Developmentally Stratified Integrated Preventive Strategies for Pediatric Oral Health: A Systematic Review with...

Background/Objectives: Within pediatric healthcare systems, integrated strategies combining dietary and oral hygiene interventions have been proposed to improve oral health outcomes. In order to evaluate the effects of combined dietary and oral hygiene approaches on behavioral, knowledge-based, and clinical outcomes in pediatric populations, this systematic review synthesized evidence from intervention studies. Methods: A comprehensive literature search was conducted on 5 September 2025 using PubMed, Scopus, Web of Science, Google Scholar, and arXiv. Children and adolescents (0-18 years old) exposed to dietary and oral hygiene interventions with documented behavioral, clinical, or knowledge-related outcomes were included in eligible studies. Studies were stratified by age groups (0-5, 6-12, and 13-18 years) in order to address developmental heterogeneity. The Cochrane RoB 2 tool for randomized trials and the ROBINS-I tool for non-randomized studies with a comparator were used to evaluate the risk of bias. For single-arm pre-post studies, a narrative risk-of-bias assessment was conducted, as ROBINS-I is not designed for uncontrolled studies. Due to methodological and clinical heterogeneity, a narrative synthesis approach was applied. Results: Out of 1231 records, eight outcome-reporting intervention studies satisfied the inclusion criteria. Improvements in self-reported oral hygiene behaviors, dietary habits, and oral health knowledge were consistently linked to integrated interventions across developmental subgroups. There was little and inconsistent evidence for clinical outcomes, such as caries and periodontal indicators. Conclusions: In pediatric populations, integrated dietary and oral hygiene interventions seem to enhance behavioral and educational oral health outcomes. These findings highlight the need for developmentally tailored preventive strategies integrated within pediatric healthcare frameworks.