Integrating oral health into planetary health governance: a framework for resilient and equitable oral healthcare.

Oral health is largely absent from climate-adaptation and planetary-health governance, even though oral health and oral healthcare depend on supplies of clean water, stable electricity, secure supply chains, and a retained workforce, which climate change is destabilizing. In this Perspective, we argue that this omission is a strategic failure for health security, and draw on the contrasting experiences of seven climate-exposed settings (Australia, Fiji, Indonesia, New Zealand, the Solomon Islands, South Africa, and the United Kingdom) to show how environmental stressors disrupt progress in promoting oral health, thereby deepening oral disease inequities. Across these settings, extreme weather damages clinics, interrupts water-dependent processes such as instrument sterilization and community water fluoridation, undermines workforce retention in the places least able to absorb staff losses, and falls hardest on populations already underserved. We propose a four-part framework that recognizes the need to embed oral health within climate-critical infrastructure, develop region-specific vulnerability assessments, protect the workforce in climate-exposed regions, and establish adaptive financing. These recommendations promote environmental sustainability through prevention-oriented oral health policy and the implementation of reduced carbon-emitting oral healthcare service delivery models.