorative approach proves unfeasible in many regions, especially in low-income countries where over 90% of caries remains untreated, highlighting the urgent need for accessible, affordable, and sustainable oral health solutions [43, 44]. Established links between chronic oral conditions and systemic diseases, including heart disease, diabetes, and neurodegenerative diseases such as Alzheimer’s and related dementias (AD/ADRDs), are likely due to inflammation caused by oral bacteria and occlusal dysfunction [9, 24, 45, 46]. Rethinking oral and planetary health can redefine global oral health strategies by fostering sustainable oral health outcomes, ensuring today's needs for the most vulnerable and underserved are met without compromising future capabilities [30].

Socioeconomic factors and access to care are significant determinants of oral health, with vulnerable groups facing the greatest challenges [4, 25, 47,48,49]. The interplay of oral health with nutrition is pivotal; diets high in sugars and fermentable carbohydrates exacerbate the risk for dental caries and disease. However, dental caries a preventable condition characterized by long duration and slow progression, directly influences food choices and an individual’s ability to eat “chew” a balanced and healthy diet. Individuals often perceive foods rather than individual nutrients, highlighting the need for dietary considerations and modifiable risk factors in oral health promotion [1,2,3,4,5,6,7, 9, 24, 50, 51]. Approximately one in six children aged 6–11 have experienced caries, and a similar proportion of adolescents have untreated cavities, while a significant number of older adults have lost all their teeth due to caries [6, 52]. The impact of caries, tooth loss, and oral function on the ability to follow the Dietary Guidelines for Americans (DGAs) is profound, with poor oral health limiting the intake of more healthful food choices, thereby influencing long-term health outcomes [5, 53]. This scoping review (SR) aims to bridge the gap between oral health and dietary guidelines by examining the landscape of preventive strategies and interventions to achieve oral health equity, with particular attention given to dental caries prevention, diet, and socioeconomic determinants across various demographic and geographic regions.

Methods

We conducted an SR according to the framework described by Peters et al. to identify relevant studies that center efforts on behavioral and educational programs/interventions to support effective preventive oral health practices in reducing caries and cariogenic bacteria [54]. This review has been reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses – Scoping Review extension (PRISMA-ScR).

Eligibility criteria

Inclusion criteria

• Population: Studies including pregnant women, young children, and older adults, with subgroup analysis where applicable;

• Study Design: Cross-sectional, case‒control, cohort, and interventional studies, including randomized controlled trials and systematic reviews;

• Impact on Health: Studies reporting a clear, positive impact on individual and/or population-level oral health outcomes, behaviors, or health promotion with a focus on health equity.

• Relevance to DGAs: Evidence that can inform DGAs with actionable recommendations to address preventable oral diseases.

• Equity Focus: Research focused on health disparities and social determinants of health.

• Language and Publication Date: English-language articles published between 2011 and 2022.

Exclusion criteria

• Language Barriers: Non-English articles.

• Publication Type: Case reports/series, opinions, commentaries, editorials, abstracts, and other non-peer-reviewed materials.

• Irrelevant Results: Studies reporting nonsignificant findings that are not relevant to the research question or those with inadequate or small sample sizes.

• Methodological issues: Articles with reported methodological flaws.

• Generalizability: Studies with results that cannot be generalized to broader populations.

• Accessibility and Sustainability: Studies involving interventions or technologies (excluding mobile phones) are not feasible for implementation among marginalized or low socioeconomic communities (e.g., expensive dental equipment).

Search strategy and data abstraction

An electronic database search of the literature was conducted on October 7, 2022, by a librarian (CW). The search was developed in PubMed (National Library of Medicine) using controlled vocabulary and keywords for four concepts (Table 1). The searches were translated into four other databases using database-specific controlled vocabulary and keyword adjustments—Embase (Elsevier), Dentistry and Oral Sciences Source (EBSCO), ERIC (EBSCO), and the Cochrane Central Register of Trials (Wiley). (Appendix. 1) Results were deduplicated in EndNote before being screened for eligibility in Covidence. The SR was conducted by a team comprising six independent reviewers: Mona Alhassan (MA), Alhassan Hameedaldeen (AH), Adam Yang (AY), Shivangi Kaplish (SK), Steffany Chamut (SC), and Tejasvita Chandel (TJ). The preliminary screening of titles and abstracts to determine the articles’ eligibility for comprehensive review was performed by MA and AH. Once an agreement was reached on which abstracts and studies were suitable for full-text review, MA, AH, AY, and SK proceeded to evaluate the full texts according to the predefined eligibility criteria. In instances of discord, SC reviewed the abstracts and full text in each stage to reach a consensus [55]. An adapted Population, Intervention, Comparator/s, and Outcomes (PICO) framework was used to carry out the data extraction strategy and charting for this SR. MA, AH, AY, and SK generated the data from the chosen articles. TJ conducted a random verification of 10% of the collated data to confirm its precision. SC and TJ, who organized the information by author, publication year, country, type of publication, outcomes of the program, and key results, evaluated the full-text data according to the eligibility criteria and primary concepts (Tables 2, 3 and 4).

