Strategies for attracting and retaining dentists in deprived areas: A scoping review

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Mohammad Mosadeghrad, Maryam Saadati, Mahnaz Afshari, Fatemeh Kazemi, and 2 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-6541879/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 13 You are reading this latest preprint version Abstract Objective (s) The shortage and improper distribution of dentists can prevent people from accessing oral and dental services, slow down the achievement of the Millennium Development Goals, and limit the achievement of desirable health outcomes. Therefore, this study aimed to identify strategies for attracting and retaining dentists in deprived areas. Methods This study was carried out using a scoping review method. All published articles on strategies for attracting and retaining dentists in underprivileged areas until the end of January 2024 were searched and collected in 9 databases and search engine. 25 articles were analyzed using MAXQDA software. Results About 62 strategies were identified for attracting and retaining dentists in deprived areas and classified. The most frequent strategies include providing platforms for professional development and increasing continuous independence for dentists in remote areas, financial support policies for dentists by creating incentives such as mortgages or loan forgiveness, strengthening the infrastructure of villages in order to develop and increase the motivation of employees. Dentistry was the equitable distribution of manpower to reduce the workload in rural areas, the development of rural access to dental services by strengthening remote dental infrastructure and the development of transportation facilities to the workplace. Conclusion Implementation of effective interventions in financing, manpower, technology, equipment and medicine, information systems, service delivery and management and leadership lead to the attraction and retention of dentists in deprived areas. Therefore, health policy makers and managers should take appropriate measures for the attraction and retention of dentists in these areas. Retaining dentists strategies deprived areas Figures Figure 1 Figure 2 Figure 3 Figure 4 Figure 5 Introduction Health and medical organizations are responsible for providing diagnostic, therapeutic, and rehabilitation services to the community. The effective and efficient execution of these tasks depends on skilled human resources who are knowledgeable, motivated, and committed. Human resources are considered the main factor for the success of organizations [ 1 ]. In most countries, about 10% of all government employees are dedicated to the health sector [ 2 ]. A sufficient number of skilled workers with equitable distribution will significantly contribute to achieving health goals and outcomes. According to the World Health Organization (WHO), all countries should have approximately 2.28 doctors, nurses, and midwives per thousand population to ensure desirable health outcomes for their population [ 3 ]. More than half of the world's population lives in poverty and in rural areas [ 4 , 5 ]. Economic and social deprivation, poverty, unhealthy lifestyles, and the emergence of diseases have led to an increased demand for health services worldwide, especially in rural areas [ 6 – 8 ]. Therefore, it is expected that more health professionals will work in such areas. Studies show that only a quarter of health workers operate in deprived areas [ 9 ]. Health service coverage in rural areas is weak [ 10 ]. In most developed and developing countries, a lower level of health service coverage in rural and deprived regions has been reported [ 11 – 13 ]. Patients in deprived and remote areas often have to travel long distances to access health services and may also experience delays in treatment. The imbalance in the distribution of health workers within countries has become a serious and common challenge. This can lead to shortages and challenges in underprivileged and less developed areas, ultimately reducing access to health services [ 14 ]. Rural communities face challenges in recruiting and retaining health providers [ 15 ]. Retaining health workers in deprived and remote areas is crucial for various reasons, including continuity of health services, maintaining optimal health performance, and allowing for the enhancement of knowledge and skills among employees [ 16 ]. Among health workers, dentists play a vital role in improving community health. In 2015, the WHO reported that the global dental workforce amounted to approximately 1.5 million people, with 80% being dentists, while the rest were oral health professionals and dental technicians [ 17 ]. However, the migration of dentists from rural and less developed areas to affluent and developed regions has raised significant concerns for policymakers and health managers. The disproportionate distribution of dentists can disrupt the functioning and stability of the health system. In many rural and underdeveloped areas, the shortage of dentists is a long-standing challenge that has serious implications for the quality and quantity of oral health services, as well as limiting people's access to these services in these regions [ 18 ]. The prevalence of oral diseases worldwide, especially in rural areas, is increasing [ 19 ]. Oral diseases affect nearly 3.5 billion people globally [ 20 ]. Poor oral hygiene is a significant factor in the development of many diseases, including diabetes, low birth weight, preterm birth, arthritis, heart problems, and respiratory diseases, impacting individuals' quality of life. Besides low fluoride exposure, various factors such as inadequate hygiene, poor diet, tobacco use, and lack of access to oral health services contribute to these problems. Unlike medical services, the vast majority of dental services