SYSTEMATIC REVIEW
Dental care in
Indigenous communities: performance and experiences of oral health professionals
Atención odontológica en comunidades
indígenas: desempeño y experiencias del personal de salud bucal
Alexander Jean
Pierre Diaz Mas 1. Milenka Kristal Gutiérrez
Almenara2. Yhedina Dunia Sánchez-Huamán3.
Gabriela del Pilar López Rodriguez4. Ximena Alejandra León Ríos 5
1 Faculty of Health Sciences, Peruvian University of
Applied Sciences. https://orcid.org/0000-0001-7857-714X
2 Faculty of Health Sciences, Peruvian University of
Applied Sciences. https://orcid.org/0009-0009-7724-8876
3 Faculty of Health Sciences, Peruvian University of
Applied Sciences. https://orcid.org/0000-0002-8867-4517
4 MSc. Faculty of Health Sciences, Peruvian University
of Applied Sciences. https://orcid.org/0009-0004-1322-8976
5 Peruvian University of Applied Sciences. Regional
Government of Andalucia. University of Granada,
Spain. https://orcid.org/0000-0002-3494-331X
Received: 16/12/2025 Accepted: 23/02/2026
ABSTRACT
Objective: To analyze
recent scientific literature on the performance, training, and experiences of oral
health professionals providing care to Indigenous communities, with an emphasis
on facilitating factors, structural barriers, and implemented intercultural
strategies. Methods: The systematic review was conducted through searches in
scientific databases (Google Scholar, Scopus, SciELO, LILACS, PubMed), using MeSH and DeCS descriptors
combined with Boolean operators. Qualitative, quantitative and mixed-methods
studies published between 2018 and 2025 were included. Systematic reviewsNon‑traditional publications, and studies without
direct participation of health professionals were excluded. After screening, 11
articles were selected.Results:
The studies included experiences from Canada, the United States, Chile,
Venezuela, El Salvador, Brazil, and Australia. Findings were grouped into six
categories: professional experiences, structural barriers, intercultural
competencies, job satisfaction, community participation, and improvement
proposals. The main barriers identified were limited training in cultural
competencies, high staff turnover, geographic and linguistic difficulties, and
weak institutional coordination. Good practices were also highlighted, such as
collaboration with Indigenous health promoters and the cultural adaptation of
interventions. Conclusion: It is imperative to redesign dental care models by
integrating an approach centered on rights, equity, and the full participation
of Indigenous peoples.
Keywords: Oral Health. Indigenous Peoples. Health
Professionals. Cultural Competency.
RESUMEN
Objetivo:
Analizar la literatura científica reciente sobre el desempeño, formación y
experiencias del personal de salud bucal que brinda atención a comunidades
indígenas con énfasis en los factores facilitadores, barreras estructurales y
estrategias interculturales implementadas. Métodos: La revisión sistemática se
realizó mediante búsqueda en base de datos científicas (Google Scholar, Scopus, SciELO, LILACS,
PubMed), utilizando descriptores MeSH y DeCS combinados con operadores booleanos. Se incluyeron estudios
cualitativos, cuantitativos y mixtos, publicados entre 2018 y 2025. Se
excluyeron revisiones sistemáticas, literatura gris y estudios sin
participación directa del personal de salud. Tras la depuración, se
seleccionaron 11 artículos. Resultados: Los estudios incluyeron experiencias en
Canadá, Estados Unidos, Chile, Venezuela, El Salvador, Brasil y Australia. Se
agruparon los hallazgos en seis categorías: experiencias profesionales,
barreras estructurales, competencias interculturales, satisfacción laboral,
participación comunitaria y propuestas de mejora. Las principales barreras
identificadas fueron: escasa formación en competencias culturales, alta
rotación del recurso humano, dificultades geográficas y lingüísticas, y débil
articulación institucional. También se destacaron buenas prácticas como la
colaboración con promotores indígenas y la adaptación cultural de
intervenciones. Conclusión: Resulta imperativo rediseñar los modelos de
atención odontológica integrando un enfoque centrado en los derechos, la
equidad y la participación plena de los pueblos indígenas.
Palabras clave: Salud bucal, poblaciones
indígenas, personal de salud, competencia cultural.