Table 1 Key concepts guiding the search strategy for oral health impacting lifetime outcomes and caries reduction

Results

A. Overview of included studies

The PRISMA flowchart illustrates the process of this SR, which initially identified a total of 9,114 articles through electronic databases, and after removing 1,129 duplicates, 1,940 articles remained for screening for full-text review (Fig. 1, Tables 2, 3 and 4). A total of 1,833 articles did not meet the inclusion criteria and were excluded. A total of 107 articles published between 2011 and 2022 were selected and included in the SR. The studies originated from Asia (N = 54), Europe (N = 24), North America (N = 10), South America (N = 7), Africa (N = 5), Oceania (N = 4), and others with multiple locations (N = 3). Most of the articles (N = 36) were cross-sectional studies, with a sample size range of 116–99,07. The remaining studies were case‒control studies (N = 10); cohort studies (N = 3); clinical trials (N = 5); cluster randomized studies (N = 1); comparative studies (N = 1); cost-effectiveness analyses (N = 1); descriptive epidemiological studies (N = 1); interventional studies (N = 4); literature reviews (N = 1); mixed methods investigations (N = 1); narratives (N = 1); pilot programs (N = 1); prospective cohort studies (N = 1); prospective observational studies (N = 1); quasirandomized field studies (N = 1); quasi-experimental studies (N = 2); reviews (N = 7); randomized controlled trials (N = 17); randomized controlled trials (N = 1); randomized cluster trials (N = 1); and systematic reviews (N = 10).

Fig. 1

PRISMA Diagram

B. Types/themes of effective interventions

Tables 2, 3 and 4 describes the included articles that are categorized under the themes of effective interventions with the primary objective of addressing various facets of oral health, with a particular emphasis on reducing the prevalence of caries, enhancing oral hygiene practices, and enhancing overall oral health knowledge among the target populations. 1) Behavioral practices (N = 33; Table 2); 2) educational intervention (N = 39; Table 3); 3) dietary best practices (N = 28; Table 4), including sugar-free gums (SFGs) (N = 7; Table 4).

Table 2 Behavioral interventions

Table 3 Educational interventions

Table 4 Dietary interventions

Behavioral interventions were investigated in 33 studies (Table 2) [56,57,58,59,60,61,62,63,64,65,66,67,68,69,70,71,72,73,74,75,76,77,78,79,80,81,82,83,84,85,86]. Overall, these studies revealed various strategies implemented across diverse demographics and geographies. These interventions were primarily focused on reducing the prevalence of caries, improving oral hygiene practices, and enhancing overall dental health knowledge [56,57,58,59,60,61,62,63,64,65,66,67,68,69,70,71,72,73,74,75,76,77,78,79,80,81,82,83,84,85,86]. Studies in Tonga and Thailand revealed that school-based fluoride mouth-rinsing programs significantly improved children’s oral health, with long-term participants showing fewer caries lesions [64, 65]. A family-centered oral health intervention targeting new parents significantly enhanced feeding and toothbrushing practices, reducing toddlers’ risk of caries [66]. Additionally, motivational interviewing within healthcare environments has proven to be a successful strategy for preventing caries in children from lower-income families [76]. Oral health education in urban schools plays a pivotal role in recognizing key factors such as brushing duration and the oral hygiene index as critical predictors of caries [70]. Gao and Jain highlighted the importance of identifying key risk factors for early childhood caries (ECC) to prevent the progression of this condition [80, 81].