are provided in the private sector, and their costs are borne directly by patients. Oral health is poorer in rural areas compared to urban areas. Although oral health has improved in recent years, the gap in oral health outcomes between rural and urban populations has not diminished. This gap is due to multiple factors, such as poor access to dental care, individual attitudes, socioeconomic status, and exposure to fluoride water. Furthermore, issues related to the recruitment and retention of dentists have led to poor oral health outcomes in rural communities [ 21 ]. Inequality within and between countries regarding dental health care is a common issue and may be attributed to restricted coverage of dental benefits and disparities among households in terms of coverage [ 22 ]. The overall global cost estimate for oral diseases in 2015 increased by about 23.2% compared to 2010 [ 24 , 25 ]. Additionally, developed countries allocate about 5 to 10 percent of health sector expenditures annually [ 26 ]. Many African, Asian, and Latin American countries face a shortage of oral health personnel, and the capacity of these systems is largely limited to pain relief or emergency care. In Africa, the dentist-to-population ratio is 1:150,000 compared to 1:2,000 in most industrialized countries [ 27 ]. On the other hand, the number of dentists and graduates in dental studies in developing countries is on the rise [ 28 ]. Iran has many rural and desert areas, most of which have poor facilities. Medical and dental care in these areas is in a critical state. In addressing this issue, policymakers and managers are paying special attention to these regions. Addressing the challenges of deprived and remote areas is among the general policies of the Ministry of Health and Medical Education [ 29 ]. Although the number of graduates from medical universities in Iran is increasing, studies conducted in impoverished and deprived areas of Iran indicate a severe shortage of healthcare workforce relative to the population in these areas due to the migration of health specialists to urban areas. Consequently, rural areas face an unequal distribution of human healthcare resources, particularly among dentists [ 5 ]. Under these circumstances, policymakers and health system managers must shift their focus toward effective workforce management and pay greater attention to the quality of work life and the needs of their employees. Human resource management is essential as one of the important and specialized functions of management for the success of any health system. Its aim is to ensure the effective and efficient employment of human resources within the organization to achieve organizational goals. Functions of human resource management include workforce planning, acquiring necessary human resources at minimal cost, developing and enhancing employees' talents and skills, retaining the workforce, fostering positive relationships among them, meeting the reasonable needs of employees, performance evaluation, compensating employees, and ensuring their reasonable satisfaction [ 30 ]. The WHO has proposed 17 recommendations to improve the recruitment and retention of health workers in deprived and remote areas [ 31 ], including enrolling rural students in health worker training programs, locating health worker training sites near rural areas, taking students from health worker training programs to rural and remote areas, aligning health worker training with the health needs of rural communities, facilitating continuous education for health workers in rural and remote areas, expanding the scope of health workers’ activities in rural areas to meet the needs of these communities, broadening the professions of health workers to address the health needs of rural communities, ensuring that mandatory service agreements come with appropriate rights, supports, and incentives, providing educational subsidies for health workers in rural and deprived areas, offering incentive packages for recruitment and retention, improving living conditions in rural and deprived areas, ensuring workplace safety in rural and deprived health facilities, guaranteeing decent work for health workers in rural and deprived areas, establishing and promoting support networks for health workforce, developing and enhancing career pathways for rural and deprived health workers, and facilitating knowledge exchange among health workers and elevating the status of rural health educators [ 32 ]. Dentists are one of the health workforce groups for which there is limited information. This is despite the fact that oral diseases represent a major health issue worldwide [ 33 , 34 ]. The burden of oral diseases on marginalized populations is significant in both developing and developed countries [ 35 – 37 ]. Therefore, this study aims to identify strategies for the retention and attraction of dentists in deprived and remote areas. Materials and Methods The present study was conducted using the Scoping Review method. The scoping review is a type of secondary study that collects and synthesizes a wide range of evidence with the aim of conveying the extent and depth of a topic [ 38 ]. Researchers can use scoping reviews as a preliminary study to assess the volume, scope, and nature of research activities. Additionally, these researchers can identify gaps in the existing literature [ 39 ]. A scoping review can provide an opportunity to identify key concepts. In this research, the protocol developed by Arskey and O'Malley was employed for conducting the scoping review, which includes six stages: identifying the research question, identifying relevant studies, selecting studies, charting data, collecting, summarizing, and reporting results, and finally, optional consultation regarding the findings [ 39 ]. The research questions for this scoping review were: "What strategies exist for attracting and