Dental public health, known in Iran as Community Oral Health, is the branch of dentistry devoted to preventing oral disease and promoting oral health at the population level. Instead of filling a single cavity, the discipline integrates policy-making, epidemiologic assessment, and resource management to protect entire communities. That makes high-quality undergraduate education in the field essential: every dentist who graduates without a solid grounding in population-based prevention becomes another practitioner in a treatment-oriented system. Yet the evidence suggests Iranian graduates have been underprepared, with an outdated curriculum, inconsistent national implementation, and insufficient infrastructure and funding undermining the field for years.

To confront the problem head-on, Iranian dental educators organized three national symposia titled Evaluating the Educational Status of DPH in Iran, held between 2019 and 2023. The initiative came from the Secretariat of the Dental Education Council of the Ministry of Health and was organized by the Iranian Association of Community Oral Health, university DPH departments, the Research Center for Caries Prevention, and the Department of DPH at Tehran University of Medical Sciences. Each gathering brought together 40 to 50 participants, including DPH specialists, department heads, PhD students, and dental school representatives, all invited through official channels to ensure broad and representative involvement.

The first symposium, held in person at Tehran University of Medical Sciences in April 2019, used a structured, participatory consultation and consensus-building process. After an opening presentation on the role of DPH departments in dental education, participants worked through multiple rounds of facilitated group discussions, with ideas recorded in real time on shared whiteboards and in facilitator notes. The organizing team consolidated the input by grouping similar contributions and removing duplicates, then refined the results through further brainstorming until consensus emerged. That process distilled the challenges into five domains: infrastructure, budget and service delivery; workforce development and management; curriculum design; community-centric research; and community engagement and outreach. Participants then formed domain-specific working groups whose proposed solutions were presented in plenary sessions, refined through collective feedback, and finalized the following day.

The second symposium, held virtually in October 2020, and the third, held in person in July 2023, revisited those findings and prioritized three domains for reform based on perceived impact, feasibility, and alignment with national needs: infrastructure strengthening, workforce development, and community engagement. The 2023 meeting also featured a training workshop for DPH educators, and participant databases and virtual groups were created afterward to sustain dialogue and resource sharing between events. The multi-year, iterative design gave the process a durability that one-off conferences rarely achieve, allowing recommendations to be tested and sharpened across changing circumstances, including the disruptions of a global pandemic.

On infrastructure, the symposia identified concrete and surprisingly practical gaps. DPH programs struggle with scarce fluoride varnish supplies, transportation difficulties reaching community course sites, and low patient referrals to dental schools, alongside province-specific problems such as oral cancer in Sistan and Baluchestan and molar-incisor hypomineralization in Ardabil. The proposed fixes include memorandums of understanding between the Ministry of Health and dental school departments to secure resources, referral pathways from schools to DPH departments with lower tariffs, insurance contracts, and patient databases maintained by DPH PhD students. To match local needs, the participants recommended agreements between DPH departments and provincial health deputies, tailored initiatives such as oral cancer screening in the hardest-hit provinces, and the introduction of Family Dentistry to give students genuine community-based experience.

The workforce picture is equally stark. Iran has too few DPH departments nationwide, low appeal of the specialty among dental students, a shortage of experts below the national goal of one DPH PhD student per school or province by 2025, underuse of PhD students in teaching, and limited cross-specialty collaboration. The solutions draw on a hub model in which ten regional lead universities share faculty and resources with nearby schools, short competency-building courses for other specialties, dual degrees with pediatrics, periodontics, and restorative dentistry, funded PhD places for top students, and expanded career paths through oral health committees and Ministry of Health service contracts. Senior PhD students past their comprehensive examinations would serve as teaching assistants, multiplying scarce faculty capacity.

Curriculum reform rounds out the agenda. Participants called for integrating the oral health needs of patients with special health care needs into DPH and other specialties’ curricula, inviting such patients directly into dental schools, and establishing dedicated committees and fellowships. Teaching improvements include nationwide educator-training workshops, three to four standardized course models to address limited hours and transportation, and practical checklists for hands-on courses. Assessment would shift toward higher-level exam questions aligned with course objectives, with part of the final grade devoted to practical application, and evaluation would rely on systematic stakeholder feedback through dialogue, surveys, and specialized forms. The establishment of the Iranian DPH board in 2022 provides an institutional anchor for these changes, while research reforms would tie postgraduate thesis topics to Ministry of Health needs assessments and translate findings into policy briefs.

