The TRIAD‐OH Model: A Systems Innovation Integrating One Health and Dental Public Health to Advance Special Care Dentistry and Global Disability‐Inclusive Oral Health.

Dear Editor, Persons with disabilities and individuals with special healthcare needs continue to face disproportionately high oral-disease burdens, unmet treatment needs, and systemic exclusion from routine dental care [1, 2]. While Special Care Dentistry (SCD) has advanced considerably, many determinants shaping oral-health outcomes for these populations lie outside the traditional clinical sphere. Environmental exposures, zoonotic interfaces, antimicrobial resistance (AMR) pressures, institutional living conditions, and social vulnerabilities interact in complex ways to influence risk, behavior, access, and outcomes [3, 4]. Addressing such multilayered determinants requires a perspective that links specialized clinical practice with ecological, environmental, and population-health systems. In response, we present the TRIAD-OH Model—Triadic Resilience Integration for Accessible Dentistry through One Health (OH)—a streamlined systems perspective designed to align OH, Dental Public Health (DPH), and Special Care Dentistry (SCD) into a coherent framework for disability-inclusive oral healthcare. The model does not aim to introduce an expansive conceptual structure, but rather to highlight the essential need for multisectoral integration within SCD as health systems face ecological disruption, infectious disease pressures, and rising disability prevalence. Many individuals with disabilities experience heightened ecological vulnerabilities. These include dependence on service or therapy animals [5], exposure to environmental hazards, immunologic susceptibility in certain disability groups such as Down syndrome [6], institutional crowding, and climate-linked stressors affecting hydration, nutrition, or mobility [7]. The OH framework—anchored in the interdependence of human, animal, and environmental health—provides a critical lens for recognizing how such exposures influence oral-health outcomes [1, 8]. For instance, climate-related heat stress may exacerbate xerostomia, unsafe water sources elevate caries and periodontal risks, and zoonotic exposure demands coordinated infection-prevention strategies [9-11]. The COVID-19 pandemic further revealed how environmental and infectious disease pressures disproportionately disrupt oral-health continuity for disability populations [10, 12, 13]. Integrating OH principles allows SCD practitioners to better anticipate and mitigate such ecological risks. DPH serves as the operational conduit through which OH principles can be translated into policy and practice. Surveillance systems, caregiver education, community-based prevention, institutional oral-health protocols, and equity-driven programs all lie within the domain of DPH [11-15]. Global policy frameworks—including the WHO Global Oral Health Action Plan 2023–2030 and Resolution WHA74.8—explicitly call for disability-inclusive, cross-sectoral, and rights-based oral health systems [12, 16, 17]. These align directly with the TRIAD-OH proposition that ecological, public-health, and clinical perspectives must be considered jointly to improve outcomes. The expanding challenge of AMR reinforces this need for integration. SCD populations often require prophylactic or repeated antibiotics due to immunosuppression, polypharmacy, or complex comorbidities [18], while dentistry continues to contribute a substantial proportion of outpatient antibiotic prescriptions [9]. OH supports multisectoral AMR control, while DPH provides stewardship, regulatory guidance, and surveillance infrastructure. As summarized in Table 1, multiple determinants relevant to disability-inclusive oral health lie at the intersection of OH, DPH, and SCD. These encompass environmental exposures, zoonotic interfaces, institutional-care challenges, AMR dynamics, and social determinants, each shaping vulnerability and access in distinct but interconnected ways. These intersections reinforce that ecological, public-health, and clinical factors continuously operate together to shape oral-health trajectories for persons with disabilities. The TRIAD-OH model (Figure 1) conceptualizes these three domains as mutually reinforcing vertices of a unified system. SCD contributes specialized clinical expertise; OH brings ecological and zoonotic awareness; and DPH anchors prevention, equity, population surveillance, and policy coherence. Together, they create a triadic platform for integrated, resilience-focused oral healthcare. Each domain feeds into and reinforces the others, generating a constantly renewing cycle of prevention, surveillance, clinical expertise, cross-sectoral coordination, and disability-responsive policy action. In this way, the model functions as an innovative, systems-oriented mechanism capable of deciphering and harmonizing the complex environmental, clinical, social, and public-health determinants shaping oral health outcomes for people with disabilities. Its circular, interlocking design reflects the reality that equity-driven oral healthcare is not linear but iterative—requiring continuous interaction across disciplines, sectors, and levels of the health system. Evidence demonstrates the feasibility of such integration. The OH Clinic providing co-located medical, dental, and veterinary services improved care utilization among underserved individuals and their animals [18-20]. Goa's multiagency OH rabies-elimination campaign achieved zero human deaths through cross-sectoral coordination [15]. Oral-hygiene interventions in long-term-care facilities have reduced pneumonia incidence, illustrating the human–environment–microbial interface central to OH and directly relevant to SCD [3, 7]. These examples reflect the practical value of coordinated approaches. Routine risk assessment incorporating environmental, zoonotic, and social determinants. Disability-inclusive surveillance and prevention embedded within national DPH systems. Integrated policy alignment with OH missions, AMR plans, climate-health strategies, and disability-rights frameworks. Transdisciplinary education and research, including ecological determinants, interprofessional teaching, and implementation science. These measures position SCD within a resilient, equity-oriented, and multisectoral oral-health ecosystem. The TRIAD-OH model offers a concise systems perspective for aligning OH, DPH, and SCD to address the complex and interdependent determinants of oral health for persons with disabilities. This triadic alignment reflects global priorities for inclusion, sustainability, and Universal Health Coverage. As ecological and systemic pressures continue to evolve, a unified approach that connects environmental insight, public-health infrastructure, and specialized clinical care is essential for ensuring equitable and resilient oral healthcare for populations most at risk. The authors declare no conflicts of interest.