retaining dentists?" and "Which strategies are most commonly used to increase the recruitment and retention of dentists?" This study focused on published research in Persian and English identifying strategies for attracting and retaining dentists in deprived areas. Searches were conducted using appropriate keywords in both English and Persian, including "strategies," "solution," "dentists," "sustainability," "recruitment," "retention," "poor areas," "deprived areas," "remote rural areas". These keywords were searched in combination and separately in the English electronic databases "PubMed," "Scopus," "Wiley," "ScienceDirect," "Emerald," "Springer," "Web of Science," and in the Persian electronic databases "SID" and "Magiran" (Table 1 ). Additionally, the "Google Scholar" search engine was also used to ensure access to relevant studies. Retrieved studies were imported into EndNote ×9 software. Table 1 Search strategy and number of studies obtained from the databases reviewed Database Keywords and search strategy Identified studies PubMed (("strategie"[All Fields] OR "strategies"[All Fields] OR "strategy"[All Fields] OR "strategy s"[All Fields] OR ("pharmaceutical solutions"[Pharmacological Action] OR "solutions"[MeSH Terms] OR "solutions"[All Fields] OR "solution"[All Fields] OR "pharmaceutical solutions"[MeSH Terms] OR ("pharmaceutical"[All Fields] AND "solutions"[All Fields]) OR "pharmaceutical solutions"[All Fields] OR "solutal"[All Fields] OR "solute"[All Fields] OR "solute s"[All Fields] OR "soluted"[All Fields] OR "solutes"[All Fields] OR "solution s"[All Fields])) AND ("sustain"[All Fields] OR "sustainability"[All Fields] OR "sustainable"[All Fields] OR "sustainably"[All Fields] OR "sustained"[All Fields] OR "sustaining"[All Fields] OR "sustainment"[All Fields] OR "sustains"[All Fields] OR ("retention, psychology"[MeSH Terms] OR ("retention"[All Fields] AND "psychology"[All Fields]) OR "psychology retention"[All Fields] OR "retention"[All Fields] OR "retentions"[All Fields] OR "retentive"[All Fields] OR "retentiveness"[All Fields]) OR ("recruit"[All Fields] OR "recruited"[All Fields] OR "recruiter"[All Fields] OR "recruiters"[All Fields] OR "recruiting"[All Fields] OR "recruitment"[All Fields] OR "recruitments"[All Fields] OR "recruits"[All Fields])) AND ("dentist s"[All Fields] OR "dentists"[MeSH Terms] OR "dentists"[All Fields] OR "dentist"[All Fields]) AND ((("poverty"[MeSH Terms] OR "poverty"[All Fields] OR "poor"[All Fields]) AND ("area s"[All Fields] OR "areas"[All Fields])) OR (("deprival"[All Fields] OR "deprivation"[All Fields] OR "deprivations"[All Fields] OR "deprive"[All Fields] OR "deprived"[All Fields] OR "deprives"[All Fields] OR "depriving"[All Fields]) AND ("area s"[All Fields] OR "areas"[All Fields])))) AND (1000/1/1:2024/1/20[pdat]) 4 Wiley "(strategies OR solution) AND (sustainability OR retention OR recruitment) AND dentists AND (poor areas OR deprived areas)" Open Access filter 1897–2022 filter 140 Web of Science ((ALL=(deprived areas )) AND ALL=(dentists)) Refined By: Languages: English 34 Scopus ALL ( strategies OR solution ) AND ALL ( sustainability OR retention OR recruitment ) AND ALL ( dentists ) AND ALL ( poor AND areas OR deprived AND areas OR "remote rural areas" ) AND ( LIMIT-TO ( PUBSTAGE, "final" ) ) AND ( LIMIT-TO ( OA, "all" ) ) AND ( LIMIT-TO ( LANGUAGE, "English" ) ) 66 Springer '(strategies OR solution) AND (sustainability OR retention OR recruitment) AND dentists AND (poor areas OR deprived areas OR "remote rural areas")' within Dentistry Remove this filter English Remove this filter 435 Science Direct (strategies OR solution) AND (sustainability OR retention OR recruitment) AND dentists AND (poor areas OR deprived areas OR "remote rural areas") (5168( 11pages reviewed) Emerald (strategies OR solution) AND (sustainability OR retention OR recruitment) AND dentists AND (poor areas OR deprived areas OR "remote rural areas") Only Open Access 11 Google scholar (strategies OR solution) AND dentists AND (deprived areas) AND (sustainability OR retention OR recruitment) 18100 (8 pages reviewed) MagIran dentists AND deprived areas 10 SID dentists 9 Bibliography of the included papers 2 Final studies 23958 The inclusion criteria for the study encompassed all research conducted on strategies to attract and retain dentists in deprived areas up to January 20, 2024. The exclusion criteria included studies published in languages other than Persian and English, studies published after January 20, 2024, and scientific resources lacking full text. Three of the authors were primarily responsible for screening the studies, and in case of any issues, a fourth author was consulted for discussion and consensus. In total, 23,958 articles were extracted from the databases. After eliminating duplicates and articles that lacked full text, 23,885 studies remained for title and abstract review. Among these, 23,817 cases were removed following the title and abstract review. A total of 68 articles related to strategies for attracting and retaining dentists in deprived areas were obtained at this stage. After a thorough examination of the remaining articles, 46 were excluded due to their irrelevance to the sustainability of dentists in deprived areas. Two additional articles were found by reviewing the references of the articles. Ultimately, 25 research articles relevant to strategies for attracting and retaining dentists in deprived areas were included (Fig. 1 ). A data extraction form was used, which included sections for author details, journal name, year of publication, country of study, study aims, sample size, research type, method of data collection, strategies, findings, and conclusions. A framework analysis approach was utilized for analyzing the qualitative data of this study [ 41 ]. Version 10 of MAXQDA software was used for data analysis. All ethical considerations relevant to