Educational interventions. Education interventions were a prominent focus in our SR, with 39 studies exploring their effects by highlighting a variety of effective strategies that have improved oral health outcomes [87,88,89,90,91,92,93,94,95,96,97,98,99,100,101,102,103,104,105,106,107,108,109,110,111,112,113,114,115,116,117,118,119,120,121,122,123,124]. These strategies target different groups, from caregivers and parents to schoolchildren and teenagers. We observed that interventions involving oral hygiene training and engaging in healthy oral hygiene practices resulted in a notably lower incidence of caries [114, 120]. Similarly, a positive correlation was found between the mother’s level of education and the frequency of her children’s dental visits and tooth brushing [93, 102, 122, 123]. The outcomes include improved oral hygiene practices, reduced caries progression, and better oral health-related QoL. Moreover, articles mentioned that the effectiveness of oral health education programs is influenced by factors such as the source of education, frequency of dental flossing, parental encouragement, and maternal education level. Targeted interventions, especially those involving caretakers and parents, have shown long-term benefits in reducing caries and improving oral health [89, 116, 125].

Dietary interventions described in 35 reported that unhealthy dietary behaviors increase the prevalence of caries, revealing significant insights into the relationship between diet and oral health [126,127,128,129,130,131,132,133,134,135,136,137,138,139,140,141,142,143,144,145,146,147,148,149,150,151,152,153,154,155,156,157,158,159,160]. Out of the 35 studies, 7 reported that oral health-related knowledge and awareness of sugar-free gum (SFG) are low, but its consumption is associated with a lower incidence of caries [154,155,156,157,158,159,160]. It was also found that feeding methods contribute substantially to caries risk during early deciduous dentition stages, while sugary habits become more influential in later stages [126]. Additionally, frequent consumption of sweet snacks was associated with a greater incidence of caries, even among individuals with otherwise healthy oral habits [127]. Notably, fluoridated water was shown to provide superior protection against caries compared to fluoridated household salt in schoolchildren from developing countries [128]. Jaghasi reported that comprehensive educational programs emphasizing dietary patterns and oral health relationships are crucial for children and their guardians [131], while Davis reported that a balanced diet, including the consumption of vegetables, can mitigate the adverse effects of sugary food intake [132]. High caries prevalence and related risk factors, such as low maternal education and inappropriate oral health behavior, were observed among kindergarten children [133]. Maternal xylitol consumption demonstrated promising preventive effects on salivary mutans streptococci and caries levels in children, while xylitol gum and erythritol showed potential for reducing caries-related factors [134,135,136,137]. In low- and middle-income countries, socioeconomic status, education, high sugar consumption, and low maternal education were identified as risk factors for caries, emphasizing the importance of oral health education and limiting sugar intake [139, 155]. Unhealthy dietary behaviors, such as frequent intake of carbonated drinks and confectionery, were linked to an increased incidence of caries [140,141,142,143,144,145,146,147, 159].

Discussion

Metabolic and systemic diseases, such as diabetes and cardiovascular disorders, are major contributors to mortality and disability in the U.S. and are significantly influenced by dietary habits [161, 162]. The critical role of the mouth in food intake, digestion, and neurostimulation underscores the importance of oral health. Compromised oral health, as evidenced by caries and tooth loss, can disrupt vital functions of daily living, leading to a preference for softer, carbohydrate-rich, and nutritionally inadequate foods. These dietary shifts can heighten the risk of broader health complications and potentially exacerbate metabolic and systemic disorders [161, 163].

This SR emerges from the urgent need to address the silent epidemic of oral diseases and provides an expansive view of how preventive oral health practices can be integrated into DGAs, with a particular focus on health equity and noninvasive evidence-based interventions. This SR explores the complex effects of behavioral, educational, and dietary interventions and synthesizes evidence from numerous studies informing policies that can pivot the nation toward better oral and systemic health. Most people cannot afford to see a dentist due to cost, and current dental financing mechanisms do not meet the needs of the U.S. population equitably [36, 164,165,166,167]. However, there is an opportunity for collaboration among other healthcare professionals to promote oral health. Registered dietitians can play a pivotal role in promoting oral health by utilizing DGAs as guidance. Their expertise in nutrition can complement dental care efforts, fostering interprofessional teamwork and expanding access to preventive care, thus promoting oral health equity. Our findings highlight the critical link between diet and oral health, reinforcing the American Dental Association’s recommendations on regular dental care, increasing fluoride use, and, when snacking, giving preference to selecting nutritious snacks and reduced sugar, as advised by the DGAs [53, 148, 168, 169].

