OBJECTIVES: Globally, dental reforms have gained momentum through enhanced policy dialogues, the rise of digital health, artificial intelligence and outreach initiatives. Yet the burden of oral disease remains disproportionately high among vulnerable populations, particularly in low- and middle-income countries, even as reforms continue to evolve. METHODS: This critical narrative review draws on existing disease burden data, documented reform strategies and an examination of structural gaps in care and prevention delivery. It interprets these through two established frameworks, epistemic humility and implementation realism, to interrogate how reforms are designed. It further proposes epidemiological humility as a new conceptual lens to question how data are interpreted and whose reality remains excluded. RESULTS: The review identifies four recurring patterns: digital innovations that outpace infrastructure and trust, standalone interventions lacking continuity, prevention strategies deployed without curative care and a growing divide between private provision and deteriorating public systems. These gaps not only hinder impact but distort the visibility of oral disease, shaping policies around what is seen rather than what is suffered. CONCLUSIONS: Oral health must be integrated into primary care and embedded in community-based delivery. Reform requires beginning with inclusion, listening before delivering and building systems that centre people's unmet needs.
Mathur et al. (2026) studied this question.