BACKGROUND: The Health Promoting Schools Initiative can provide a platform to explore integration of oral health promotion activities within the broader context of healthcare delivery. OBJECTIVES: To understand the contextualised delivery of oral health service provision within Health Promoting Schools, to conduct a situational analysis of existing services provided at these schools and to review current health and education policies. METHODS: The explorative study design used a mixed methods approach. Twenty-three schools of a total sample of 154 were selected using multistage cluster sampling. Data collection comprised policy reviews, a self-administered questionnaire, a data capture sheet and an interview schedule. The study was approved by the Humanities and Social Sciences Research Ethics Committee of the University of KwaZulu-Natal (HSS/0509/013D. RESULTS: Although policies included statements on oral health promotion, this was not translated into practice at school level. Barriers and challenges identified for successful implementation of an oral health promotion programme included lack of funds, human resources, knowledge and ownership, as well as high workloads and time constraints. CONCLUSION: Current delivery of oral health promotion services within the Health Promoting Schools Initiative will not reap the desired oral health outcomes owing to the inherent mismatch between policy planning and implementation. More research needs to be conducted to address opportunities and challenges facing educators and other oral healthcare providers working in the school environment.