BACKGROUND: Oral health is essential for children's overall well-being, yet dental caries remain a significant global health issue. Gamification has gained attention as an innovative approach to improving children's oral health by enhancing engagement and promoting behavior change. Although previous studies have examined different aspects of gamification in pediatric oral health, no review has addressed it as a comprehensive framework encompassing education, behavior change, engagement, and digital platforms.
OBJECTIVE: This systematic review aimed to evaluate the effectiveness of gamification in pediatric oral health management, focusing on game design elements; intervention platforms; and outcomes such as oral hygiene knowledge, behavior, and engagement.
METHODS: Following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, a comprehensive search was conducted across multiple databases (PubMed, MEDLINE, Embase, Cochrane Library, Scopus, Web of Science, and PsycINFO), identifying studies from January 1, 2014, to February 9, 2025. The review included randomized controlled trials, quasi-experimental studies, cohort studies, systematic reviews, and qualitative studies with measurable outcomes that focused on gamified interventions for children's oral health. A standardized form was used to collect study details, interventions, demographics, outcomes, and risk of bias. Data synthesis was conducted using a narrative approach due to the heterogeneity of the included studies. The synthesis focused on identifying common themes, evaluating intervention effectiveness, and highlighting methodological strengths and limitations.
RESULTS: In total, 41 studies were reviewed, and most (n=24, 59%) used digital interventions such as mobile apps, serious games, and augmented reality. Game elements such as rewards, progress tracking, and interactive feedback were commonly used to enhance user engagement and improve health outcomes. The effect of the digital-based interventions was generally positive, with 38% (9/24) of the studies reporting improvements in oral health knowledge and behaviors. In nonexperimental studies, gamified interventions demonstrated substantial improvements in parental engagement and awareness of oral health practices, which translated into better brushing habits and increased preventive dental visits. Digital-based interventions were more effective in fostering long-term behavior change compared to nondigital alternatives. Engagement metrics revealed higher participation rates in gamified interventions, with improved adherence to oral hygiene routines. However, most studies (39/41, 95%) exhibited moderate risk of bias, including self-reported data and potential selection biases.
CONCLUSIONS: This review synthesized findings from 41 studies on gamification in children's oral health. Gamification, particularly mobile apps and augmented reality, has potential to significantly enhance pediatric oral health management by increasing engagement, improving oral hygiene behaviors, and promoting sustained health behavior change. Future research should explore the long-term effects of these interventions, develop culturally adaptive tools, and integrate gamification with existing public health programs to maximize their impact.
TRIAL REGISTRATION: PROSPERO CRD42025644118; https://www.crd.york.ac.uk/PROSPERO/view/CRD42025644118.
