The progression from adolescence to adulthood, also known as “youth”, is characterized by numerous changes that may significantly influence individuals' health and overall welfare. These changes encompass personal, psychological, and social development, including academic achievement, employment acquisition, attaining financial independence, and avoiding involvement with the criminal justice system (1).

Youth can be described as the transitional phase between childhood and adulthood, characterized by a continuum of developmental changes rather than rigid age-based boundaries or specific milestones—for example, engagement in employment or sexual activity initiation (2). The United Nations Department of Economic and Social Affairs (UNESDA) defines youth as individuals typically aged between 15 and 24 years, yet acknowledges the variability of this classification across member states (3). Alternative age brackets, such as 18–30, have also been proposed by institutions such as Statistics Canada, highlighting the diverse perspectives on what age group classifies as youth (3).

A distinct subgroup of youth, identified as socially marginalized youth, experiences additional obstacles in their progression to adulthood. These impediments include but are not limited to lower family income, enduring struggles with substance abuse, and the inability to complete their education (1). Additionally, these impediments also cause a significant burden on their health, including oral health. This subgroup could be disproportionally comprised of recent immigrants, Indigenous peoples, individuals experiencing homelessness, people living with HIV, sexual minorities, and those with low socioeconomic status.

Some common oral health conditions reported by socially marginalized youth are tooth pain, gingivitis, dental caries, periodontal diseases, and dental erosion (4, 5). Furthermore, Johansson and Östberg (6) highlighted that poor oral health among socially marginalized youth is often due to negative past experiences, dental anxiety, dental trauma, and pain associated with dental treatments. Consequently, there exists a notable underutilization of dental care services in this vulnerable population, underscoring the importance of addressing the barriers that impede access to oral care services.

Studies indicate that various socio-economic characteristics including financial limitations, lack of insurance, cultural and language differences, geographical constraints, and psychological factors, function as barriers that restrict the accessibility of socially marginalized youth to essential oral healthcare services. For instance, Sharma and Basnet (7) reported that youth with low socioeconomic status exhibited lower utilization of dental care services. Furthermore, cost and geographical proximity are also reported as a significant determinant of dental care utilization. Approximately 25% of individuals aged 18 and above reported not visiting a dentist due to the inability to afford services (8, 9). For example, Wiener (10) highlighted the limited access to dental care services among Indigenous youth due to extended travel times and reliance on external assistance for transportation. Additionally, Hill et al. (11) reported that participants identifying themselves as Alaska Native, American Indian, Native Hawaiian, or other Pacific Islander were 1.6 times less likely to receive preventive services, such as dental cleaning, compared to their Caucasian counterparts despite having dental insurance. This disparity underscores an inadequate awareness regarding oral care practices among socially marginalized youth.

Furthermore, literature highlights that barriers such as dental anxiety and gender-based discrimination, particularly among transgender and gender nonbinary individuals, play a significant role in limiting access to oral healthcare services. These barriers adversely influence their experiences in dental care settings, perceptions of oral health, and likelihood of seeking preventive care, often in contrast to their cisgender counterparts (12–14). For example, Raisin et al. (12) reported that approximately 48% of participants avoided dental visits due to concerns related to their gender identity. The study further highlighted frequent instances of misgendering and the use of incorrect pronouns, which can serve as negative triggers, contributing to a non-inclusive environment. Such experiences exacerbate barriers to dental care for transgender and gender nonbinary individuals, thereby restricting equitable access to oral health services (12).

The presence of such barriers impeding that access contributes to suboptimal utilization of oral care services among socially marginalized youth, resulting in unmet oral health needs and poor oral health status. Finally, unmet needs in this subpopulation may culminate in exacerbated and severe oral health conditions during later life stages, if left untreated. Despite these concerning findings, there is a lack of comprehensive evidence for individual and societal barriers to accessing dental care and oral health service utilization among socially marginalized youth. Therefore, this scoping review aims to analyze the extent of available literature on the unmet oral health needs of socially marginalized youth globally and investigate the breadth of literature available on barriers to accessing oral healthcare among them.

The Joanna Briggs Institute (JBI) Reviewers Manual was utilized to conduct this scoping review (15). This manual offers detailed instructions for authors to adhere to, covering distinct sections dedicated to synthesizing various kinds of evidence pertinent to different types of review inquiries (15). The manual was utilized as a reference resource to address queries concerning the scoping review procedure. Based on the suggestion provided in the JBI Manual, the scoping review protocol was registered with the Open Science Framework, as PROSPERO has specified that scoping reviews do not qualify for registration in their database (15). We adhered to the reporting guidelines outlined in the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) for this review (16, 17). A completed PRISMA-ScR checklist has been provided as Supplementary File 1. Before commencing study screening, a protocol for this scoping review was registered on the Open Science Framework (doi.org/10.17605/OSF.IO/T82D3). The pre-registered protocol contains essential details concerning selection criteria and the extraction of data from the included publications. This step was taken to ensure maximum transparency in the scoping review process and to affirm that our original objectives aligned with our methodology.

