Introduction: Children and young people in India have a high prevalence of dental decay. As part of a broader epidemiological study, we interviewed 10 head teachers to understand the status of, and challenges to, inclusion of oral health education in the curricula of public and private schools in Tamil Nadu, India. Objectives: The two main objectives of this study were (1) to describe the views of head teachers about the implementation of oral health education in school curricula and (2) to identify challenges to achieving oral health education in public and private schools in Tamil Nadu. Method: Qualitative descriptive design, with a purposive sample of 10 head teachers who participated in semi-structured interviews. Thematic coding was used to analyse and report on the data. Results: There is a lack of oral health education in public and private schools in Tamil Nadu, India. Four main types of barriers to the initiation and implementation of oral health education were lack of recognition, academic burden, prioritisation of other health needs and policy inequities. Head teachers acknowledged the lack of oral health education in their schools, yet also acknowledged the importance of oral health education in promoting students' health. Conclusion: Health curricula in Tamil Nadu schools lack integration of oral health education. Limited access to the services, cultural factors, policy deficiencies, insufficient awareness among policy-makers, the nature of the education system and lack of research contribute to the current situation. Policy-makers should address these barriers to enable and promote oral health education strategies in both private and public schools of Tamil Nadu.