What makes the Iranian experience resonate far beyond its borders is how closely its challenges mirror global patterns. In Egypt, limited postgraduate training has left DPH teaching largely to pediatric dentistry faculty, and community-based training is used by only about a quarter of schools. Across Europe, only about two-thirds of dental schools have dedicated DPH departments, and outreach accounts for a mere 11 percent of teaching, often cited as good practice rather than routine. Colombia and Kenya have no dedicated DPH track, Brazil offers only three programs, and India’s community outreach remains insufficiently structured. Iran’s difficulties, in other words, are not an outlier but a symptom of how prevention is undervalued in dental systems worldwide, where clinical and specialty-based dentistry traditionally outranks public health in prestige and resources.

The commentary is candid about its limitations. The insights emerged from discussions among academic and institutional stakeholders rather than empirical measurement, participation was invitation-based and may have introduced selection bias, and the influence of senior participants on group consensus cannot be excluded. The findings are also shaped by Iran’s specific educational and policy context. Still, the multi-year process and participation from across the country lend the recommendations breadth and credibility. Progress, the authors suggest, can be tracked through tangible indicators: the number of newly established DPH departments, competency-based DPH modules, and expanded community-based training opportunities, with periodic stakeholder reviews to monitor reform. If those measures take hold, Iran could offer a replicable blueprint for any country wrestling with the same quiet crisis in dental public health education, and its dentists could finally be equipped to treat the causes of oral disease, not just the symptoms.

Subject of Research: Reform of undergraduate dental public health education in Iran based on national consensus symposia

Article Title: Strengthening undergraduate dental public health education in Iran: insights from national symposia

Article References: Varmazyari, S., Eshrati, M., Hessari, H., & Khami, M. R. (2026). Strengthening undergraduate dental public health education in Iran: insights from national symposia. BMC Medical Education, 26(1), Article 1570. https://doi.org/10.1186/s12909-026-10474-6

Image Credits: AI Generated

DOI: 10.1186/s12909-026-10474-6

Keywords: dental public health, dental education, Iran, oral health, curriculum reform, workforce development, community engagement, health policy, medical education, consensus-building, prevention, BMC Medical Education

The stakes in Saxony-Anhalt are unusually high. The state carries the highest dementia prevalence in Germany, a consequence of pronounced demographic ageing combined with sustained population decline that has thinned out services across large rural areas. Recognizing these structural pressures, the state government established the State Competence Center for Dementia Saxony-Anhalt in 2022 with a mandate to develop a regional Dementia Strategy. While more than a dozen countries have adopted national dementia strategies over the past decade, regional strategies such as this one are designed to respond to local demographic and structural realities that a national framework cannot fully capture. The research team’s task was to generate consensus on the objectives required to ensure adequate care and improve the quality of life of people living with dementia and their family caregivers.

Methodologically, the study employed a mixed-method, two-phase participatory design. The first phase was a two-round Delphi process, a technique long used in health services research to distill group judgment from dispersed experts. Rather than restricting participation to clinicians or academics, the researchers deliberately recruited nine distinct interest-holder groups, including people living with dementia themselves, informal caregivers, health and social care professionals, policymakers, and civil society representatives. This breadth was a deliberate design choice: strategies built only on professional perspectives, the authors argue, risk overlooking the lived realities that determine whether policy objectives are meaningful in practice. Participants rated proposed objectives in the first round, and items that failed to reach agreement were re-rated in a second round, allowing the researchers to track where consensus emerged and where genuine disagreement persisted.

The numbers involved are striking for a process of this kind. In total, 406 participants completed the first Delphi round, and 262 of them returned for the second round, a substantial retention rate for a multi-stage survey. From an initial pool of 88 proposed objectives, 47 reached consensus in round one and a further 21 in round two. That left a residue of items where the groups could not agree, and rather than discarding them, the researchers moved to the second phase of the design: deliberative dialogues. Eighteen participants attended these facilitated sessions, which were structured to explore the selected non-consensus objectives in depth, allowing participants to articulate the reasoning behind their ratings, hear opposing views directly, and work toward refined formulations that a simple rating exercise could never produce.