This review sought to assess the breadth and scope of literature addressing the barriers to oral health care access and the utilization of oral health services among socially marginalized youth on a global scale. Despite the increased developments in research and efforts directed toward promoting the health of equity-seeking populations, substantial effort is still required to attain health equity for socially marginalized youth. This vulnerable population has limited access to oral healthcare and insurance coverage which exacerbates adverse health outcomes, including mental illnesses such as depression and anxiety, as well as chronic diseases like diabetes (24). To our knowledge, this is the first scoping review that examines the literature on oral health care across multiple socially marginalized youth groups, and it found that oral health research particular to this vulnerable population is limited.

Our results highlight poor oral health outcomes among socially marginalized youth due to unmet oral health needs. In four of seven studies, participants reported conditions such as decayed and missing teeth, infections, and periodontal issues (19–21, 23). These adverse outcomes may stem from limited awareness of preventive oral health measures and available services (25, 26). Consequently, there is a need for the development of targeted educational interventions aimed at improving the oral health of socially marginalized youth. Public health interventions tailored to this group could enhance awareness about the importance of oral health. Our results highlighted that unmet dental treatment needs were strongly associated with access to dental care facilities, with socioeconomic factors such as cost and insurance coverage, significantly influencing service utilization. Therefore, it is imperative for policymakers to prioritize the mitigation of these social determinants to improve access to dental services. Interventions such as income-based subsidies could play a critical role in improving both the affordability and accessibility of dental care services (27).

Among socially marginalized youth, our studies identified groups such as refugees and other ethnic minorities with severe dental problems and unmet needs when compared to their counterparts. This highlights the intersectionality of various social determinants of health with unmet oral health needs and dental service utilization. According to Crenshaw (28), intersectionality is described as the interaction of an individual's social attributes such as race, ethnicity, age, gender, education, socioeconomic status, and sexual orientation or gender identity which collectively determine their social identity. However, limited knowledge exists regarding the interaction of these social determinants and their cumulative impact on oral health and access to care particularly in this population (29). Existing evidence indicates that the cumulative effect of social determinants substantially increases the risk of unmet dental needs and limited access to dental care. For instance, Anticona et al. (29) reported a higher prevalence of unmet dental needs among immigrants with low education and income compared to non-immigrants with higher education and income. Similarly, Bastos et al. (30) identified significantly higher odds of avoiding dental visits among Black men living below the poverty line when compared to White men living above the poverty line. Consequently, it is imperative to investigate the intersectional experiences of individuals in dental care, considering factors such as ethnicity, socioeconomic status, and religious beliefs (31). Adopting an intersectionality framework could enhance the understanding of health inequities. This approach could facilitate identifying populations that are most susceptible to barriers in utilizing dental services causing these populations to disengage from care.

Our review also highlighted the low utilization rates of dental care services in this population (8, 18, 20). This low utilization of services can be attributed to a lack of insurance, as unemployed individuals do not have access to employer-sponsored private insurance (32). Furthermore, inadequate education among low-income individuals may lead to a lack of awareness and knowledge about preventive health services, thereby limiting access to dental care (33). Other factors such as age, gender, education, and occupation can be associated with low dental service utilization. For example, Rahman (34) reported that individuals with lower educational levels had a reduced likelihood of utilizing dental care compared to those with higher educational levels. Similarly, Kim et al. (35) reported that individuals with only an elementary-level education or lower were less likely to utilize dental services, resulting in unmet needs, compared to individuals with university-level education or higher. These findings underscore the barriers socially marginalized youth experience while accessing oral health services. In addition to these social barriers, Griner et al. (36) also identified various psychological barriers restricting accessibility to oral care among socially marginalized youth.

Our findings underscore that anxiety and fear experienced by participants substantially influenced their willingness to seek dental care (22). A significant factor contributing to this anxiety was identified as discomfort with receiving treatment from practitioners of the opposite gender than that of the patient (22). Additionally, Griner et al. (36) indicate that discrimination based on gender, race, or ethnicity may further heighten anxiety and fear among youth, thereby restricting their access to dental care services.

