Multilevel Determinants of Adolescent Dental Care Access: A Scoping Review Using a Health Disparities Framework

This scoping review examined barriers and facilitators influencing dental care access among adolescents (ages 10-19) using a multilevel health disparities framework to capture behavioral, social, and structural determinants. Following the Arksey and O'Malley framework and Joanna Briggs Institute methodology, 6 databases and gray literature were searched for English-language studies (2011-present) on dental care access among adolescents. Data were categorized at individual, interpersonal, community, and societal levels. Fifty-eight studies met inclusion criteria. Common barriers included dental anxiety, minority status, low parental education, limited income, weak peer support, geographic disparities, unstable insurance, and provider shortages. Facilitators included public insurance programs, school-based dental clinics, culturally tailored education, caregiver modeling, and community engagement. An ecomap illustrated multilevel predictors and research gaps, identifying strategies such as peer-led programs, safety-net investment, patient navigation, and policy reforms to strengthen access. Adolescent dental access is shaped by intersecting determinants at behavioral, social, and systemic levels. Coordinated efforts integrating infrastructure, health education, and policy interventions are essential to reduce oral health disparities and inform future research directions. The multilevel ecomap presented in this review provides an adaptable, evidence-based foundation for developing actionable strategies to improve adolescent oral health across different social backgrounds and geographic regions.