Dental Anxiety as a Bottleneck in Oral–Systemic Health Pathways: A Conceptual Mapping Review of Review Articles

Background/Objectives: Dental anxiety (DA) is common worldwide and strongly linked to avoidance of dental care, delayed treatment and poorer oral health. Although many studies have examined determinants and management of DA, its broader placement as a potential bottleneck along oral systemic health pathways, from determinants of DA to consequences i.e.oral and systemic outcomes via dental avoidance, has not been clearly mapped across the review literature. This review aimed to conceptually map how existing DA reviews are distributed across this pathway and identify key gaps. Methods: We conducted a conceptual mapping review of DA-focused review articles published between 2005 and 2025. PubMed and Scopus were searched for English-language narrative, systematic, scoping and umbrella reviews and meta-analyses addressing determinants or consequences of DA. One reviewer screened records, extracted review characteristics, and classified each review into predefined domains (determinants, dental avoidance, oral health outcomes, psychosocial impact, and systemic health outcomes) using prespecified coding rules. Classifications were cross-checked using a structured prompt for independent AI-assisted full-text coding. Final codes were adjudicated by the reviewer against the source text. Domains were coded as covered (substantive focus), mentioned (brief mention), or not addressed. or not addressed. No meta-analysis was conducted. The review was not registered and involved no stakeholders. Results: The search identified 851 records; after removing 426 duplicates, 425 unique records were screened, and 40 reviews met inclusion criteria. Narrative reviews were most common (18/40, 45.0%). Determinants dominated the evidence base (psychological 31/40, 77.5%; environmental 27/40, 67.5%). As consequences, avoidance (25/40, 62.5%) and oral health outcomes (21/40, 52.5%) were covered in about half of reviews. Psycho-social impacts were rarely covered (shame/embarrassment 5/40, 12.5%; Oral health-related quality of life 4/40, 10.0%). Systemic health outcomes were least addressed (covered 1/40, 2.5%; mentioned 5/40, 12.5%). Conclusions: Review level evidence supports a pathway from DA to avoidance and poorer oral health, but offers limited synthesis on outcomes beyond the oral domain. Given the oral-systemic link and the role of behavioural barriers to access and delayed treatment, future research should test pathways from DA to quality of life and systemic outcomes using clear mechanisms and appropriate temporal designs.