review studies were adhered to in this research. Researchers did not allow their personal opinions to influence the data collection, analysis, and reporting stages. Findings A total of 25 articles focused on strategies for attracting and retaining dentists in deprived areas were published between November 2004 and January 20, 2024 (see Table 2 ). All published articles were in English (100%). The majority of the articles were published in the International Dental Journal (6 articles). The largest sample size was 821 dentists in one quantitative study, while the smallest sample size pertained to a review study that included 7 articles. The studies comprised predominantly of reviews (11 cases), quantitative studies (5 cases), qualitative studies (7 cases), and mixed methods (2 cases). In the review studies, databases were utilized to extract relevant articles (11 cases), while qualitative studies employed semi-structured interviews (8 cases). In the quantitative studies, information was collected through questionnaires (8 cases) and focus groups (1 case). The majority of the articles reviewed were published in 2016 (4 cases) (Fig. 2 ). The studies on strategies for retaining dentists in deprived areas were conducted across 9 countries (Australia, Iran, the United States, Scotland, Wales, Turkey, England, South Africa, and Thailand). Approximately 13% of the research was conducted in North America (USA), 13% in Asia (Iran and Thailand), 18% in Europe (Wales, Scotland, England, and Turkey), 51% in the Pacific region (Australia), and about 5% in Africa (South Africa) (Fig. 3 ). A total of 62 strategies for attracting and retaining dentists in deprived areas were identified. These strategies were categorized into six groups: governance and leadership, financing, human resources, technology, equipment and medications, information systems, and service delivery (Table 2 ). Table 2 Strategies for attracting and retaining dentists in disadvantaged areas Building blocks Strategies for dentists to remain in underserved areas (frequency) Governance and Leadership 1. Developing dental care policies based on the popular culture of the people (1) 2. Implementing supportive and participatory management styles (3) 3. Formulating transparent and flexible programs suitable for current conditions (1) 4. Organizing supportive and constructive programs for young dentists (1) 5. Increasing intersectoral collaboration (1) 6. Integrating oral healthcare into primary healthcare services (3) 7. Monitoring the performance of dentists in remote areas (1) 8. Recognizing the efforts of dentists in remote areas (1) 9. Increasing the capacity to accept local students in dental and oral health programs (1) 10. Developing diverse career programs for dentists (2) 11. Providing professional development opportunities and enhancing ongoing independence for dentists in remote areas (5) 12. Promoting managerial competencies and skills among managers in this field (3) 13. Using credible research evidence to improve the oral health of rural populations and retain dentists in villages (1) Financing 1. Equitable distribution of resources and budgets allocated for health and medical services in villages and cities (1) 2. Financial support policies for dentists through incentives such as housing loans or loan forgiveness (5) 3. Securing financial resources and loan facilities for volunteer staff (1) 4. Establishing a reward system for dentists committed to service (1) 5. Signing long-term contracts with significant financial advantages (2) 6. Providing incentive insurance for dentists in remote areas, such as life insurance, health insurance, malpractice coverage, licensing fees reimbursement, and retirement insurance (1) 7. Paying salaries through various methods, such as daily wages with bonuses (1) 8. Offering financial aid and discounts on dental services for rural residents to increase demand (2) 9. Evaluating the cost-effectiveness of financial assistance for accessing dental services for rural residents (1) 10. Equitable allocation of financial resources among male and female employees working in villages (1) 11. Providing financial and educational support for local rural students (1) Human Resources 1. Equitable distribution of human resources to reduce workload in rural areas (4) 2. Targeted training that encompasses all aspects of oral healthcare (1) 3. Hiring and training graduates to practice practical skills in villages (1) 4. Employing young educated individuals and young families in rural areas (1) 5. Collaborating between rural dental service centers and provincial dental schools (1) 6. Encouraging graduates to serve in rural areas (1) 7. Granting voluntary leave rights to rural staff (1) 8. Providing bonuses to employees who recruit staff (1) 9. Hiring local rural students, especially female students (2) 10. Improving the content and training programs for dentists (1) 11. Facilitating mentorship and networking for less experienced dentists with support from senior dentists and professional associations (1) 12. Granting dentists the authority to purchase practices in villages (1) 13. Allowing leave and missions for dentists working in rural areas for further education and research (1) 14. Reforming organizational structures and supporting human resource relocation plans (1) 15. Providing bonuses for entering and remaining in job positions in rural areas (1) 16. Establishing specific limitations and conditions for the graduate studies of urban dentists (1) 17. Organizing practical training programs and clinical rotations for rural students in village settings (1) 18. Providing job, educational, and related resources for dentists’ spouses (3) 19. Strengthening educational frameworks in rural schools for the children of specialists (3) 20. Intersectoral collaboration with education departments to develop educational systems in villages (3) Technology, Equipment and Medicine 1. Increasing rural residents’ access to dental services by enhancing tele-dentistry infrastructures (4) 2. Developing internet infrastructure and telephone triage systems (1) 3. Strengthening village infrastructure to enhance motivation among dental staff (5) 4. Evaluating the cost-effectiveness of new dental treatments for rural residents compared to previous treatments (1) 5. Developing transportation facilities to the workplace (4) Information Systems 1. Collecting epidemiological data on oral health in rural populations (1) 2. Developing research on the cost-effectiveness of tele-dental services (1) 3. Developing marketing services and using evidence-based strategies to enhance social connectedness (1) 4. Establishing managed clinical networks for dental specialties to reach rural and remote areas (1) Health Service Delivery 1. Utilizing less skilled staff in rural areas due to easier recruitment (1) 2. Providing opportunities for participation in service projects and partnering with the community of dentists in remote areas (1) 3. Encouraging interdisciplinary collaboration and employing health assistants in this field (1) 4. Creating opportunities for collaboration with the private sector to exchange work experiences and personnel transfer (1) 5. Developing alternative service delivery systems (such as partnerships with the private sector, contracts with private entities for profit or nonprofit) (1) 6. Collaborating with and supporting dental clinics in adjacent urban areas (1) 7. Using incentives and providing mandatory service for dental graduates in a combined approach (1) 8. Distributing human resources in remote areas with a commitment and guarantee from them at the beginning of their service (2) 9. Flexibility in working hours and workloads for young staff (1) The majority of strategies were related to human resources (20 cases), governance and leadership (13 cases), financing (11 cases), health service delivery (9 cases), technology, equipment and medications (5 cases), and information systems (4 cases) (Fig. 4 ). The frequency of the strategies with the highest occurrence is illustrated in Fig. 5 . The most frequently mentioned strategies include: Providing professional development and continuously increasing autonomy for dentists in remote areas (5 cases), Financial support policies for dentists, including incentives such as housing loans or loan forgiveness (5 cases), Strengthening rural infrastructure to enhance and motivate dental staff (5 cases), Improving rural access to dental services by enhancing tele-dentistry infrastructure (4 cases), Developing transportation facilities to work locations (4 cases), Fair distribution of human resources to reduce workload in rural areas (4 cases), Providing job, educational, and relevant equipment opportunities for dentists' spouses (3 cases), Intersectoral collaboration with educational affairs to develop educational systems in villages (3 cases), Strengthening educational structures in rural schools for the children of specialists (3 cases). Discussion and Conclusion This study aimed to identify strategies for attracting and retaining dentists in deprived and remote areas. A total of 62 strategies were identified regarding the recruitment and retention of dentists in these regions, categorized into six groups: governance and leadership, financing, human resources, technology, equipment and medications, information systems, and service delivery. The governance and leadership category addresses issues related to legislation, policy-making, planning, stewardship, communication, coordination of national policies and local responses, intersectoral collaboration, and monitoring and evaluation [ 42 ]. Legislation and regulation are crucial for establishing coordination and strengthening intersectoral collaboration, ensuring the necessary resources for the health sector, modifying the work methods of health personnel, managing human resources, and ensuring public access to health services—all of which require strong governance and leadership. Health sector policies will not be effectively implemented without the participation and collaboration of other government organizations. Policymakers and senior health system leaders must establish good relationships with other politicians and senior officials and utilize appropriate tools to influence national and local policies. They should develop clear plans for allocating government resources to the health system, particularly for hiring healthcare workers, especially dentists, in deprived and remote areas. Transparent strategies for workforce management in these regions should be developed, ensuring coherence and consideration of the interrelations between health and the economy. Political, social, and economic factors significantly impact the health system; thus, enhancing intersectoral collaboration in providing health services will lead to integrated service delivery and better outcomes. Improving communication between dental providers and primary healthcare providers can increase referral rates between dental clinics and health centers and facilitate intersectoral collaborations [ 43 ]. Effective management of the health workforce in deprived and remote areas requires political and financial commitments. Therefore, political leaders play a crucial role in mobilizing resources in these areas. The government can address this shortage by employing oral health workers in rural and remote areas. The employment of oral health workers in these regions can be particularly effective [ 44 ]. An analysis of patient records in practices in Wales indicated that at least one-third of routine dental care in primary care could be provided by hygienists and therapists [ 45 ]. The WHO has developed a program aimed at retaining health personnel in deprived and rural areas. This program provides