Introduction <p>Oral health is an important yet often neglected aspect of antenatal care. Despite evidence linking poor maternal oral health with adverse pregnancy outcomes, pregnant women underutilize dental services due to individual, cultural, and systemic barriers. This is the first systematic review using mixed-methods approach that synthesized quantitative and qualitative evidence on this topic.</p> Methods <p>A mixed-methods systematic review was conducted using Joanna Briggs Institute (JBI) methodology and reported per PRISMA guidelines. Eligible studies included those exploring barriers and facilitators to dental service utilization among pregnant women. Searches across six databases and grey literature sources were conducted. Quantitative data were qualitized and integrated with qualitative findings using JBI’s convergent integrated approach. Findings were reported based on Andersen’s Behavioral Model of Health Services Use.</p> Findings <p>The review included 55 studies (37 quantitative, 17 qualitative, 1 mixed-methods) from 24 countries. Eight key themes based on Andersen’s Behavioral model emerged. Barriers included misconceptions, safety concerns, dental treatment fear, high costs, lack of insurance coverage, poor referral systems, limited provider training, competing priorities, and cultural taboos. Facilitators included higher education, employment, urban residence, and provider support.</p> Discussion <p>This is the first systematic review offering a comprehensive synthesis of the multifaceted barriers and facilitators shaping pregnant women’s decisions to seek oral care. It integrated global prevalence data from quantitative studies with the lived experiences of pregnant women through qualitative studies. Andersen’s model enabled structured interpretation of individual, contextual, and health-related determinants.</p> Recommendations <p>It is important to develop culturally sensitive and integrated strategies to enhance maternal oral health service utilization across diverse settings. Policies should mandate integration of oral health into antenatal care, expand dental insurance for pregnant women, and enhance interprofessional training. Further research should explore longitudinal patterns, develop validated tools, and address intersectional disparities in access.</p> Systematic review registration <p>PROSPERO CRD42025642722.</p>