INTRODUCTION
Oral health is a key part
of overall well-being. Good oral health lets people eat, speak, and socialize
without pain, discomfort, or stigma, directly affecting their quality of life
(1). Yet, Indigenous populations worldwide face stark inequalities in dental
care access, quality, and outcomes (1). These gaps result from colonization,
social exclusion, lasting structural barriers, and the lack of culturally
appropriate policies. Indigenous peoples—distinct groups with their own social,
cultural, and historical identities—face shared challenges such as health
inequities, territorial dispossession, and exclusion, even though they have
diverse cultures and languages (2–4).
It is essential to
recognize that, for many Indigenous communities, health is conceived from a
holistic perspective that integrates body, mind, spirit, community, and
territory, in contrast to conventional biomedical models (4). This
comprehensive worldview directly influences community understandings of oral
health and the adoption of traditional care practices, which are deeply linked
to cosmovision, spirituality, and collective bonds. Nevertheless, factors such
as poverty, institutional discrimination, and the lack of integration of these
perspectives into formal health systems contribute to the persistence of
significant gaps in oral health indicators within this population group (5).
In this context, the role
of the oral health workforce becomes decisive in promoting sustainable
improvements in Indigenous communities. Evidence shows that training in
cultural competencies, adaptation of services to sociocultural realities, and
the active participation of community health promoters are key elements for
achieving effective and culturally safe interventions (6,7).
Programs such as the Children’s Oral Health Initiative (COHI), implemented in
remote First Nations communities in Canada, demonstrate that considering
cultural and regional contexts can significantly strengthen children’s oral
health (6).
Similarly, studies
conducted in Indigenous Australian communities have identified facilitators at
the family, community, and institutional levels that contribute to culturally
appropriate and safe oral health care practices (7).
In this regard, differences
exist globally among countries. In the Venezuelan Amazon and in various
Indigenous peoples across the American continent, efforts have mainly focused
on prevention projects and community-based strategies grounded in traditional
narratives (8,9). In the United States and Canada, lack of
continuity in services and socioeconomic barriers continue to affect program
effectiveness (10,11). In contrast, countries such as Australia and
New Zealand have made progress toward integrating Indigenous content into
professional training curricula and implementing innovative clinical
interventions, such as the use of silver fluoride for caries prevention in
Aboriginal populations (12,13). Additionally, Australia has promoted
transformative frameworks to decolonize oral health and advance a human
right–based approach (12).
These differences respond
not only to historical and political particularities, but also to the level of
recognition of Indigenous peoples’ right to receive culturally safe care (1,4).
In Latin America, studies conducted in Chile, Venezuela, and El Salvador show
that significant inequalities persist in access to and quality of dental
services (5,9,14).
Despite certain advances,
relevant gaps remain in the literature, particularly regarding the longitudinal
follow-up of programs, systematic evaluation of service quality, and the
effective incorporation of Indigenous knowledge into daily clinical practice (3,13,15).
Likewise, the limited inclusion of communities in decision-making processes
restricts the sustainability of implemented initiatives (15).
Within this framework, the
present systematic review aims to analyze recent literature on the performance
and training of the oral health workforce serving Indigenous communities in the
American continent, identifying implemented intercultural strategies,
persistent challenges, and opportunities to advance toward more equitable,
relevant, and culturally safe models of dental care.
MATERIALS AND METHODS
Between April and May 2025,
a detailed exploration of scientific literature was conducted across multiple
bibliographic sources—PubMed, SciELO, ScienceDirect, Scopus, and Google
Scholar—to identify studies addressing the experiences and performance of the
oral health workforce serving Indigenous populations. The guidelines of the
PRISMA statement were followed (16). Controlled terms from the MeSH and DeCS thesauri were used,
combined with Boolean operators.
In English: ("oral
health" OR "dental health") AND ("indigenous
populations" OR "native communities" OR "ethnic
groups") AND ("community health workers" OR "health
providers" OR "dental professionals"). In
Spanish: ("salud bucal" OR "salud
dental") AND ("poblaciones indígenas" OR "comunidades
nativas") AND ("trabajadores comunitarios de salud" OR
"odontólogos" OR "promotores de salud bucal")
Articles published in
English and Spanish between 2018 and 2025 were considered. Eligible studies
included qualitative, quantitative, or mixed methods designs involving
dentists, promoters, technicians, or assistants that examined performance,
perceptions, experiences, training, knowledge, competencies, strategies,
barriers, and/or challenges related to dental care for Indigenous communities. Non‑traditional
publications—such as institutional reports, letters to the editor, technical
reports, reviews, conference proceedings or abstracts, and theses—was excluded.
