Associations Between Lifestyle, Habits, Quality of Life and Non-Carious Diseases: A Scoping Review

Abstract

This scoping review aimed to map and synthesize the scientific evidence on how lifestyle factors and quality of life are associated with the onset and progression of non-carious diseases (NCDs) in young and adult populations, identifying patterns, methodological characteristics, and gaps in the existing literature. A systematic literature search was conducted across PubMed, Embase, Scopus, and Web of Science databases to retrieve studies evaluating the influence of lifestyle habits and quality of life indicators on NCDs development and worsening. Most included studies were conducted in Brazil, with cross-sectional designs being the most prevalent. The main modulating factors identified included gastroesophageal reflux, post-bariatric conditions, smoking, bruxism, and anxiety. The results were summarized through a descriptive narrative synthesis. Considerable methodological heterogeneity was observed, particularly due to the absence of standardized protocols for NCDs assessment. Methodological quality was also evaluated to contextualize the robustness of the available evidence. Overall, lifestyle and quality of life factors play an important role in the progression of NCDs, underscoring the need for their integration into diagnostic and therapeutic planning. Further clinical studies are warranted to deepen the understanding of the relationship between NCDs and broader health domains, with particular attention to early oral aging syndrome (EOAS).

1. Introduction

Non-carious cervical lesions (NCCLs) began to receive more scientific attention in 1991, when the study entitled “Abfractions: A New Classification of Hard Tissue Lesions of Teeth”, summarized NCCLs as a type of abfraction lesion resulting from biomechanical stress forces acting on the tooth structure [1]. Another term frequently used in the literature is erosive wear or dental erosion, also scientifically referred to as tooth wear [2]. However, this terminology has gradually fallen out of favor with the emergence of newer classifications [3].

Over the decades, further studies were conducted, until defined non-carious diseases (NCDs) were defined as oral conditions of non-bacterial origin that are intrinsically associated with individual habits, lifestyle, and quality of life [3]. The term NCD is based on a specific conceptual framework. The study in question describes NCDs as a group comprising non-carious lesions (NCLs), dentin hypersensitivity (DH), gingival recession (GR), fractures/cracks, and pulpal damage (PD) [3]. In cases of pulpal damage, ischemia, calcification, or necrosis may be observed. GR may be associated with the occurrence of bone resorption. NCLs are more commonly found and related on the cervical surface but may also occur on the occlusal, incisal, palatal, or buccal surfaces. DH affects the cervical, palatal, buccal, occlusal, or incisal surfaces. Finally, fractures or cracks can be observed in the enamel or dentin [3,4,5].

The application of anamnesis is an essential component in the diagnostic process and in dental treatment planning, enabling the clinician not only to identify the patient’s chief complaints but also to understand the broader context of their overall health. A detailed anamnesis, including an investigation of daily habits and lifestyle factors such as diet, physical activity, and even sleep quality, is crucial for identifying risk factors that may impact oral health. This practice is particularly relevant to help in the diagnosis of NCDs, which are frequently associated with behavioral factors, thereby reinforcing the need for a holistic approach. In this way, anamnesis guides the selection of the most appropriate therapeutic interventions, promoting comprehensive health and preventing the progression of conditions that may compromise the patient’s quality of life [3,4,5].

The Early Oral Aging Syndrome (EOAS) is a term used to describe individuals whose oral cavity exhibits pathological signs of accelerated aging that are inconsistent with their physiological age. These individuals present with a mouth free of bacterial plaque accumulation but with clinical features that deviate from what is considered normal. This syndrome arises from a combination of multiple factors associated with NCDs and can be classified into four levels or stages: EOAS-0, EOAS-1, EOAS-2, and EOAS-3. Among these, EOAS-1 is the only stage considered reversible [3,4,5]. When analyzing the behavior of NCDs, their occurrence is often found to be correlated with the presence of gastric diseases, temporomandibular disorders, orofacial pain, psychiatric/psychological disorders, sleep disturbances, and dietary habits. In other words, the patient’s lifestyle and specific habits play a modulatory role in the development of NCDs [3,4,5,6].

In this context, risk groups and contributing factors for these conditions, and for the potential development of EOAS, can be identified and described as correlated. These include: moderate to severe anxiety disorders, individuals with obstructive sleep apnea (OSA), former orthodontic appliance users, individuals who use electronic smoking devices (ESDs), presence of awake and/or sleep bruxism, as well as the use of illicit substances or corrosive medications, pharmacological treatment for anxiety and ADHD, high-performance athletes, individuals following an acidic or sport-specific diet, burnout syndrome, excessive occupational demands, double work shifts, and individuals with other psychiatric disorders. Additional associated conditions include gastroesophageal reflux disease (GERD), mouth breathing, bulimia, anorexia, post-bariatric surgery patients, salivary alterations, and individuals with molar-incisor hypomineralization (MIH) [3,4,5,6,7,8,9].