a list of factors that influence the improvement of staff recruitment and retention, including education, laws and regulations, financial incentives, and professional and personal support [ 46 ]. Legislators and health officials should formulate policies to reduce the shortage of dentists in remote and deprived areas and improve access for these populations. These policies should consider physical barriers to accessing dental services, funding oral health services, increasing the number of health workers, and establishing comprehensive oral health services in primary care. The provision of appropriate and comprehensive dental services to meet clinical needs and improve access in these areas, particularly in deprived and remote regions, is essential [ 47 , 48 ]. Strengthening the healthcare workforce [ 49 ], access to insurance and coverage [ 50 ], and tele-dentistry [ 51 ] are common approaches to enhance oral health services in rural communities. Tele-dentistry encompasses a wide range of dental services, including video consultations, sharing images and records among healthcare providers, conducting training sessions, and managing patients' oral health. It serves as an emerging tool to connect rural and non-rural residents with dental care. Although challenges such as reimbursement issues, quality of care, and patient safety exist, tele-dentistry can increase the capacity of practices for disease screening and connect patients to necessary care [ 52 ]. Another government strategy to overcome geographical challenges in rural areas involves providing oral health care through mobile dental services [ 51 ]. This service allows a mobile dental clinic to offer oral health services up to 30 miles from the fixed clinic location [ 52 ]. The use of low-interest loans can facilitate the attraction and retention of dentists in deprived and remote areas. Additionally, such loans can support oral health workers and dentists during their studies to encourage them to settle in these remote and rural areas [ 52 , 50 ]. The financing block addresses the collecting, pooling, and purchasing of health services [ 53 ]. Adequate budget allocation for attracting and retaining dentists plays a significant role in improving access to healthcare services in rural and remote areas. In Iran, most dental services are provided by the private sector, with over 90% of dentists practicing in this domain [ 54 ]. Moreover, dental services in Iran are not covered by government health insurance, with nearly 20% of total dental service costs falling under the public health system [ 55 ]. Equitable access to dental care enhances public health and potentially reduces healthcare costs. However, achieving affordable, accessible, and optimal oral health care is considered an economic challenge in many countries [ 56 – 58 ]. A study in Australia conducted in 2019 revealed that about two million people in the country defer dental visits each year due to costs and insurance coverage. Reducing inequalities should be considered in all aspects of oral healthcare, including resource allocation for dental care, actual uptake of dental services, quality of dental services, workforce in oral healthcare, and financing of dental care [ 59 – 62 ]. The quality of individuals' lives related to oral health varies with socio-economic status [ 63 , 64 , 47 ], education level [ 65 , 41 ], income [ 41 ], and regional deprivation [ 66 , 67 , 47 ]. The Health Resources and Services Administration (HRSA) and the Federal Office of Rural Health Policy (ORHP) in the United States provided financial assistance to rural communities to implement community-based oral health programs as part of the 330A Outreach Authority program. This program focuses on reducing healthcare and treatment inequalities and expanding health services in rural and remote areas [ 43 ]. The human resources block of the health system includes workforce planning, recruitment, selection and hiring, training and empowerment of staff, managing employee relations, performance evaluation, and staff compensation. Health workers are the most crucial asset of any health system. Implementing any changes requires diligent, committed, and specialized staff [ 53 ]. Training, enhancing knowledge and skills, and protecting health workers, especially dentists in rural and remote areas, from physical and psychological harm are essential. To attract and retain dentists in rural and remote areas, the government can utilize educational, legal, regulatory, financial, and professional and personal support interventions. Actions such as establishing dental schools in deprived areas and enrolling local dental students [ 33 ], providing scholarships contingent on work in deprived regions, offering sustainable financial incentives (higher salaries and benefits, banking facilities, and tax exemptions) [ 49 ], ensuring accommodation and facilities for dentists [ 50 ], creating well-equipped and safe work environments, and implementing continuous professional development education programs are effective in retaining dentists in underserved areas. More than 530 million children suffer from dental caries, making it one of the most common chronic diseases in childhood worldwide [ 20 ]. While significant progress has been made in European countries compared to previous decades, the prevalence of caries is still associated with socio-economic deprivation in many European regions [ 68 ]. Epidemiological studies in England and Wales found that approximately 23% and 34% of five-year-old children, respectively, experienced dental caries [ 69 , 70 ]. To address any issue effectively, it is essential to tackle the root cause. In this regard, proper education about the benefits of oral health should be a fundamental part of every child’s education. Schools in rural and remote communities should instruct children on how to care for their