BackgroundThere is limited understanding of the complexities surrounding public oral health service delivery in South Africa and the resulting impact on oral health outcomes.AimThis study aimed to identify the strengths and challenges in oral health decision-making within the public health sector and to propose a conceptual framework to guide oral health service delivery in the province.SettingThis study was performed in the Limpopo province.MethodsNational and provincial health policy documents were reviewed to identify statements on oral health service delivery. A face-to-face, semi-structured interview was conducted with the Limpopo Provincial Manager of Department of Health, Oral Health Services. Data were collected on oral health policies and the organisational structure of public oral health services. A self-administered questionnaire was completed by five district managers of public oral health services to obtain data on the delivery of public oral health services in Limpopo province.ResultsThe results indicated that oral healthcare was not explicitly mentioned, included or referred to in the examined health policy documents. The interviews indicated that public oral health services do not have a dedicated budget and were not considered a priority. The questionnaire results revealed challenges in infrastructure, human resources and perceived marginalisation from the healthcare services. Participants agreed that there was a need for oral health to be clearly expressed and prioritised in health policy statements.ConclusionThis study proposed a framework that incorporated the identified core components that influenced oral health services provision in Limpopo province.