The school setting, identified as a creative and cost effective way for improving oral health, provides an ideal opportunity for preventing oral diseases in the influential stages of a child's life when lifelong beliefs, attitudes and skills are developed. Although oral health has been included in the Integrated School Health Policy, there is a lack of published evidence on whether this has been translated into practice and evaluated. This study, which was conducted at 23 health promoting schools from the 11 districts in KwaZulu-Natal, investigated the challenges experienced for the inclusion of oral health promotion activities at schools. Mixed methods, using both qualitative and quantitative components, were used for this study. However, this paper reports only on the qualitative component focusing on the challenges experienced and perspectives of teachers and health promotion managers from data obtained during interviews and focus group discussions. Results demonstrate that although oral health promotion activities was incorporated into the school programme, teachers and school health nurses lacked capacity and resources to implement these programmes. The school setting therefore has the potential to improve the oral health status of children in South Africa provided teachers and school health nurses are equipped with the necessary training and resources.