Our findings corroborate that cost is a significant factor for youth in avoiding dental care services (8, 19, 20, 22). This issue is heightened by factors such as the lack of insurance and homelessness (8, 20). For instance, Stormon et al. (20) reported that approximately 64% of homeless youth avoided visiting dental care facilities due to high costs. Consequently, our review indicated that participants often accessed dental care services for emergency purposes rather than preventive measures (19). Additionally, distance and lack of transportation present significant barriers to accessing care (20, 22, 23). The lack of adequate transportation increases inaccessibility issues among socially marginalized youth who live far from dental care facilities. Therefore, to mitigate barriers to oral health services, policymakers should consider implementing subsidies that facilitate dental care access for equity seeking communities. This approach is particularly crucial in regions where oral health services are predominantly privately administered, such as in Canada and the United States (37).

Regarding study designs, most of the studies exhibited limited sample sizes, raising concerns regarding the generalizability of their findings. However, recruitment challenges within equity seeking populations may have contributed to these sample sizes (38–40). Gatlin and Johnson (39) highlight the difficulties in data collection among equity seeking communities such as immigrants, Indigenous individuals, transgender individuals, and racial and ethnic minorities. Researchers often encounter issues such as mistrust toward health-related research, challenges in conveying the benefits of participation, time constraints, fear of public exposure, cultural beliefs that discourage participation, and low literacy levels (39). Additionally, few of the identified studies used a non-binary form of gender expression and lacked inclusion of gender and sexual minorities (LGBT+) (20–22). Significant gaps exist in understanding the oral health of LGBT+ youth, with very limited to no evidence on unmet oral health needs and patterns of dental service utilization within this population (14). Therefore, to address these challenges and enhance recruitment, strategies such as engaging community navigators or providing financial compensation and gift vouchers could be implemented to achieve a representative sample population (40–42).

This review has several limitations. A notable limitation of this review is the variability in the age ranges reported across the included studies. The literature suggests that youth cannot be accurately defined by specific age brackets. Therefore, achieving consistency in age ranges among the included studies proved challenging. Although most of the included studies stratified participants by age, two of the seven studies did not implement age-based stratification (18, 22). Consequently, the findings reported are not age-specific but rather generalizable to the wider age spectrum (>18 years, and 18–40 years, respectively). Nonetheless, despite this broad age spectrum, the findings of the two studies provide crucial insight into the target population. Furthermore, the limited number of studies included in this review highlights a critical research gap, underscoring the need for a more tailored approach that specifically addresses the oral health needs of socially marginalized youth. Developing such an approach is crucial for understanding the impact of marginalization on this demographic and its effects on access to oral healthcare.

Another significant limitation of this review is the focus on marginalization as a collective phenomenon, without adequately addressing the distinct environmental challenges experienced by specific subgroups of socially marginalized youth. Subpopulations such as refugees, racial and ethnic minorities, LGBTQ+ individuals, and homeless youth likely encounter unique environmental barriers that influence both their access to and utilization of dental care. To address this gap, future research should conduct subgroup-specific analyses and propose targeted, evidence-based interventions tailored to the particular challenges faced by each group. Such an approach could yield more precise insights and strategies for effectively addressing barriers unique to these populations. Furthermore, there exists an absence of information regarding the influence of national or regional policies on the accessibility of dental services for socially marginalized youth. Subsequent studies should examine the impact of existing policies, evaluating their effectiveness in enhancing access to dental care for marginalized populations and identifying potential gaps that require further attention and intervention.

Additional limitations of this review are the restricted geographic scope of the included studies, which may limit the generalizability of the findings to other global contexts. Also, the search strategy was limited to English-language papers, thereby excluding research published in other languages. However, the extent of relevant studies in languages other than English remains unclear.

Our review identified a significant research gap concerning the unmet oral health needs and barriers to accessing dental services among socially marginalized youth. However, limited available evidence highlights poor oral health outcomes within this population, with a high prevalence of unmet needs, including dental caries and periodontal diseases. Furthermore, the barriers experienced by these individuals significantly restrict their utilization of dental care services. Although some studies utilized validated measures (e.g., the DMFT index) to assess oral health, our findings highlight significant limitations, including small sample sizes and lack of varied study designs. Despite these limitations, this review provides a comprehensive overview of the available evidence concerning the barriers to oral health services for socially marginalized youth, identifies gaps in the literature, and suggests directions for future research. Notably, more robust and representative research is required to gain a deeper understanding of the oral health status of marginalized youth. Future efforts by oral health advocates should focus on ensuring that socially marginalized youth populations can both access and benefit from oral health care services. Potential intervention strategies could include increasing awareness of the importance of oral health through the distribution of informational materials, such as brochures and leaflets, and organizing oral health awareness programs in educational institutions and community settings. Additionally, engaging community healthcare providers and dental professionals in developing tailored dental education resources and programs may enhance the effectiveness of these initiatives.