Integration of oral health promotion in primary school health programs: A scoping review

Children experience significant oral health problems, compromising learning and quality of life. Schools are effective in promoting children's overall health, within which oral health can be integrated. This scoping review aimed to map integration of oral health within primary school health programs. The review was guided by Arksey and O'Malley's framework and adhered to Preferred Reporting Items for Systematic reviews and Meta-Analyses extensions for Scoping Reviews (PRISMA-ScR). JBI Manual for Evidence Synthesis was referred to for data extraction. A systematic search was performed across six databases with no restrictions on dates and locations. The review included 31 articles published between 1981 and 2025. Over 70% studies were concentrated exclusively in high-income and upper-middle income regions. Quantitative methods were reported in twenty-one studies. All studies reported programs targeting children. Only 12 included parents or guardians, mostly as passive recipients. Most common intervention delivery agents were teachers, identified in 25 studies. Unhealthy diet and poor hygiene were frequently targeted common risk factors, identified in 18 and 11 studies respectively. Tobacco use, stress, and injury were largely overlooked. Twenty-seven studies reported activity-based learning to promote general health. Classroom education, followed by interest holder engagement and structured toothbrushing were used to promote oral health, focusing on student skill-building and empowerment, alongside teacher involvement. None of the studies applied integration-specific or implementation science frameworks or models. Twenty-six studies assessed child-level oral health outcomes. In contrast, only seven reported changes in knowledge, attitudes, and practices among educators and parents. Ten reported program-related outcomes. Structured programs engaging children, targeting risk factors related to hygiene and diet alongside interest holder engagement and curriculum integration hold promise. This review highlights the need for theoretically informed, comprehensive, policy-focused, multi-level, multi-risk factor approaches to support sustainable integration of oral health into school health programs.