Thus, this exploratory review aimed to map and synthesize the scientific evidence on how lifestyle factors and quality of life are associated with non-carious diseases in young and adult populations, identifying patterns, methodological characteristics, and gaps in the existing literature.

2. Materials and Methods

2.1. Protocol and Registration

This review was not registered in a formal protocol prior to its development. Nevertheless, the entire process was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) and the Joanna Briggs Institute (JBI) methodological guidance. No substantial methodological changes were made after the initiation of the review. The research question, eligibility criteria, search strategy structure, and analytical procedures adhered to the steps originally defined by the research team. Minor operational adjustments, such as refining search terms within specific databases and expanding gray literature sources, were made solely to improve retrieval precision and did not alter the scope or objectives of the review.

2.2. Eligibility Criteria

Technical and scientific publications that discussed the influence of lifestyle and the progression of NCDs, considering individuals’ and/or groups’ specific habits and related risk factors, were considered eligible. Articles characterized solely as clinical or therapeutic protocols, laboratory-based studies, ex vivo or animal studies, as well as texts that did not align with the study scope or did not address a young or adult population, were excluded.

2.3. Information Sources

This study is a scoping review addressing how lifestyle and quality of life influence the onset and progression of NCDs. This type of systematic literature review enables a broad analysis of bibliographic productions, generating a narrative that enhances the understanding of existing research and the proposed topic [10]. To ensure methodological rigor, the checklist from the Preferred Reporting Items for Systematic Reviews and Meta-Analyses–Extension for Scoping Reviews (PRISMA-ScR) was followed (Table S1).

The research question was formulated using the Population, Concept, and Context (PCC) framework. In this review, the Population, initially defined as “young adults,” was operationalized with flexibility because many relevant studies included broader age ranges. Thus, studies involving young and adult populations were included when they contributed evidence to the topic. The Concept encompassed non-carious diseases (including dental erosion, dental wear, tooth wear, non-carious lesions, non-carious cervical lesions and similar) and their relationships with lifestyle and quality of life. The Context included community-based, outpatient, and population-based settings, without geographic restrictions, to reflect real-world conditions under which NCDs develop.

Accordingly, the research question guiding this review was:

“What has the scientific literature reported on the influence of lifestyle and quality of life in young and adult populations as modulatory factors of non-carious diseases?”

2.4. Search Strategy

The databases selected to identify scientific and technical literature related to the topic were: PubMed, Embase, Scopus, and Web of Science. Additional databases such as Cochrane Library, LILACS and SciELO were not included because exploratory searches indicated minimal contribution of these sources to the identification of primary studies relevant to the topic. The Medical Subject Headings (MeSH) vocabulary was used to identify the main descriptors: “non carious disease,” “quality of life,” and “young adult.” Search terms and their synonyms were combined using the Boolean operators “AND” and “OR” to construct search expressions tailored to each of the selected databases (Table S2).

The search strategy was conducted in February 2024. Being constantly updated during the writing of the study until December 2025, in order to analyze possible new articles that contemplate the scope of the review. The identified scientific and technical records were exported to the Zotero reference manager. Duplicate records were automatically removed and then manually reviewed by the authors for additional deduplication.

2.5. Selection Process

The article selection process was conducted independently and duplicated by two individual researchers (RSTF and GMTP), based on the established eligibility criteria. Initially, studies were screened by title. In the second phase, abstracts were reviewed, followed by the full-text screening in the final phase. All discrepancies were discussed and resolved by the reviewers, and a third reviewer (PVS) was consulted when necessary to reach consensus.

2.6. Data Extraction

Two summary tables were developed to extract and organize the most relevant information from each article. The items extracted for Table 1 included general publication data (author and year), study characteristics (study design, country of origin, age and gender of the population studied, number of participants, and total sample size), as well as methods used to analyze risk factors and NCDs. For Table 2, the extracted data included general publication information (author and year), the groups of NCDs analyzed, associated modulatory risk factors, and a brief summary of each article.

Table 1. General characteristics of the studies included in the review, detailing author, year of publication, study design, country, age group, gender distribution, number of participants, total sample size, and method of analysis.

