Costs in dental care: a scoping review of methodologies and trends

Oral diseases remain among the most widespread non-communicable conditions globally, disproportionately affecting low- and middle-income populations. Despite the substantial and rising financial burden-estimated at US$ 298 billion in 2010-existing cost studies in dentistry often omit indirect costs and lack methodological consistency. These gaps hinder fair reimbursement, cost-effectiveness modeling, and equitable resource allocation. This scoping review aimed to map current methodologies for dental cost estimation, identify how frequently and by what means overhead costs are incorporated, extract standardized unit costs for common procedures, and assess the sources and valuation techniques underpinning these estimates.

Following an a priori protocol registered with the Isfahan University of Medical Sciences Ethics Committee (Approval Code: IR.MUI.

REC.1402.1), we conducted a comprehensive search across six major databases and gray literature sources. Studies were screened using the Participants-Concept-Context (PCC) framework. Eligible studies were original economic evaluations in dentistry that reported detailed cost data. Data extraction was performed using customized charting forms, and all reported costs were standardized to 2024 international dollars (Int'l $) using exchange rates, U.S. Consumer Price Index (CPI) data, and purchasing power parity (PPP) adjustments. Results are reported in accordance with the PRISMA-ScR guidelines.

Out of 31,619 retrieved records, 124 studies met inclusion criteria. Most studies were conducted in urban, high-income settings and reported only direct costs (58.1%), while fewer accounted for overheads (41.9%). Advanced allocation techniques such as Activity-Based Costing (ABC) or Time-Driven ABC (TD-ABC) were used in less than 10% of studies. Bottom-up valuation was the predominant approach (72.5%). Unit costs for frequently reported procedures showed wide variation (e.g., surgical tooth removal: Int'l $6-501), driven by methodological and contextual heterogeneity.

Despite increasing interest in dental cost estimation, major gaps remain-especially in rural settings, overhead cost inclusion, and methodological transparency. Standardizing costing frameworks, piloting ABC/TD-ABC in real-world settings, and developing open-access dental cost repositories could substantially improve future economic evaluations and reimbursement equity. This review offers a comparative foundation for dentists, researchers, and policymakers to support value-based oral health planning.