BACKGROUND:
Oral health systems in many countries remain dominated by surgical, restorative and extraction-based care, despite strong evidence that oral diseases are largely preventable. At the same time, oral healthcare contributes to environmental impacts through materials, waste streams, energy use, and mercury-related pollution. Global policy momentum now calls for prevention-oriented, equitable, and environmentally sustainable oral health systems.

OBJECTIVES:
To map the global evidence on system-level strategies that shift oral healthcare from extraction-based models toward prevention-first models, while advancing sustainability (environmental, financial, and social) and equity.

METHODS:
A scoping review approach following PRISMA-ScR principles was used to identify and chart literature on prevention-oriented oral health system reforms and sustainability interventions. Evidence was synthesized thematically across governance/financing, service delivery, workforce, surveillance, and environmental sustainability.

RESULTS:
The literature clusters around (1) integration of oral health into primary healthcare and UHC, (2) financing/payment reform to incentivize prevention, (3) population-level prevention and commercial determinants (e.g., sugar policy), (4) workforce redesign and task-sharing, (5) minimally invasive dentistry and appropriate care pathways, (6) sustainability in clinical operations (waste, procurement, energy, materials, mercury phase-out), and (7) metrics/targets for monitoring. Global frameworks increasingly endorse prevention-first and UHC-oriented reforms, but implementation evidence remains uneven, particularly from LMICs and humanitarian/migrant settings.

CONCLUSIONS:
Transitioning “from extraction to prevention” requires aligning policy, financing, workforce, and environmental stewardship. Future research should evaluate scalable models, equity impacts, and standardized sustainability metrics.