Author	Year	Study Design	Country	Age	Gender	Participants	Total Sample Size	Method of Analysis
Bader JD, McClure F, Scurria MS et al. [11]	1996	Case-control study	United States	-	Male and female	-	264	Clinical examination; Dietary and behavioral questionnaires; Study model analysis; Saliva data collection
Jiang H, Du MQ, Huang W et al. [12]	2009	Cross-sectional study	China	35–44 and 65–74	Male and female	M: 1064 F: 1064	2160	Clinical examination; Questionnaire on oral health habits (brushing frequency, bruxism); Questionnaire on socioeconomic status
Yoshikawa H, Furuta K, Ueno M et al. [13]	2011	Clinical study	Japan	26–79	Male and female	M: 31 F: 39	70	Clinical examination; Questionnaire on medical, dietary, and dental history; Endoscopic examination for GERD diagnosis and classification; Salivary flow volume test; Repetitive saliva swallowing test
Fukumoto Y, Horibe M, Inagaki Y et al. [14]	2013	Clinical study	Japan	19–79	Male and female	M: 192 F: 254	446	Clinical examination; Questionnaire on smoking habits; Plaque assessment; Evaluation of tooth wear level
Closs LQ, Bortolini LF, dos Santos-Pinto A, Rösing CK [15]	2014	Retrospective study	-	14–29	Male and female	-	-	Lateral cephalograms scanned and analyzed with Radioceph® (São Paulo, SP, Brazil); Lower incisor inclination measured via IMPA
Zhang Y, Cheng R, Cheng G, Zhang X [16]	2014	Case-control study	China	30–69	Male and female	M: 654 F: 786	1440	Clinical examination; Investigative questionnaire; Fluoride concentration measurement in water
Rios FS, Costa RSA, Moura MS et al. [17]	2014	Cross-sectional observational study	Brazil	>35	Male and female	M: 213 F: 810	1023	Clinical examination; Questionnaire on smoking exposure and oral hygiene; History of periodontal treatment; Calculus percentage evaluation
Costa RSA, Rios FS, Moura MS et al. [18]	2014	Cross-sectional observational study	Brazil	35–95	Male and female	M: 398 F: 827	1225	Clinical examination; Questionnaire on smoking habits
Isaksson H, Birkhed D, Wendt LK et al. [19]	2014	Longitudinal study	Sweden	20	Male and female	M: 235 F: 259	494	Clinical examination; Questionnaire on dietary habits
Hasselkvist A, Johansson A, Johansson AK. [20]	2016	Prospective longitudinal study	Sweden	13–14	Male and female	-	227	Clinical examination; Questionnaire on consumption habits and lifestyle factors; Written survey (oral hygiene routines, oral/GI symptoms, medication intake, general health, acidic soft drink retention); Oral interview (current/former beverage intake)
Seong J, Bartlett D, Newcombe RG et al. [21]	2018	Cross-sectional epidemiological study	United Kingdom	18–35	Male and female	M: 128 F: 221	350	Clinical examination; Questionnaire on demographics and oral hygiene practices
Teixeira DNR, Zeola LF, Machado AC et al. [22]	2018	Cross-sectional study	Brazil	19–50	Male and female	M: 68 F: 117	185	Clinical examination; Questionnaire on medical history, hygiene quality, brushing type, dietary habits, parafunctional habits, gastroesophageal disorders; Occlusal trauma assessed with carbon paper; Non-carious cervical lesions (NCCLs) classified by morphology (saucer/wedge) and depth (shallow, moderate, deep)
Savage KO, Oderinu OH, Oginni AO et al. [23]	2019	Cross-sectional study	Nigeria	18–35	-	-	1349	Clinical examination; Questionnaire
Taghat N, Werling M, Östberg AL [24]	2019	Cross-sectional observational study	Sweden	21–60	Male and female	M: 161 F: 492	653	Oral Health Impact Profile (OHIP-49) questionnaire
Medeiros TLM, Mutran SCAN, Espinosa DG et al. [25]	2020	Cross-sectional study	Brazil	18–49	Male	M: 43	43	Clinical examination; Questionnaire; Laboratory salivary analysis
Xiang B, Wong HM, Perfecto AP, McGrath CPJ [26]	2020	Cross-sectional study	Hong Kong	Mean age: 14, 32	Male and female	M: 619 F: 540	1207	Clinical examination; Child Perception Questionnaire
Demarco FF, Cademartori MG, Hartwig AD et al. [27]	2021	Cohort study	Brazil	31	Male and female	M: 273 F: 265	539	Clinical examination; Questionnaire on smoking habits; Questionnaire on brushing frequency; Questionnaire on bruxism and tooth wear
Kolak V, Ristić T, Melih et al. [28]	2022	Cross-sectional observational study	Serbia	19–55	Male and female	M: 169 F: 225	394	Clinical examination; Questionnaire on dietary habits (citrus fruits and energy drink consumption)
John S, John PK [29]	2023	Cross-sectional study	India	18–87	Female	-	354	Clinical examination (gingival index, plaque index, attached gingiva, frenal insertion, biotype, occlusal trauma, malocclusion); Questionnaire on demographics, behavioral factors, and comorbidities
Goergen J, Costa RSA, Rios FS et al. [30]	2023	Cross-sectional study	Brazil	35–60	Male and female	M: 397 F: 625	1022	Clinical examination; Questionnaire on xerostomia, halitosis, and perceived need for dental treatment
Zimmer R, Barbosa GF, Portella FF, Soares PV, Reston EG [31]	2025	Cross-sectional study	Brazil	18–45	Male and female	M: 42 F: 115	157	Clinical examination; DH measure using a visual numeric scale (VNS); Questionnaire related to their lifestyle and daily habits and Beck Anxiety Inventory (BAI)

Table 2. Main findings of the eligible studies, including the non-carious diseases described, modulating factors, and a summary of the key results.

