Sustainability in Dentistry: A Systematic Literature Review of Environmental, Economic, and Social Dimensions in Dental Practice

Background: While sustainability is increasingly recognized as a priority in dentistry, it remains unclear what the map of the available empirical evidence to guide this transition looks like in terms of its breadth, depth, and quality. This systematic review provides a critical appraisal of the dental sustainability literature to identify its core characteristics, expose critical research gaps, and propose an evidence-based agenda for the future. Methods: Following PRISMA guidelines, a systematic search was conducted across PubMed/MEDLINE, Web of Science, and Google Scholar for empirical studies published between 2010 and 2025. Data on study design, geographic origin, sustainability dimensions (environmental, economic, social), and key findings were extracted. A narrative synthesis was performed, focusing on dimensional balance, methodological rigor, and thematic patterns. Results: From 140 initial records, 18 studies were included. The findings reveal a field in its infancy, characterized by three profound imbalances. First, a dimensional imbalance: research is overwhelmingly focused on Environmental sustainability (89% of studies), with scant attention paid to Economic (17%) and Social (22%) dimensions. Second, a methodological imbalance: the evidence base is dominated by low-level descriptive evidence, primarily cross-sectional surveys (61%), with a notable scarcity of intervention studies or objective quantitative research like Life Cycle Assessments (11%). Third, a geographic imbalance: research is concentrated in specific regions, with limited evidence from low- and middle-income countries. Publication trends show a marked increase in interest since 2022. Conclusions: The map of the current empirical evidence for sustainability in dentistry reveals a landscape that is insufficient to guide robust policy or practice change. It lacks the economic analysis, social inquiry, and high-quality methodological approaches necessary for a truly evidence-based transformation. This review presents a detailed research roadmap, prioritizing a shift towards more balanced, methodologically rigorous, and globally representative research to mature the field from a state of describing problems to one of testing solutions.