This SR underscores the effectiveness of a comprehensive approach to improving oral health and preventing diseases such as caries, which may also reduce the risk of NCDs and enhance broader health promotion initiatives. Substantiated by data from the Centers for Disease Control and Prevention (CDC), the National Health and Nutrition Examination Survey (NHANES), and Healthy People 2030, our findings emphasize the direct effects of dietary choices, particularly high and frequent sugar intake, on caries and its broader implications for social determinants of health (SDOH) [4, 41, 161, 170,171,172]. In line with national health initiatives such as the National Plan to Address Alzheimer's Disease (NAPA) by the US Health and Human Services (HHS), our findings highlight the critical role of comprehensive oral health approaches in addressing not only caries but also the prevention and management of NCDs [11]. Such alignment has the potential to not only improve oral health but also contribute to “accelerate action to promote healthy aging and reduce risk factors for AD/ADRD”, a goal that the NAPA and similar initiatives aim to achieve through their multifaceted public health strategies [173].

Behavioral interventions for preventing caries and improving oral health

Behavioral interventions and modification strategies have emerged as essential strategies for mitigating the public health challenge of reducing the prevalence of caries and enhancing overall oral health (Fig. 2) [174].

Fig. 2

Essential components of nonrestorative and non-invasive management of caries

Impact of regular oral hygiene on oral health

The foundation of behavioral interventions lies in regular dental hygiene practices, such as toothbrushing and flossing, and regular access to fluoride sources [52]. Numerous studies have consistently shown their positive impact on reducing the prevalence of caries and improving oral health. Research has consistently highlighted the positive impact of these practices on oral health. Notably, interdental cleaning devices are associated with decreased oral disease incidence and fewer missing teeth. Effective brushing habits correlate with reduced cariogenic bacteria and lower caries incidence, emphasizing the need to modify daily oral hygiene behaviors to achieve substantial benefits in oral health [62, 175]. Programs focusing on early interventions, such as supervised toothbrushing initiatives, are critical and have proven to be valuable preventive techniques, especially for young children. For example, the “National Supervised Toothbrushing Program” in Scotland illustrates the effectiveness and substantial benefits of such early intervention, emphasizing the value of advocacy in instilling good oral hygiene habits from a young age [175].

Integrating oral health education across settings

A parent/child approach that integrates nutrition and oral health education underscores the need for comprehensive, family-oriented initiatives to ensure the continuity and effectiveness of oral health practices [84]. School-based interventions have also shown a positive impact, especially among schoolchildren, in fostering proper oral hygiene practices, indicating their potential to significantly enhance oral health outcomes when implemented within the educational system [66, 67]. Research consistently indicates that motivational interviewing is particularly impactful for adolescents and members of lower-income families, showcasing its potential as a powerful catalyst for change [76,77,78] (Fig. 3).

Fig. 3

Educational interventions for oral health

Reinforcing oral health through positive parenting and fluoridation

In line with the above interventions, positive parenting practices, such as engagement, encouragement, and problem solving, are fundamental for reducing the prevalence of childhood caries [75, 86]. For instance, learning the distinct patterns of risk factors associated with ECC, as identified in our study, enables parents and caregivers to tailor their approaches to better suit their children’s specific needs, thus enhancing the effectiveness of preventive measures and ultimately leading to a significant decrease in the incidence of ECC [80, 81]. Such practices not only benefit the immediate oral health of children but also contribute to establishing lifelong healthful habits.

Our review is consistent with the thrust of behavioral modification for sustained oral health and supports the daily use of high-fluoride products in conjunction with standard toothpaste, particularly for high-risk older children and adults, which is not advised in young children due to fluorosis concerns. This recommendation aligns with the broader theme of comprehensive behavior modification and is supported by studies such as Sonbul et al. (2011), which validate the effectiveness of high-fluoride products in enhancing and sustaining oral health [82]. Furthermore, while advocating for the integration of fluoride-based products as a cornerstone of preventive oral health measures, it is essential to acknowledge existing controversies surrounding fluoridation. Addressing concerns and promoting informed discussions regarding the safety and efficacy of fluoride interventions are paramount. Additionally, ongoing research into alternative clinical solutions that complement or supplement traditional fluoride approaches can offer valuable insights into enhancing oral health outcomes for diverse populations.

Educational interventions for enhanced oral health (Fig. 3)

In addition to established behavioral interventions, educational programs play a pivotal role in oral health promotion. The evidence suggests that interactive and contextually tailored education leads to significant improvements in oral hygiene behaviors, increased utilization of preventive services, and a reduction in the incidence of caries (Fig. 3).