Author	Year	Non Carious Disease Described	Modulating Factor	Summary
Bader JD, McClure F, Scurria MS et al. [11]	1996	Non-carious cervical lesion	Occlusal pattern; Diet/Endogenous factors; Medication; GI disorders; Toothbrushing habits; Salivary variables	This article highlights that non-carious cervical lesions are multifactorial. The factors involved in lesion onset may differ from those associated with progression. Associations were analyzed between non-carious cervical lesions and occlusion, diet/endogenous factors, medication, salivary variables, gastrointestinal issues, and brushing habits.
Jiang H, Du MQ, Huang W et al. [12]	2009	Non-carious cervical lesions	Brushing frequency; Bruxism; Socioeconomic status	Urban residents had a higher prevalence of non-carious cervical lesions than rural ones. Lower brushing frequency and the presence of bruxism were linked to increased non-carious cervical lesions. Higher family income also correlated with a greater prevalence of these lesions.
Yoshikawa H, Furuta K, Ueno M et al. [13]	2011	Dental erosion	Gastroesophageal reflux disease; Xerostomia; Swallowing difficulties	Patients with xerostomia and gastroesophageal reflux disease related swallowing difficulties had a higher prevalence of dental erosion.
Fukumoto Y, Horibe M, Inagaki Y et al. [14]	2013	Gingival recession; Dentin hypersensitivity; Dental erosion	Brushing habits	The study suggests an association between dentin hypersensitivity and gingival recession, with the primary cause being abrasion from hard-bristled toothbrushes. No significant link was found between smoking or acidic food intake and hypersensitivity. V-shaped cervical lesions were strongly correlated with hypersensitivity.
Closs LQ, Bortolini LF, dos Santos-Pinto A, Rösing CK [15]	2014	Gingival recession	Orthodontic treatment	Chin symphysis dimensions alone were not associated with post-orthodontic gingival recession. However, plaque control and gingival thickness were identified as risk factors.
Zhang Y, Cheng R, Cheng G, Zhang X [16]	2014	Dentin hypersensitivity	Brushing habits; Acidic diet; Gastroesophageal reflux disease; Bruxism; Soft drink intake	Gastroesophageal reflux disease was the only significant risk factor for dentin hypersensitivity. Diet, oral hygiene habits, and economic development influenced dentin hypersensitivity incidence. Lower prevalence was observed in areas with mild dental fluorosis.
Rios FS, Costa RSA, Moura MS et al. [17]	2014	Gingival recession	Smoking; Education level	A history of smoking increased gingival recession. Interestingly, higher education levels (especially tertiary education) were also associated with greater recession frequency.
Costa RSA, Rios FS, Moura MS et al. [18]	2014	Dentin hypersensitivity; Gingival recession; Dental erosion	Smoking; Gingival recession	Smoking was found to be a major aggravating factor for dentin hypersensitivity. Premolars were the most affected teeth. Gingival recession was a significant risk indicator for dentin hypersensitivity.
Isaksson H, Birkhed D, Wendt LK et al. [19]	2014	Dental erosion	Acidic diet	Dental erosion was shown to be multifactorial, influenced by dietary and behavioral habits—especially acidic food intake and brushing.
Hasselkvist A, Johansson A, Johansson AK [20]	2016	Dental erosion	Acidic beverage intake; Snacking frequency; Use of dietary items; Brushing habits	The study found common erosive lesions in Swedish adolescents, with a significant relationship between lifestyle choices and dental erosion progression.
Seong J, Bartlett D, Newcombe RG et al. [21]	2018	Gingival recession; Dentin hypersensitivity; Non-carious cervical lesions	Daily training time; Fasting lemon water intake; Use of desensitizing toothpaste; Dentin hypersensitivity; Prior orthodontic treatment	Desensitizing toothpaste may mask dentin hypersensitivity and delay diagnosis. Fasting lemon water intake and daily training (≤1 h) were associated with increased non-carious cervical lesions prevalence.
Teixeira DNR, Zeola LF, Machado AC et al. [22]	2018	Non-carious lesions; Dentin hypersensitivity; Gingival recession	Daily training time; Lemon water intake; Desensitizing toothpaste; Orthodontic treatment	Fasting lemon water intake, ≤1 h daily training, and prior orthodontics were associated with increased non-carious lesions. Desensitizing toothpaste delayed diagnosis.
Savage KO, Oderinu OH, Oginni AO et al. [23]	2019	Dentin hypersensitivity	Brushing habits; Acidic diet	Dentin hypersensitivity was associated with brushing after breakfast, brushing frequency, and technique. Fresh fruit and juice intake were also modulating factors. No significant link was found with smoking, medication use, or chewing gum.
Taghat N, Werling M, Östberg AL [24]	2019	Non-carious lesions	Gastroesophageal reflux disease; Vomiting episodes; Bariatric surgery	Dentin hypersensitivity was worsened in patients post-bariatric surgery, likely due to increased vomiting and acid reflux.
Medeiros TLM, Mutran SCAN, Espinosa DG et al. [25]	2020	Non-carious lesions	Daily training time; Fasting lemon water; Toothpaste type; Dentin hypersensitivity; Prior orthodontic treatment; Occlusal pattern	Early-stage non-carious cervical lesions with stress signs were observed in athletes. Despite normal cortisol and salivary parameters, >2 h daily training, lemon water, and prior orthodontics were considered modulating factors.
Xiang B, Wong HM, Perfecto AP, McGrath CPJ [26]	2020	Non-carious lesions	Socioeconomic status; Anxiety; Diet	Adolescents with higher anxiety levels were more likely to develop non-carious lesions.
Demarco FF, Cademartori MG, Hartwig AD et al. [27]	2021	Non-carious cervical lesions	Gingival recession; Smoking	Non-carious cervical lesions were more prevalent in premolars in the maxilla and less common in women. Smokers had more non-carious cervical lesions. Gingival recession increased the odds of non-carious cervical lesions by tenfold.
Kolak V, Ristić T, Melih et al. [28]	2022	Non-carious cervical lesions; Dentin hypersensitivity	Acidic diet; Poor oral hygiene; Bruxism; Smoking	Parafunctional habits such as bruxism accelerated tooth wear and non-carious cervical lesion development. Infrequent brushing and abrasive toothpaste use contributed to lesion progression. Acidic foods/drinks also played a role.
John S, John PK [29]	2023	Gingival recession	Smoking; Socioeconomic status; Malocclusion; Brushing habits	Gingival recession was linked to low socioeconomic status and malocclusion. Smoking and hard-bristled toothbrushes were aggravating factors.
Goergen J, Costa RSA, Rios FS et al. [30]	2023	Non-carious cervical lesions	Xerostomia; Brushing frequency; Dental visits frequency; Smoking; Systemic conditions	Gingival recession was indirectly associated with reduced oral health-related quality of life due to increased dentin hypersensitivity. Tobacco exposure (in years) was a relevant factor for non-carious cervical lesions, along with xerostomia, halitosis, and brushing frequency.
Zimmer R, Barbosa GF, Portella FF, Soares PV, Reston EG [31]	2025	Non-carious cervical lesions; dentin hypersensitivity	Anxiety; Antidepressants; Whitening toothpaste; Brushing teeth immediately after meals	The prevalence of DH reached 84.7%, while NCCL were observed in 49.7% of the sample. Both conditions were highly frequent and demonstrated mutual association, as well as relationships with individuals’ lifestyle patterns and daily habits. Participants exhibiting signs of anxiety showed a greater likelihood of presenting DH, whereas those who possessed knowledge about the etiological factors displayed a reduced prevalence of the condition.

