Sustainability of Oral Healthcare Services: A Mapping Review

Environmental sustainability is increasingly recognized as a key component of healthcare governance, and dentistry represents a high-impact subsector due to its intensive use of materials, resources, and biosafety-driven disposables. Despite rising scientific interest, available evidence remains fragmented and methodologically heterogeneous. This study aims to systematically map the existing review-based evidence on sustainability in oral healthcare services.

The protocol was prospectively registered on OSF. Narrative, scoping, and systematic reviews evaluating sustainability within oral healthcare services were eligible. Comprehensive searches were conducted in Embase, PubMed/MEDLINE, Scopus, Web of Science, LILACS, Cochrane Library, and regional databases (WPRIM, WHOLIS, BBO, BDENF, IBECS, PIE, ColecionaSUS), without language or date restrictions. Two reviewers independently screened studies via Rayyan, resolved discrepancies by consensus, and extracted descriptive and thematic data using a structured Population-Concept-Context eligibility framework. A qualitative inductive synthesis identified recurring domains, and methodological rigor was appraised with a modified 12-item AMSTAR-2 tool.

Of 5793 records retrieved, 17 reviews met inclusion criteria (8 narrative, 5 scoping, 4 systematic). Most publications (82.4%) were from the past five years. Three thematic axes were identified: (1) the 4Rs (rethink, reduce, recycle, reuse); (2) waste and effluent management; and (3) barriers, practices, and sustainability policies. Evidence was strongly concentrated in high-income countries, and methodological quality varied widely, with ten reviews scoring below 60% on AMSTAR-2.

Review-based evidence on sustainable dentistry is expanding yet remains limited and operational in focus. The literature remains disproportionately centered on operational issues-primarily waste management and material consumption-while broader systemic determinants such as governance, equity, financing, and professional education receive comparatively little attention. Strengthening methodological rigor, harmonizing sustainability indicators, and advancing empirical evaluations are essential for guiding equitable and environmentally responsible oral healthcare systems.