Following the bibliographic
search, a preliminary review of titles and abstracts was conducted based on the
selection criteria. Studies were excluded if, despite involving Indigenous
communities, they focused exclusively on clinical aspects of the population
served without considering the active role of health professionals, as well as
publications without access to the full text. Studies reflecting direct
participation of oral health human resources—whether in community
interventions, intercultural training processes, or the implementation of
educational and preventive strategies—were selected.
This process resulted in 11
studies with significant evidence. Methodological quality was assessed using
the Critical Appraisal Skills Programme (CASP)
checklist, consisting of 10 questions for qualitative studies. In this review,
each item was scored as follows: affirmative answers (“Yes”) received 1-point,
uncertain answers (“Not sure”) 0.5 points, and negative answers (“No”) 0
points. Studies were considered high quality when at least two-thirds of the
responses were “Yes,” moderate quality when four to six affirmative responses
were recorded, and low quality when more than two-thirds of the responses
corresponded to “No” (17) (Figure 1) (Table 1).
ANALYSIS AND DISCUSSION OF
RESULTS
The reviewed publications
covered diverse regions of the American continent—Canada, the United States,
Venezuela, Chile, Brazil, and El Salvador as well as Australia and one
multinational study incorporating data from Canada, the United States, New Zealand,
and Australia. Most studies were conducted in rural, remote areas, or
predominantly Indigenous communities, allowing exploration of the performance
of health professionals in social contexts and territorial vulnerability.
From a methodological
perspective, qualitative approaches predominate, focusing on interviews, focus
groups, thematic analysis, and participatory methods such as sharing circles.
Three studies adopted mixed methods designs, combining surveys with
ethnographic or documentary analysis, while others examined professional
training and performance through phenomenological perspectives or multiple case
study approaches. Methodological quality assessed using the CASP scale was high
across all articles (scores 9–10), supporting the the
findings.
Motivation, commitment, and
barriers
The literature shows that
the experience of oral health professionals in Indigenous contexts is
characterized by a constant tension between community commitment and multiple
occupational challenges. Studies such as those by Schroth
et al. (6) and Shrivastava et al. (19) highlight that
dentists, hygienists, assistants, and community promoters deeply value close
interaction with Indigenous families, which strengthens trust and supports
continuity of care. However, this work takes place in settings marked by
logistical constraints, workload overload, and the need to adapt communication
to contexts where language, cultural meanings, and traditional practices play a
decisive role in the care experience.
Consistently, research
identifies that the main barriers to access and effectiveness of oral health
services have structural, historical, and sociocultural roots. These include
long geographic distances—documented in regions such as Alaska, the Amazon, and
rural Australian communities—economic constraints, limited-service
availability, lack of staff continuity, and the absence of culturally safe
services (3,15,19). Institutional weaknesses related to bureaucracy
and inadequate infrastructure are also reported (10). These barriers
not only affect quality of care but also erode Indigenous communities’ trust in
formal health systems.
These findings align with
international reviews indicating that historical inequalities and institutional
discrimination continue to significantly influence oral health indicators among
Indigenous peoples (2,3,16). Nevertheless, this review highlights
the strategic role of community participation, the indigenization of training
curricula, and the strengthening of health promoters as key axes for
transforming services.
Professional training and
cultural competencies
Several studies emphasize
that socioeconomic and historical factors strongly condition oral health in
Indigenous communities, requiring professionals to incorporate cultural
competencies into their practice (5). The importance of community
participation in curriculum design and the indigenization of dental education
is underscored, as is the development of educational models based on
self-determination and Indigenous traditional knowledge (13). In
this framework, the value of bicultural health teams and effective communication
that consider the social determinants of health is highlighted (18).
From a comparative
perspective, significant regional differences are observed. Countries such as
Australia, Canada, and New Zealand have advanced in implementing regulatory
frameworks oriented toward cultural safety, mandatory intercultural training,
and the incorporation of Indigenous knowledge into professional education (4,7,12,13,16).
In contrast, in Latin America progress is more fragmented and largely dependent
on local initiatives or non-governmental organizations, with less structural
and financial support (5,8,9,14,15). This disparity reflects the
absence of consolidated state policies that sustainably ensure training and
support for oral health professionals in Indigenous contexts.