Enhancement of oral hygiene behaviors

Educational interventions have demonstrated their ability to significantly improve oral hygiene behaviors. Studies have consistently shown that individuals who receive oral health education demonstrate better oral hygiene practices than those who do not receive such education. The effectiveness of hands-on demonstrations and integration into school curricula is particularly noteworthy, resulting in improved oral hygiene and a decrease in caries among students. This finding reinforces the value of incorporating oral health education into early learning environments [87, 88, 91].

Innovation in teaching methods

The use of gamified mobile applications and other educational tools for oral health and nutrition has made learning more engaging and effective. Practical demonstrations, animated screenings, and experiential learning have helped individuals better understand the practical aspects of maintaining good oral health through proper nutrition and hygiene practices [93, 111, 176].

School-based and community-level programs

Educational programs that incorporate hands-on demonstrations and are integrated into school curricula are instrumental in fostering better oral hygiene and reducing the incidence of caries. The strategic integration of oral health education within the general health curriculum has emerged as a pivotal approach to enhancing oral health literacy and outcomes (Fig. 3). Additionally, school-based and community-level programs are vital forums for the widespread dissemination of oral health and nutrition education. Often, these initiatives are geared toward promoting healthy eating habits and understanding the nutritional value of foods. By embedding effective oral hygiene education and practices within a comprehensive health framework, these programs highlight the interdependence of good oral health and overall health and nutrition. Acknowledging that optimal nutrition can be compromised by poor oral health further accentuates the significance of maintaining oral hygiene as a cornerstone of nutritional and overall well-being. Involving schoolteachers as health educators who regularly promote healthy dietary and oral health habits and practices within standard school curricula is key to providing extensive health education, offering substantial benefits to both students and the wider community [94, 96, 99, 104, 113, 119].

However, it is essential to recognize the potential challenges faced by schoolteachers when assuming additional responsibilities in health education. Limited time within the curriculum, competing educational priorities, and varying levels of teacher training in oral health and nutrition may pose obstacles to effective implementation. Strategies such as providing specialized training for teachers, integrating oral health and nutrition education into existing subject areas, and collaborating with external healthcare professionals can help mitigate these barriers, ensuring that comprehensive health education remains a priority within school settings. To further bolster these efforts, policy support and incentives are essential. Implementing policies that support the integration of oral health and nutrition education into school curricula, coupled with incentives such as professional development opportunities and recognition for teachers who excel in health education, can effectively motivate and support educators in delivering high-quality health education to students.

Community-level considerations

Effective oral health promotion extends beyond individual practices, connecting broader oral health and nutrition challenges to the overall wellbeing of communities. Health program planners can foster a culture of health by leveraging local resources to advocate for healthy lifestyle choices and spread positive messages about nutrition and oral health, thereby mitigating negative influences and promoting healthy habits within the community [89, 103, 108, 120] (Fig. 3). Recognizing that people spend a significant amount of time in settings such as preschools, long-term care facilities, churches, and programs such as the Head Start and Special Supplemental Nutrition Program for Women, Infants, & Children (WIC), integrating oral health and nutrition education into these community-based settings can have a profound and lasting impact on improving oral and overall health outcomes and well-being for children and adults.

Family-centered education

Targeting the family unit, particularly caregivers and parents, is essential for the prevention of ECC [177]. Education targeting families acknowledges the critical role that parents play in shaping their children's oral health routines, emphasizing how educational attainment correlates with health outcomes. Research has highlighted the nexus between a mother’s education level, the frequency of her child’s dental visits, and her tooth brushing habits, underscoring the influence of socioeconomic status on oral health practices [122, 123] (Fig. 3).

The role of diet in caries prevention and oral health enhancement (Fig. 4)

Fig. 4

Key dietary and behavioral factors influencing oral health outcomes

In addition to behavioral and educational measures, dietary strategies are crucial for preventing caries and enhancing overall oral health. By improving nutritional intake and reducing sugar consumption, these interventions not only lower the incidence of caries but also promote broader oral wellness [161].

