Digital Health Interventions for Preventive Oral Care in Older Adults: A Narrative Review Through the Lens of the Prevention Paradox

The global oral disease burden in older adults remains high despite a well-established preventive evidence base. Digital health interventions, including teledentistry, mobile health (mHealth), artificial intelligence (AI), and Internet-of-Things (IoT) devices such as smart toothbrushes, are increasingly proposed as solutions to bridge access gaps. Whether these technologies reach those most in need has rarely been examined through the lens of the Prevention Paradox. Despite a well-established preventive evidence base, the global burden of oral disease in older adults remains high, with disparities widening across socioeconomic, geographic, and functional strata. Digital health interventions, including teledentistry, mobile health (mHealth), artificial intelligence (AI), and Internet-of-Things (IoT) devices, are increasingly proposed to bridge access gaps. Whether these technologies reach the older adults at greatest risk, rather than those already well served, has seldom been examined. This narrative review synthesises peer-reviewed literature on digital health interventions for preventive oral care in older adults, interpreted through the Prevention Paradox and the PROGRESS-Plus equity framework. A structured Scopus search yielded 143 records; after applying inclusion and exclusion criteria, 71 records formed the working corpus, complemented by full-text analysis of 62 papers and three foundational theoretical sources. This narrative review addresses that gap by interpreting the digital oral health evidence through the Prevention Paradox and the PROGRESS-Plus equity framework, two lenses not previously applied jointly to this field. A structured Scopus search executed on 13 May 2026 yielded 143 records; after predefined inclusion and exclusion criteria, 71 records formed the working corpus, of which 62 were analysed as full text alongside three foundational theoretical sources, then thematically clustered and appraised narratively. Teledentistry has matured into a methodologically defensible field, with multiple validation studies showing high diagnostic accuracy and an umbrella overview of 30 systematic reviews documenting access and quality impacts. Evidence on mHealth, AI, and smart toothbrushes for older adults remains sparse but converging. eHealth literacy emerges as a mediating social determinant of digital uptake. No retrieved primary study framed digital oral health interventions explicitly within the Prevention Paradox.Teledentistry emerged as a methodologically maturing field, supported by multiple diagnostic-accuracy studies and an umbrella overview of 30 systematic reviews, although equity was its least examined domain. Evidence on mHealth, AI, and smart toothbrushes remained sparse but converging, and eHealth literacy recurred as a mediating determinant of uptake. Digital interventions are feasible and acceptable, but their population-level equity impact remains unproven and possibly paradoxical. Without deliberate equity-by-design anchored in PROGRESS-Plus stratification, digital interventions risk reproducing the inequities they aspire to resolve.No retrieved primary study framed digital oral health within the Prevention Paradox. Digital interventions appear feasible and acceptable, yet their population-level equity impact remains unproven and potentially paradoxical without deliberate equity-by-design anchored in PROGRESS-Plus stratification.