2.7. Data Mapping Process

Data extraction was performed independently by two individual reviewers (RSTF and GMTP) using pre-designed and pilot-tested forms developed by the research team. These tools were calibrated to ensure consistency and minimize potential errors during data collection. In cases of disagreement, a third reviewer (PVS) was consulted to resolve discrepancies and reach consensus.

2.8. Data Items

The extracted variables included: (1) General study information: author, year of publication, and country of origin; (2) Characteristics of the analyzed population: age, gender, and sample size; (3) Study design: type of study and methods employed; (4) Identified modulating factors: lifestyle, habits, systemic and behavioral conditions; (5) Main findings: relationship between modulating factors and non-carious diseases.

When a given variable was not reported in the included studies, it was assumed to be absent.

2.9. Critical Appraisal of Individual Sources of Evidence

Although scoping reviews do not require a formal risk of bias assessment, we followed PRISMA-ScR and JBI guidance to describe the overall methodological quality of the included evidence. For this purpose, we conducted a structured appraisal of key methodological characteristics across all eligible studies.

This appraisal did not aim to generate individual risk-of-bias scores. Instead, it sought to identify recurring strengths and weaknesses that may influence the robustness of the synthesized evidence. The following domains were examined:

• Study design and level of evidence (e.g., cross-sectional, cohort, case–control).
• Sampling strategy, including use of convenience samples or unclear recruitment procedures.
• Sample representativeness, particularly regarding population diversity and clinical settings.
• Diagnostic criteria and outcome measurement, noting heterogeneity or lack of standardized methods.
• Calibration and training of examiners, when applicable.
• Potential sources of bias, such as recall bias, self-reported data, or limited adjustment for confounding factors.
• Overall clarity and completeness of reporting, following principles consistent with STROBE and JBI guidance.