oral health. Furthermore, campaigns that support and encourage dental professions in these communities should be established to help children develop an interest in maintaining healthy and strong teeth [ 71 ]. Ongoing and adequate training should be continually provided to dentists and oral health workers in rural and remote areas. Delivering quality dental health services requires training and educating the workforce in evidence-based practices. The block concerning equipment, supplies, medications, and vaccines in the health system involves needs assessment, purchasing, and maintenance of equipment and medications [ 53 ]. Strengthening the management and distribution systems for medical supplies, medications, and vaccines in primary healthcare must emphasize infrastructure improvement, particularly in underserved areas. Guidelines for the use of health equipment should be prepared and disseminated, and intersectoral coordination should be established to mobilize resources outside the health system while seeking support for the provision and production of medical supplies [ 72 ]. Accurate, timely, and precise information must be collected from dentists and oral health workers to provide the necessary evidence for policymakers and health managers. Weaknesses in the primary healthcare information system lead to inadequate access to comprehensive information regarding needs, priorities, resources, performance, and quality of oral health services. The information management process includes components such as creating an information management system, data collection, data analysis, and utilization of information [ 53 ]. Delivering safe, effective, and quality services is the primary goal of any health system. Managers must prioritize access to and ensuring the quality of dental services in rural and remote areas as one of the key objectives of healthcare. They should select appropriate strategies to achieve this goal while developing relevant laws and regulations [ 53 ]. Various strategies, such as educational, legal, regulatory, financial, and professional and personal support interventions, can be employed to improve dental care. Establishing dental schools in deprived areas and enrolling local dental students, offering scholarships contingent upon working in underserved areas, providing sustainable financial incentives (higher salaries and benefits, banking facilities, and tax exemptions), ensuring accommodation and facilities for dentists, creating well-equipped and safe working environments, and implementing continuous professional development training programs can significantly contribute to the retention of dentists in deprived areas. Improving the living conditions of dentists in underserved regions, providing social and emotional support, ensuring quality education for their children, creating suitable working conditions for the dentists' spouses, and fostering a sense of belonging among them in the local community are also essential elements for effective retention strategies. Declarations Consent for publication: Not applicable. Availability of data and material : The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request. Competing interests : The authors declare that they have no competing interests. Funding : Research funding from Zabol University of Medical Sciences Authors' contributions : MM and PI participated in the design of the study. PI, MS, Fk,MA, and ZA undertook the literature review process. PI, and MM developed and implemented the Delphi stage. All authors drafted the manuscript. All authors read and approved the final manuscript. Acknowledgments : The authors would like to extend their most sincere gratitude and appreciation to the esteemed reviewers of the article. References Mosadeghrad AM, Afshari M. The impact of quality management on job satisfaction of operating theatre department employees of Valiasr Hospital in Tehran: A participatory action research. Journal of Health Based Research 2016; 2:147-58 Mohammadiaghdam N, Doshmangir L, Babaie J, Khabiri R, Ponnet K. Determining factors in the retention of physicians in rural and underdeveloped areas: a systematic review. BMC family practice 2020; 21:1-23 WHO. The world health report 2006: working together for health: World Health Organization 2006 Cortez LR, Guerra EC, da Silveira NJD, Noro LRA. The retention of physicians to primary health care in Brazil: motivation and limitations from a qualitative perspective. BMC health services research 2019;19:1-12 Ehsani-Chimeh E, Majdzadeh R, Delavari S, Gharebelagh MN, Rezaei S, Rad EH. Physicians' retention rate and its effective factors in the Islamic Republic of Iran. Information for authors 1995;1 Gedik FG, Buchan J, Mirza Z, Rashidian A, Siddiqi S, Dussault G. The need for research evidence to meet health workforce challenges in the Eastern Mediterranean Region. Eastern Mediterranean Health Journal 2018;24:811 Hillmer J. Strategies to Recruit and Retain Physicians to Rural Health Care: The College of St. Scholastica 2019 McCallum M, MacDonald S, McKay J. GP speciality training in areas of deprivation: factors influencing engagement. A qualitative study. BJGP open 2019;3 Verma P, Ford JA, Stuart A, Howe A, Everington S, Steel N. A systematic review of strategies to recruit and retain primary care doctors. BMC Health Services Research2016;16:1-25 Kumar P, Kumar R. Rural health scenario–role of family medicine: Academy of Family Physicians of India position paper. Journal of family medicine and primary care 2018;7:1157 Darkwa EK, Newman M, Kawkab M, Chowdhury ME. A qualitative study of factors influencing retention of doctors and nurses at rural healthcare facilities in Bangladesh. BMC health services research 2015;15:1-12 Belaid L, Dagenais C, Moha M, Ridde V. Understanding the factors affecting the attraction and retention of health professionals in rural and remote areas: a