Candidatus Saccharibacteria (TM7) is an underexplored bacterial group within the human oral microbiome. These ultra-small, host-dependent organisms, despite their reduced genomes, significantly influence microbial balance and host immunity, exhibiting dual roles in oral health and disease and emerging as a key focus in microbiome research. This systematic review aimed to synthesize evidence on the prevalence, host interactions, genomic features, and ecological roles of TM7 in the oral cavity. A total of 13 peer-reviewed studies published between 2020 and 2025 were selected for detailed review based on predefined inclusion criteria, including clinical, laboratory, and metagenomic analyses focusing on TM7 detection, isolation, host specificity, and interactions with oral microbial communities. TM7 was found to be predominantly oral-adapted, exhibiting site-specific colonization with higher abundance in saliva. Coculture experiments demonstrated strict host dependence, particularly on Actinomyces, Schaalia, and Arachnia species, with strain-specific variations affecting host viability and microbial networks. TM7 genomes are highly reduced, with specialized adaptations including type IV pili and arginine deiminase pathways. Interactions with the immune system were context-dependent, with both immunomodulatory and pro-inflammatory outcomes observed. Detection methods significantly influenced TM7 prevalence and functional interpretation. Overall, TM7 represents a host-dependent, ecologically influential oral bacterium with genomic specialization, strain-level variability, and complex interactions within microbial communities. These findings highlight its potential roles in oral health and disease and emphasize the need for advanced multi-modal analytical approaches.