Bridging Gaps in Oral Health Frameworks: Mapping With Hodges' Health Career - Care Domains - Model

 ABSTRACT

Objectives

Despite decades of national and global strategies, persistent inequities in oral health outcomes, access, and service provision remain. Existing frameworks often fail to integrate clinical and behavioral factors with social, cultural, and political determinants. This study aimed to map and evaluate oral health frameworks using Hodges' Health Career—Care Domains-Model (HCM), a meta-framework that spans clinical, behavioral, sociological, and political domains. The goal was to identify conceptual gaps and opportunities for greater integration.

Methods

A structured scoping review was conducted using MEDLINE, CINAHL, EBSCO, and search engine Google Scholar (1995–2025) to identify oral health-related conceptual frameworks. Frameworks were eligible if they addressed oral health determinants, behaviors, policies, or interventions. Two reviewers independently screened records and analyzed full-text articles. Frameworks were categorized by theoretical orientation and mapped against the four HCM domains to identify patterns of emphasis or omission.

Results

Of 226 identified records, 21 frameworks met inclusion criteria. These were classified into three thematic groups: balanced (addressing all domains), clinically led (focused on clinical/behavioral aspects), and policy/public health-focused (emphasizing sociological/political factors). Seven cross cutting themes emerged, including health promotion, systems integration, social justice, and cultural safety. While many frameworks promoted equity and policy reform, few offered implementation guidance or had been empirically validated.

Conclusions

HCM proved useful for systematically comparing frameworks and revealed consistent underrepresentation of political and structural domains. It offers a practical tool for oral health professionals, educators, and policymakers developing integrated oral health models that align with equity, sustainability, and universal health coverage goals.

S. Bettiol, P. Jones, H. A. Onyedikachi, and W. G. Kernohan, “ Bridging Gaps in Oral Health Frameworks: Mapping With Hodges' Health Career - Care Domains - Model,” Journal of Public Health Dentistry (2026): 1–14, 
https://doi.org/10.1111/jphd.70034