Beyond dietary interventions

Effective oral health promotion involves more than just reducing sugar and fermentable carbohydrate intake. The incorporation of nutritious alternatives such as high-quality proteins and vitamins (i.e. A, B, and C) and other micronutrients, which significantly improve oral health outcomes, is needed to reduce chronic inflammation and the burden of oral diseases [12]. Public health policies must emphasize comprehensive dietary improvements, not just reducing sugar consumption. Recent studies, demonstrate the significant impact of taste preferences, age, oral microbiota, and use of dental prostheses on dietary choices, which in turn influence oral health behaviors and outcomes, underscoring the need for integrated strategies that consider both taste perception and nutritional education in oral health promotion and identify populations at risk [24, 178,179,180].

By increasing public awareness of the harmful effects of frequent sugar intake and promoting a balanced diet, these policies can broaden the scope of oral disease prevention strategies and enhance overall oral health [134, 149, 181].

Sugar-free gum (SFG)

The role of SFG, particularly that containing xylitol, in caries prevention is well documented. The regular use of SFG contributes significantly to reducing caries risk by stimulating saliva flow, which neutralizes acids produced by bacteria in biofilms (plaques), helps to remineralize tooth enamel, and aids in managing and improving oral health outcomes [138, 142, 155]. Studies suggest that maternal use of SFGs can effectively reduce caries risk in mothers and their children older than 4 years [138, 142, 182]. This preventive dietary ally, though not a source of nutrition, can serve as an adjunct to good dietary practices. Its cost-effectiveness suggests the potential for broader public health applications with potential national savings on dental care costs. Thus, consideration should be given to how various public health and nutrition assistance programs can promote SFG use, emphasizing its role as a supplement to a balanced healthy diet and oral care practices [145, 155]. One potential avenue could be to make SFG available at schools or in vending machines alongside soda and chips or to provide it to students for free, similar to feminine hygiene or birth control products; however, further studies are necessary to implement such a recommendation effectively.

Breastfeeding and early dietary effects

While breastfeeding offers numerous health benefits, its relationship with caries, especially prolonged breastfeeding, is complex. It is essential to maintain good oral hygiene practices for children breastfed beyond one year to mitigate caries risk and ECC. This underscores the need for comprehensive recommendations from healthcare providers for reducing nocturnal breastfeeding, and cleaning “wipes” the child’s mouth after feeding is vital for balancing the benefits of breastfeeding with oral health [133, 139].

Diet quality and oral health

A high-quality diet rich in dairy, proteins, fruits, and vegetables can protect against caries. The Healthy Eating Index (HEI) shows an inverse relationship with ECC risk, suggesting that dietary patterns are more indicative of oral health outcomes than individual nutrients [131, 132, 183]. Post-sugary meal practices, such as consuming dairy or xylitol gum, can further reduce caries risk. On the other hand, combining sugar with starch or having a dietary pattern high in desserts and crackers would intensify the cariogenic effect [132, 134, 138, 151].

Social determinants of health and dietary choices

Access to a healthy diet and fluoridated water, which are crucial for caries prevention, is significantly influenced by social determinants of health (SDOHs), which also shape health behaviors [184, 185]. Our review strongly supports the effectiveness of community water fluoridation, as seen in Australia's National Oral Health Plan, and advocates for its broader implementation to help prevent caries [129, 130]. Economic barriers, however, often make sugary foods and starches more accessible, challenging healthy dietary choices [186]. Added sugar consumption is notably affected by factors such as socioeconomic status, household dietary habits, the locality of sugar sources, and peer influences [187]. Policies aimed at limiting sugary food consumption and enhancing fluoridation access are vital for reducing oral health disparities [129, 130, 133, 139, 148, 183]. Additionally, ensuring access to affordable, nutritious food is crucial, particularly in underserved communities. Educational strategies should provide practical guidance on budget-friendly, healthy food choices and must consider the cultural relevance of dietary recommendations to effectively promote long-term dietary changes and enhance oral health [139, 187].

Implications for practice and policy

Proper advocacy and implementation of these solutions and strategies within the DGAs framework can address some of the underlying upstream factors contributing to social gradients in oral diseases, thus, significantly contributing to equitable health outcomes and reducing the strain on the national healthcare system [188]. We recommend that policymakers integrate these evidence-based strategies into public health policies to address oral health disparities and lessen the overall healthcare burden [172] (Figs. 5, 6). Effective public health strategies should not only aim to improve food security and promote healthy eating, but also ensure access to oral health education, literacy, and services for all groups, particularly high-risk groups (Fig. 6). Collaborative efforts among dietitians, allied health professionals, dental-behavioral-mental health experts, and policymakers, especially those representing underrepresented minorities, are essential to developing and implementing comprehensive oral-nutrition guidelines, thereby preventing metabolic and systemic disorders and easing healthcare burdens [189].

