Challenges in providing oral care for children from the perspective of primary caregivers: A systematic review and meta-synthesis of qualitative studies

Objectives: This systematic review aimed to synthesize qualitative evidence on barriers and enabling factors influencing caregivers’ ability to provide oral healthcare for children across diverse sociocultural contexts. Methods: A constructivist interpretive meta-synthesis was conducted using the SPIDER framework. Twenty-seven qualitative studies from global settings were included. Thematic synthesis was applied to derive descriptive and analytical themes. Confidence in findings was assessed using the GRADE-CERQual approach. Reflexive practices and peer debriefing were incorporated to enhance analytical rigor and transparency. Results: Six interrelated domains of barriers were identified, including oral health behaviors, emotional burden, parent–child dynamics, sociocultural influences, healthcare accessibility, and system navigation challenges. Enabling factors included trust in healthcare providers, supportive communication, positive family norms, improved health literacy, and accessibility of dental services. Caregiver roles were shaped by cultural identity, structural inequities, and competing daily caregiving responsibilities. Conclusions: Caregivers face complex, multidimensional challenges in supporting children’s oral health. Strengthening health education, enhancing provider–caregiver communication, and improving service accessibility are essential to improve pediatric oral health outcomes across populations.