Job satisfaction and
working conditions
Job satisfaction among
personnel is closely linked to working conditions. Studies conducted in Canada
and the United States report frustration due to limited infrastructure and
resources, as well as high staff turnover, which hinders continuity of care and
the development of trusting relationships (3,6,9). Nevertheless,
many professionals express pride and satisfaction in contributing to children’s
health and engaging closely with communities, particularly when participating
in culturally adapted approaches or community-based activities. These findings
suggest that improving working conditions and strengthening institutional
support may positively impact staff motivation and retention.
Community participation as
a key facilitator
Community participation
consistently emerges as a central facilitator of successful oral health
interventions. Experiences documented in Australia (7), Canada (6),
and Alaska (8) show that collaborative work with Indigenous
promoters and leaders facilitates the adoption of healthy practices, especially
in childhood. The use of traditional narratives and participatory approaches
increases community empowerment and ownership of oral care practices,
strengthening trust in services (8).
Overall, the findings
reinforce the notion that the performance of oral health professionals cannot
be understood from a clinical perspective, but also from their ability to
establish horizontal, respectful, and culturally sensitive relationships with
communities (6–8,18,19).
Strengths, limitations, and
implications
Methodologically, this
review presents notable strengths, including searches across multiple
international databases, inclusion of diverse study designs, and application of
PRISMA guidelines in the selection process (16). Quality assessment
using CASP indicated that most studies exhibit good methodological quality,
reinforcing the consistency of the findings (17). However, important
limitations exist, including heterogeneity of designs and contexts, exclusion
of grey literature, and predominance of qualitative studies, which limits
generalizability. Additionally, conceptual variability is identified around the
terms “performance” and “training” of oral health professionals, which in many
studies are addressed implicitly or subordinated to broader public health
approaches. This lack of analytical delimitation complicates systematic
comparison and highlights the need for clearer theoretical frameworks (20).
The implications of these
results are relevant for clinical practice, public health, and policy
formulation. The importance of ongoing training in intercultural competencies,
strengthening communication skills, and recognizing traditional knowledge is emphasized.
Likewise, the need for participatory programs, policies that ensure staff
retention in territories, and the indigenization of dental curricula is
underscored. Finally, evidence gaps are identified that guide future research,
particularly longitudinal and comparative studies evaluating the impact of
intercultural approaches on staff performance and oral health outcomes.
CONCLUSION
This systematic review
shows that oral health professionals serving Indigenous communities face
structural, educational, and contextual limitations, particularly insufficient
intercultural training, geographic and linguistic barriers, staff turnover, and
the lack of culturally relevant institutional policies. While successful
experiences based on participatory approaches and cultural adaptation of
interventions were identified, progress in Latin America remains incipient
compared to countries such as Australia, Canada, and New Zealand. In this
context, strengthening intercultural training, continuing education, and
inclusive public policies is a priority to advance toward culturally safe,
equitable, and human rights–based models of dental care.
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AUTHOR
CONTRIBUTION STATEMENT
“Conceptualization and
design: Alexander Diaz
and Milenka Gutiérrez; Literature review: Alexander
Diaz and Milenka Gutiérrez; Methodology and
validation: Alexander Diaz and Milenka Gutiérrez;
Formal analysis: Alexander Diaz and Milenka
Gutiérrez; Investigation and data collection: Alexander Diaz and Milenka Gutiérrez; Resources: Not applicable; Data
analysis and interpretation: Alexander Diaz and Milenka
Gutiérrez; Writing – original draft preparation: Alexander Diaz and Milenka Gutiérrez; Writing – review and editing: Yhedina Sánchez, Gabriela López, Ximena León; Supervision:
Yhedina Sánchez, Gabriela López, Ximena León; Project
administration: Not applicable; Funding acquisition: Not
applicable.”
CONFLICTS OF
INTEREST
The authors declare that
there were no conflicts of interest during the conduct of this research. In
addition, the manuscript was submitted exclusively to the Revista
Científica “Especialidades Odontológicas UG” for review and publication.
FUNDING
The authors report that
personal funds were used to carry out this research.
COPYRIGHT
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Commons Attribution License (CC BY NC ND). The use, distribution or
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the copyright owner(s) are credited and that the original publication in this
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terms.
HOW TO CITE:
Diaz
Mas AJP, Gutierrez Almenara MK, Sanchez
Huaman YD, López Rodriguez
G del P, Leon-Rios XA. Dental care in Indigenous communities: performance and
experiences of oral health professionals. Revista
Científica Especialidades Odontológicas UG. 2026;9(1):38-44