The deliberative dialogues proved decisive for seven objectives that were ultimately refined and validated through discussion. The remaining 26 non-consensus items were thematically aggregated into broader strategic objectives, a technique that preserves the substance of contested proposals without forcing artificial agreement on narrow wording. Once the participant-driven objectives had been consolidated, the researchers aligned them with the relevant state ministries to ensure that every item in the final strategy was politically and administratively feasible. This alignment step, often absent from participatory exercises, is what distinguishes a genuine policy instrument from a wish list: each objective in the final document has a plausible pathway into government action.

The resulting Dementia Strategy comprises 40 strategic objectives organized across four main topics: social participation, medical and nursing care, support for people with dementia and their informal caregivers, and the promotion of dementia research. The breadth of these domains reflects a modern understanding of dementia as a condition whose impact extends far beyond the clinic. Social participation objectives address how people living with dementia can remain embedded in their communities, while the care objectives grapple with the organization and capacity of medical and nursing services. The support domain acknowledges the central role of family caregivers, who provide the majority of day-to-day care in Germany as elsewhere, and the research domain signals an ambition to build local evidence capacity alongside service provision.

Beyond the agreed objectives, the process surfaced a set of structural challenges that participants identified as barriers to any strategy’s success. These included shortages of services, particularly in rural areas, limitations in the health and care workforce, bureaucratic barriers that complicate access to support, and the heavy burden carried by informal caregivers. The researchers documented these as contextual factors relevant to implementation rather than as objectives in their own right, an analytical distinction that matters: a strategy can commit to improving care, but if the underlying workforce and administrative conditions are not addressed, implementation will stall regardless of how well the objectives are worded.

The authors are careful about what their study does and does not demonstrate. They present it as proof of the feasibility of a structured participatory approach for regional dementia strategy development, not as evidence that the resulting strategy will improve outcomes. The strategy, they write, provides a foundation for future action, and the development of a dedicated implementation strategy will be essential to translate the agreed objectives into practice. That caveat is familiar from the international experience with national dementia strategies, several of which have struggled to move from published documents to funded, monitored action. The Saxony-Anhalt team’s decision to involve ministries throughout the process is explicitly intended to reduce that implementation gap by ensuring ownership on the government side from the outset.

The study’s broader significance lies in its potential as a transferable model. Other regions facing demographic ageing, in Germany and across Europe, confront similar combinations of rising dementia prevalence, thinning rural services and strained caregiver networks. The combination of a large-scale Delphi survey spanning nine interest-holder groups with deliberative dialogues for contested items, followed by ministerial alignment, offers a replicable template for evidence-informed and participatory health policy development. The researchers also emphasize the contribution of the people whose voices are most often absent from such exercises: people living with dementia and informal caregivers, whose perspectives, the authors note, substantially enriched the development of the strategy. The study received ethical approval from the Ethics Committee of the Medical Faculty of Martin Luther University Halle-Wittenberg and was funded by the Ministry of Labour, Social Affairs, Health and Equality of Saxony-Anhalt, the regional associations of the statutory long-term care insurance funds, and the Association of Private Health Insurance, none of which influenced the study design or analysis. Whether the 40 objectives can be converted into measurable improvements in the lives of people with dementia in Germany’s most ageing state will now depend on the implementation phase, but the process itself has already demonstrated that consensus across patients, families, professionals and policymakers is achievable when the method is designed to hear them all.

Subject of Research: Participatory development of a regional dementia strategy using a Delphi study and deliberative dialogues in Saxony-Anhalt, Germany.

Article Title: The development process of a regional dementia strategy: a Delphi study and deliberative dialogues

Article References: The development process of a regional dementia strategy: a Delphi study and deliberative dialogues. (n.d.). https://doi.org/10.1186/s12913-026-15595-8

Image Credits: AI Generated

DOI: 10.1186/s12913-026-15595-8

Keywords: dementia, regional health policy, dementia strategy, participatory research, Delphi method, interest-holder engagement, deliberative dialogues, Saxony-Anhalt, health services research, informal caregivers, social participation, consensus building