Introduction:
Oral diseases remain a major global health challenge, affecting app. 3.5 billion people. While traditional etiological models have focused primarily on behavioural and microbial factors, the disproportionate disease burden in industrializing regions suggests the presence of overlooked non-behavioural determinants.

Objective:
The aim of the review is to synthesize current literature regarding the ‘oral exposome’ analyzing how environmental determinants-specifically atmospheric pollutants, heavy metals and chemical contaminants impact oral health throughout the lifespan.

Brief description of the state of knowledge:
Recent research suggests that environmental toxicants may act as systemic stressors, potentially compromising oral homeostasis through a variety of mechanisms. Regarding dental caries, exposure to second-hand smoke (SHS) suppresses local immune responses, while heavy metals, such as lead, induce enamel hypoplasia via ionic substitution in the hydroxyapatite lattice. Periodontal health is similarly modulated by environmental factors, fine particulate matter and cadmium exposure trigger systemic oxidative stress and inflammation, accelerating alveolar bone resorption. Furthermore, maternal exposure to ambient air pollution and occupational hazards acts as a critical teratogen for orofacial clefts, particularly when interacting with genetic variants in folate metabolism. Finally, longitudinal data implicate gaseous pollutants and formaldehyde in the pathogenesis of nasopharyngeal carcinoma.

Summary:
Evidence necessitates integrating environmental risk assessment into preventive dentistry. Pollutants are involuntary risk factors acting synergistically with other determinants. Mitigation strategies are urgent for reducing the disease burden and informing policy.