Barriers and facilitators of preventive oral health care in Iran from the perspective of dentists: a qualitative study

Oral diseases are among the most prevalent and largely preventable non-communicable diseases, yet many health systems remain treatment-oriented. In Iran, oral health care is delivered predominantly in the private sector on a fee-for-service basis, and most preventive procedures are not covered by insurance. Iranian evidence comes mainly from a survey with pre-specified barrier categories, which cannot show what dentists count as prevention or how barriers at different levels relate to one another. This study aimed to explore the barriers and facilitators of preventive oral health care in Iran from the perspective of dentists. Semi-structured interviews were conducted with 13 dentists selected through two-stage purposive sampling with maximum variation, including dentists who did and did not deliver preventive care. Data were analysed using reflexive thematic analysis (Braun and Clarke), supported by MAXQDA. Reporting follows the COREQ checklist. Participants held no shared definition of prevention. Four themes were constructed. The first three grouped barriers by the source to which participants attributed them: patients (low perceived value of prevention, pain-driven attendance, distrust and cost), the profession (ambivalence between endorsing prevention and practising within a treatment-driven economy), and governance (tariffs and insurance rules that do not pay for prevention, and no identifiable body responsible for it). The fourth described where prevention persisted: it rested on continuity, trust and personal commitment, whereas the changes participants called for were predominantly structural. In many interviews, patients were named as the immediate reason for limited prevention, while tariffs, insurance and the organisation of practice were described as the conditions under which participants themselves had reduced it. In dentists’ accounts, limited preventive care arose from patient-, profession- and governance-level constraints that participants described as interconnected. Preventive practice that persisted depended largely on individual effort. Participants identified tariffs, insurance coverage, education and the standing of oral health as areas requiring change, suggesting that measures addressing dentists’ motivation alone may be insufficient; these perceptions warrant examination alongside the views of other stakeholders.