Abstract: PURPOSE: To investigate the multidimensional dilemmas confronting the construction of dental clinics in primary healthcare institutions in the Yangtze River Delta region and propose systematic optimization pathways. METHODS: A qualitative study was conducted using literature analysis and semi-structured in-depth interviews with 37 key informants across three provinces and one municipality, encompassing primary oral healthcare administrators and clinicians, administrators and dental specialists from secondary and tertiary institutions, as well as health policymakers and researchers. Core issues were distilled using an ecological systems theory. RESULTS: Although dental clinics in the Yangtze River Delta region developed rapidly, they still faced intertwined multidimensional dilemmas. At the macrosystem level, there existed regional developmental imbalance, absence of unified construction standards, and ambiguous functional positioning. At the mesosystem/exosystem level, two-way referral systems underperformed, hierarchical diagnosis and treatment mechanisms were poorly coordinated, medical-preventive integration remained largely nominal, and information technology support was markedly inadequate. At the microsystem level, the entire talent chain from recruitment and cultivation to retention and utilization was obstructed; salary incentives were poorly aligned with position value; and certain clinics confronted significant operational pressures. CONCLUSIONS: At the macro-institutional level, policy and standard supply should be strengthened to establish a unified, hierarchically progressive construction framework. At the meso-collaborative level, network linkages should be reshaped to facilitate channels for tiered diagnosis and treatment and medical-preventive integration. At the micro-element level, talent empowerment should be prioritized to activate organizational endogenous momentum.

Key words: Dental clinics, Primary healthcare institutions, Yangtze river delta, Ecological systems theory