The appraisal results were summarized narratively and tabulated to facilitate comparison across study designs. This descriptive methodological assessment guides the interpretation of the findings by clarifying the limitations that commonly affect observational research and by reinforcing that reported associations cannot be interpreted as causal relationships.

The data were organized into summary tables to facilitate the presentation and comparison of findings. The results were grouped according to the objectives of the review, with emphasis on modulating factors of non-carious diseases and their implications for quality of life. A qualitative analysis was conducted to identify relevant patterns and trends within the extracted data.

3. Results

3.1. Selection of Sources of Evidence

The search strategy yielded a total of 10.886 articles. During the selection process, 8.143 records were excluded based on title and abstract screening, resulting in 41 articles selected for full-text reading. Ultimately, 21 articles were deemed eligible for inclusion in the study. Figure 1 presents the PRISMA-ScR flowchart illustrating the identification and selection process of the studies.

Figure 1. PRISMA flowchart illustrating the identification, screening, eligibility, and inclusion of studies in the review process.

Details of the selected studies, including the analyzed population and the factors considered in the qualitative synthesis, are presented in Table 1 and Table 2. The MapChart (Figure 2) presents the distribution of publications and corresponding sample sizes across countries.

Figure 2. Geographical distribution of the included studies and their corresponding sample sizes across countries, generated using MapChart.

3.2. Characteristics of the Sources of Evidence

3.2.1. General Characterization of the Studies Selected for Qualitative Synthesis

Most of the included studies were conducted in Brazil, and the most common study design among those selected for synthesis was cross-sectional. The analyzed populations were predominantly composed of young and adult individuals, particularly in the 18–45 age range. Among the evaluated groups of NCDs, DH, GR and NCLs were included, along with the various terminology alternatives reported in the scientific literature that have the same clinical meaning. However, conditions related to cracks/fractures and pulpal damage were not assessed. Of the 21 studies included in the analysis, 10 reported NCCLs or NCLs (47%), 5 mentioned dental erosion (25%), 7 addressed GR (35%), and 9 investigated DH (42%).

3.2.2. Association Between NCDs and Systemic and/or Surgical Conditions

The modulatory factors of NCDs, considered a possible risk factor for these conditions, generally do not act in isolation but rather exhibit interrelated patterns. Moreover, these modulatory factors, often linked to an individual’s lifestyle or quality of life, may originate from or be associated with systemic and/or surgical conditions. Examples include GERD and patients who have undergone bariatric surgery [13,24].

3.2.3. Association Between NCDs, Habits, Behaviors, and Socioeconomic Status

Lifestyle-related habits were also shown a possible association to influence the modulation of NCDs. For instance, smoking was reported in 7 out of the 20 studies included in the synthesis (35%). Behavioral and socioeconomic factors also emerged as significant modulators of NCDs. In 10 of the 21 studies (47%), conditions such as bruxism, anxiety, and socioeconomic status were identified as a possible influence to the prevalence of these conditions.

3.2.4. Association Between NCDs and the Absence of Standardized Assessment Protocols

Finally, the analysis revealed a lack of standardized protocols for the evaluation and diagnosis of NCDs. A wide range of clinical examination methods and questionnaires were reported for identifying risk and modulatory factors. These included instruments such as the Oral Health Impact Profile (OHIP-14), Pain and Discomfort Questionnaires, Dietary and Behavioral Habit Questionnaires, BAI and Risk Assessment Tools. The absence of uniform methodologies contributes to variability in outcomes and limits the identification of consistent patterns among modulatory factors [11,12,13,14,15,16,17,18,19,20,21,22,23,24,25,26,27,28,29,30,31].

3.3. Methodological Characteristics and Overall Quality of the Included Evidence

A descriptive methodological appraisal was performed across all included studies using the domains outlined in the Methods Section. The synthesis revealed substantial variability in study design, sample characteristics, and diagnostic approaches. Most studies were cross-sectional and relied on convenience sampling, which limits representativeness. Heterogeneity in diagnostic criteria and limited reporting of potential confounders were also observed in some studies.

3.4. Results of Individual Sources of Evidence

The data extracted from each included study is organized in summary tables (Table 1 and Table 2). The general characteristics of the studies included information such as author, year of publication, study design, country of origin, participants’ age and gender, sample size, and methods used for analysis. For example: Employed a cross-sectional design to assess the influence of bruxism and brushing frequency on NCCLs in a sample of 2160 individuals in China [12]. Investigated the association between smoking and NCCLs in a Brazilian population of 539 participants, using clinical methods and questionnaires [27].

3.5. Synthesis of Results

The main findings highlighted the association with a possible several modulatory factors associated with NCDs, such as (1) Identified gastroesophageal reflux as a significant risk factor for DH [16]. (2) Reported that post-bariatric surgery patients can presented a higher prevalence of dental erosion/non-carious lesions due to increased episodes of vomiting and acid reflux [24]. Emphasized that smoking possible significantly increases the incidence of gingival recession [17]. The findings of this scoping review reinforce the associations of lifestyle and quality of life on NCDs:

3.5.1. Behavioral and Systemic Risk Factors

• Smoking: Reported in 7 out of 20 studies, associated with GR and DH.
• Bruxism and anxiety: Identified in 10 studies as possible modulators of NCDs, particularly in the progression of NCCLs and DH.

