Oral Disease Burden and Barriers to Preventive Dental Care Among Incarcerated Adults: A Systematic Review and Meta-Analysis

Abstract

Background: Evidence on dental disease among incarcerated adults is fragmented across small national surveys, and no pooled estimate links that burden to the barriers that keep preventive care from people in custody.
Methods: This systematic review followed PRISMA 2020. Google Scholar and web and agency sources were searched on 16 October 2026, with citation searching of two systematic reviews. Studies reporting oral health, service use or barriers among incarcerated or formerly incarcerated adults were eligible. Mean DMFT and caries prevalence were pooled by REML random-effects meta-analysis with Hartung-Knapp intervals; barriers were mapped to the Andersen behavioural model.
Results: Thirty-two reports were included. Across seven studies (1,042 adults) from Brazil, Finland, Poland, Portugal, Saudi Arabia and the United Kingdom, pooled mean DMFT was 15.24 (95% CI 12.46 to 18.01; I² = 94.8%). Across seven studies (1,742 adults), pooled caries prevalence was 87.9% (95% CI 71.7% to 95.4%). In Silesia, incarcerated patients had 2.95 more DMFT teeth (95% CI 1.50 to 4.40) than matched controls, driven by untreated decay. Barriers clustered in the enabling domain: reactive service models, extraction-led treatment and loss of coverage after release.
Conclusions: Untreated caries affects most incarcerated adults, and the binding constraints are institutional. Custodial dental services should be commissioned for scheduled prevention and restoration, with decayed and extraction components reported separately.