Fig. 5

Integrating diet and oral health-A framework for preventive practices

Fig. 6

Health literacy environment

Targeting oral-nutrition public health initiatives is crucial for preventing not only caries, but also enhancing quality-adjusted life years (QALYs) and reducing disability-adjusted life years (DALYs) [190,191,192,193]. Unfortunately, oral health continues to be overlooked within the current healthcare and policy frameworks [23]. In light of recognizing quality healthcare as a fundamental human right, [194] and in alignment with the WHO Global Oral Health Action Plan, it is imperative to fully integrate oral health within the healthcare system to achieve comprehensive systemic, planetary, and One Health outcomes [30]. Oral health is as critical as any other aspect of healthcare; and systemic health cannot be fully realized without incorporating oral health into the equations for healthy eating habits and healthcare management [44, 195]. Considering socioeconomic and cultural contexts, local authorities can raise awareness of how eating habits influence oral health and the broader spectrum of NCDs. By integrating public health campaigns and regulatory measures tailored to the unique demographic and geographic variations in oral health practices and resources, authorities can ensure effective and inclusive health promotion strategies [195].

Strengths and limitations

While this scoping review aimed for comprehensive coverage, the literature search may not have been exhaustive, possibly omitting relevant studies. The included literature encompassed articles focusing on equity principles, health disparities, and SDOH because we aimed to identify and highlight cost-effective, accessible strategies that benefit the broader population, especially those with constrained resources. The focus on equity and inclusivity may have introduced biases or overlooked certain articles. These limitations underscore areas for future research efforts. The review process itself is subject to potential selection biases and the heterogeneity of study designs, cautioning against overinterpretation of findings and suggesting methodological improvements for future studies. Inconsistencies in research data comparability further challenge conclusive interpretations, calling for methodological advancements in data collection and analysis. Despite these limitations, this review lays a foundation for future studies by highlighting the critical role of dietary choices in achieving equitable oral and overall health. Further research is warranted to explore the long-term effects of interventions across diverse populations, including those with varying socioeconomic backgrounds and access to dental care. Our findings can inform targeted interventions and policy changes to improve oral health outcomes and guide future research directions. The SR’s commitment to transparency through comprehensive documentation enhances the integrity and utility of its conclusions. Moving forward, long-term studies and randomized controlled trials are needed to elucidate the mechanisms and effectiveness of interventions, such as sugar-free gum, and to develop tailored oral health promotion programs adaptable to individual needs and contexts.

Conclusion

Effective management of oral health is essential for promoting long-term health equity. This scoping review emphasizes the importance of an integrated approach that includes behavior change, education, and dietary modifications for optimal oral and overall health outcomes. The strategic use of sugar-free chewing gum, such as those containing xylitol, offers a practical and cost-effective alternative to traditional oral hygiene and dietary practices, providing protective benefits against caries and potential healthcare savings.

A robust strategy that combines behavior modification, oral-nutrition health literacy enhancement, and targeted dietary practices, especially in reducing sugar consumption, is imperative. This tripartite approach, which emphasizes personal habits, informed choices, and consumption, serves as the cornerstone for preventing caries and promoting general-systemic health while reducing healthcare expenditures. Integrating educational enhancement, behavioral change, nutritional management, and dietary regulation, particularly in managing sugar intake, forms the foundation for improving oral health. Incorporating oral health recommendations within the DGAs highlights the critical relationship between societal factors and individual behaviors, holding the potential to enhance QoL and foster sustainable practices that lead to improved health outcomes and positively impact the nation’s economic landscape.

This global-to-local perspective emphasizes the urgent need for integrated, multidisciplinary approaches that consider oral health not just as an isolated issue, but as an integral part of overall health and well-being. These efforts are crucial for both improving global health outcomes and addressing specific challenges within the U.S., ensuring that all individuals have access to the necessary resources and care to maintain optimal oral health. Choosing the right foods not only supports overall health, but also safeguards the wellness of the mouth. Committing to this comprehensive approach not only ensures that optimal oral health becomes an achievable goal for everyone, but also fosters transdisciplinary, multi-level, and cross-sector collaboration essential for promoting equitable health and well-being. This approach contributes to a future where oral health achievements are possible, even in context where dental care is limited, absent, or significant oral health inequalities exist.