3.5.2. Systemic and Surgical Conditions

• GERD: Patients in 3 studies exhibited a higher prevalence of dental erosion/non-carious lesions.
• Post-bariatric conditions: Associated with increased incidence of vomiting and acid reflux.

3.6. Lack of Standardized Protocols

The methodologies employed across the studies varied considerably, including the use of questionnaires and specific clinical examinations, underscoring the need for standardized assessment protocols.

4. Discussion

4.1. Summary of Evidence

Most studies were conducted in young and adult populations, with a predominance of cross-sectional designs (70%), focusing primarily on behavioral factors such as acidic diet, anxiety, use of antidepressants, bruxism, and improper brushing habits.

To begin with, it is essential to emphasize that specific categories of NCDs can function as modulators of other NCDs, shaped by risk factors linked to an individual’s lifestyle and overall quality of life. When considering the clinical approach to diagnosing NCDs and identifying their modulatory risk factors, the first step is to conduct thorough anamnesis. Anamnesis represents the initial phase of diagnosis and involves the detailed collection of information regarding the patient’s chief complaint and medical history, being essential for high-quality care [32]. During this phase, it is possible to identify comorbidities such as diabetes, cardiovascular diseases, and hypertension, as well as to understand the patient’s emotional state, which is critical for appropriate management throughout treatment [33]. For a more accurate diagnosis and the development of patient-centered dentistry, an individualized anamnesis, addressing lifestyle factors and the human aspects of the patient, enables the dental professional to design a more effective and tailored treatment plan [34].

The accelerated transformations in lifestyle and quality of life, previously driven by globalization, were further intensified by the COVID-19 pandemic. This led to a significant global increase in anxiety levels [35]. During the pandemic, the uncertainty and complexity of the situation exacerbated psychological issues across the population, making individuals more vulnerable to stress [36]. In recent years, unhealthy relationships with work have also contributed to high stress levels, including instances of burnout. This is largely due to the intensification of work demands and the lack of clear boundaries between professional and personal life, resulting in an overall decline in well-being and quality of life [37].

The Beck Depression Inventory (BDI), when administered to patients in dental settings, can provide valuable insights into their emotional state, allowing for a better understanding of their oral health and lifestyle habits. This, in turn, contributes to a more holistic and integrated treatment approach [38]. Studies from external literature have shown that patients with BDI scores indicative of depression often present with DH, dental erosion, and habits involving the consumption of acidic foods and beverages, as well as dental clenching. Therefore, the BDI serves as an important tool for identifying potential etiological factors linked to psychological conditions, particularly in cases involving hypersensitivity, clenching, and dental erosion [39].

Furthermore, by linking an acidic diet as a significant factor in the prevalence of NCLs, it was observed that the frequent consumption of acidic foods and beverages, such as citrus fruits and energy drinks, plays a crucial role in the progression of these lesions [28]. 12 of the 20 (60%) articles included in the qualitative synthesis reported at least one type of dietary habit. Meanwhile, other studies have reported that individuals with lower income and higher anxiety levels were more likely to develop NCCLs, while bruxism was identified as a relevant risk factor in several studies included in the qualitative analysis [12,37].

There is a clear need for a standardized protocol for the assessment and evaluation of NCLs, as well as the incorporation of individualized anamnesis, particularly in the current context characterized by increased levels of anxiety, stress, and the pursuit of professional development [3]. Such a protocol, used alongside clinical examination and patient history, would facilitate the identification of risk factors related to lifestyle and quality of life, as well as personal habits and characteristics that influence the modulation of NCDs. The lack of a specific protocol hampers the standardization of diagnostic approaches.

It is worth noting that the population analyzed in the studies included consisted of young and adult individuals, as NCDs are considered pathological within this age group and, together with associated risk factors, constitute part of the EOAS. In contrast, when lesions such as NCLs, DH, GR, cracks/fractures, and pulpal damage occur in older adults, they are regarded as physiological and age-appropriate manifestations [3,7]. However, in the present review, studies addressing cracks/fractures and pulpal damage were not included, highlighting a gap in the clinical-scientific literature regarding factors associated with Early Oral Aging Syndrome (EOAS) in these specific contexts.

Three key aspects must be considered when evaluating the clinical examination for the diagnosis of NCDs: salivary assessment methods, DH testing, and GERD screening. Salivary proteins can provide protection against erosive tooth wear by regulating calcium and phosphate ions around the enamel surface [40]. Reductions in salivary flow may result from external factors such as comorbidities or intense physical activity, as well as from metabolic changes following surgical interventions, such as in post-bariatric patients. These reductions can compromise the protective capacity of saliva [41].

The harmful habit of smoking can also affect the composition and function of the salivary glands, exacerbating xerostomia by reducing salivary flow [42]. Saliva thus plays a crucial role in modulating NCDs, with hyposalivation and xerostomia being potential clinical features [39]. Studies have shown that smoking is associated with a higher prevalence of gingival recession, which consequently increases vulnerability to DH and NCCLs [17,27]. These findings support the multifactorial complexity of NCLs, in which behavioral and environmental factors interact and contribute synergistically.

The diagnostic process of DH should be multidimensional, starting with a comprehensive anamnesis that covers the patient’s medical and dental history, followed by a thorough clinical examination. This includes the use of air flow and water rinsing to simulate potential stimuli and assess the patient’s pain response, which can be measured using the Visual Analog Scale (VAS) [4,7,31,43,44]. It is essential that the dentist is able to differentiate DH from other dental conditions and to understand the etiological factors leading to this condition, such as the exposure of dentinal tubules and nerve endings, in order to ensure an accurate diagnosis and effective treatment [45].

The habit of brushing teeth with high frequency or using hard-bristled toothbrushes is reported as a risk factor for increased DH and gingival recession. Some studies highlight that vigorous brushing may be one of the main etiological factors in gingival recession, which is strongly associated with DH [14]. However, toothbrushing should not be considered the primary factor in the progression of the disease, but rather a contributing factor associated with another modulatory risk factor for NCDs [3].

Patients with GERD often present with NCLs, also known as dental erosion, which are detectable during clinical examinations. This finding is of utmost importance for indicating the presence of GERD or supporting its diagnosis [3,46,47]. Additionally, reflux indicators can also be identified in saliva, as patients with this condition tend to exhibit elevated levels of salivary bile acids, such as taurocholic acid and glycolic acid [3]. Early detection of GERD through clinical examination is essential to prevent the progression and spread of NCLs, thereby allowing the dental surgeon to initiate prompt intervention in the treatment of the disease, reducing the associated dental complications and, consequently, the severity classification within the new framework of the EOAS. Furthermore, it was observed that GR increased the prevalence of NCLs by approximately 10× [27].

These findings underscore the complexity and interrelationship among different NCDs, emphasizing the need for integrated approaches to diagnosis, treatment, and the identification of risk factors involved in disease modulation.

4.2. Limitations

This scoping review has some limitations that should be acknowledged to contextualize the interpretation of its findings. Although critical appraisal is not mandatory in scoping reviews, the absence of a formal assessment may limit the ability to judge the strength and reliability of the included evidence. Overall, the body of literature presented considerable methodological variability, including heterogeneous diagnostic criteria for NCDs, differences in data collection methods, and frequent use of convenience samples without clinical calibration. Most of the included studies employed cross-sectional designs, which inherently prevent establishing temporal relationships and therefore cannot support causal inferences between lifestyle factors, quality of life and non-carious diseases. The presence of common confounders, such as socioeconomic status, oral hygiene behaviors, dietary habits, and access to dental care, further constrains the interpretation of observed associations. Additionally, the geographical concentration of studies in Brazil and China may limit the generalizability of the results to broader populations. Despite these limitations, this scoping review offers a comprehensive mapping of current evidence, highlights important knowledge gaps, and underscores the need for well-designed longitudinal studies with standardized diagnostic frameworks to strengthen future research on modulating factors of non-carious diseases.

4.3. Implications for Research and Practice

This scoping review synthesizes the heterogeneous evidence on how lifestyle and quality of life have been examined as modulatory factors of non-carious diseases. By organizing the existing knowledge and identifying methodological gaps, the review supports a clearer understanding of the field and offers guidance for future research and preventive approaches in dental practice

5. Conclusions

This scoping review mapped how lifestyle, behavioral and quality of life factors have been examined as modulators of NCDs. The evidence synthesized indicates that dietary habits, particularly frequent exposure to acidic foods and beverages, were the most consistently reported contributors to the progression of non-carious lesions. Behavioral and psychosocial factors, such as anxiety, parafunctional habits, and bruxism, were also frequently associated with non-carious cervical lesions and dentin hypersensitivity. Smoking, use of antidepressants and systemic conditions, including gastroesophageal reflux and post-bariatric states, additionally appeared as relevant modulatory factors within the included studies.

While the heterogeneous methodologies and predominance of cross-sectional designs limit the strength of inferences, the overall findings reinforce the multifactorial nature of NCDs and highlight the importance of incorporating lifestyle-related risk assessment into preventive and therapeutic dental care. This review also identifies important gaps, such as the lack of standardized diagnostic criteria and the scarcity of longitudinal evidence, which should guide future research. By organizing and clarifying the current evidence landscape, this scoping review contributes to advancing the clinical and scientific understanding of NCDs and supports the development of more integrated approaches consistent with the EOAS conceptual framework.