mixed-method study in Niger. Human resources for health2011; 15: 17 Bastani P, Mohammadpour M, Mehraliain G, Delavari S, Edirippulige S. What makes inequality in the area of dental and oral health in developing countries? A scoping review. Cost Effectiveness and Resource Allocation 2021;19:1-12 Vujicic M, Shengelia B, Alfano M, Thu HB. Physician shortages in rural Vietnam: using a labor market approach to inform policy. Social science & medicine 2011;73(7):970-7 Weinhold I, Gurtner S. Understanding shortages of sufficient health care in rural areas. Health Policy 2014;118:201-14 Dieleman M, Harnmeijer JW. Improving health worker performance: in search of promising practices. Geneva: World Health Organization 2006;1:1-64 Nair RD, Gohil DA, Reddy KVR, Mohammadnezhad M. Factors that influence the retention and turnover of dental professionals: Suggestion for Pacific nations. Journal of International Oral Health 2021;13:319 Girasek E, Eke E, Szócska M. Analysis of a survey on young doctors' willingness to work in rural Hungary. Human resources for health 2010;8:1-6 Sun X, Bernabé E, Liu X, Zheng S, Gallagher JE. Meeting the oral health needs of 12-year-olds in China: Human resources for oral health. BMC Public Health2017;17:1-12 Peres MA, Macpherson LM, Weyant RJ, Daly B, Venturelli R, Mathur MR, et al. Oral diseases: a global public health challenge. The Lancet 2019;394:249-60 Crocombe L, Godwin D, Hoang H, Bell E, Blizzard L. Dental practitioners: Rural work movements 2016 Carrasco-Labra A, Brignardello-Petersen R, Glick M, Guyatt GH, Neumann I, Azarpazhooh A. A practical approach to evidence-based dentistry: VII: how to use patient management recommendations from clinical practice guidelines. The Journal of the American Dental Association 2015;146:327-36 Jakab M, Akkazieva B, Habicht J. Can people afford to pay for health care? New evidence on financial protection in Kyrgyzstan 2018 Righolt A, Jevdjevic M, Marcenes W, Listl S. Global-, regional-, and country-level economic impacts of dental diseases in 2015. Journal of dental research 2018;97:501-7 Hakeem N-E, Eshwar S, Srivastava B, Jain V. Micro-health insurance in dentistry: the road less travelled 2019 Nahvi M, Zarei E, Marzban S, Jahanmehr N. Utilization of dental services and its out-of-pocket payments: a study in dental clinics of Ramsar. Journal of Mashhad Dental School 2017;41:171-82 Northridge ME, Kumar A, Kaur R. Disparities in access to oral health care. Annual review of public health 2020;41:513 Jin L, Lamster I, Greenspan J, Pitts N, Scully C, Warnakulasuriya S. Global burden of oral diseases: emerging concepts, management and interplay with systemic health. Oral diseases2016;22:609-19 Koeleman PM, Koole GM. Optimal outpatient appointment scheduling with emergency arrivals and general service times. IIE Transactions on Healthcare Systems Engineering 2012;2:14-30 Mosadeghrad AM, Afshari M. The impact of quality management on job satisfaction of operating theatre department employees of Valiasr Hospital in Tehran: A participatory action research. Journal of Health Based Research 2016;2:147-58 Mohammadiaghdam N, Doshmangir L, Babaie J, Khabiri R, Ponnet K. Determining factors in the retention of physicians in rural and underdeveloped areas: a systematic review. BMC family practice 2020;21:1-23 WHO. The world health report 2006: working together for health: World Health Organization2006 Cortez LR, Guerra EC, da Silveira NJD, Noro LRA. The retention of physicians to primary health care in Brazil: motivation and limitations from a qualitative perspective. BMC health services research 2019;19:1-12 Ehsani-Chimeh E, Majdzadeh R, Delavari S, Gharebelagh MN, Rezaei S, Rad EH. Physicians' retention rate and its effective factors in the Islamic Republic of Iran. Information for authors 1995;1 Gedik FG, Buchan J, Mirza Z, Rashidian A, Siddiqi S, Dussault G. The need for research evidence to meet health workforce challenges in the Eastern Mediterranean Region. Eastern Mediterranean Health Journal 2018;24:811 Hillmer J. Strategies to Recruit and Retain Physicians to Rural Health Care: The College of St. Scholastica 2019 McCallum M, MacDonald S, McKay J. GP speciality training in areas of deprivation: factors influencing engagement. A qualitative study. BJGP open 2019;3 Verma P, Ford JA, Stuart A, Howe A, Everington S, Steel N. A systematic review of strategies to recruit and retain primary care doctors. BMC Health Services Research2016;16:1-25 Kumar P, Kumar R. Rural health scenario–role of family medicine: Academy of Family Physicians of India position paper. Journal of family medicine and primary care 2018;7:1157 Darkwa EK, Newman M, Kawkab M, Chowdhury ME. A qualitative study of factors influencing retention of doctors and nurses at rural healthcare facilities in Bangladesh. BMC health services research 2015;1:1-12 Belaid L, Dagenais C, Moha M, Ridde V. Understanding the factors affecting the attraction and retention of health professionals in rural and remote areas: a mixed-method study in Niger. Human resources for health2011; 15: 17 Bastani P, Mohammadpour M, Mehraliain G, Delavari S, Edirippulige S. What makes inequality in the area of dental and oral health in developing countries? A scoping review. Cost Effectiveness and Resource Allocation2021;19:1-12 Vujicic M, Shengelia B, Alfano M, Thu HB. Physician shortages in rural Vietnam: using a labor market approach to inform policy. Social science & medicine 2011;73:970-7 Weinhold I, Gurtner S. Understanding shortages of sufficient health care in rural areas. Health Policy 2014;118: 201-14 Dieleman M, Harnmeijer JW. Improving health worker performance: in search of promising practices. Geneva: World Health Organization 2006;1:1-64 Nair RD, Gohil DA, Reddy KVR, Mohammadnezhad M. Factors that influence the retention and turnover of dental professionals: Suggestion for Pacific nations. Journal of International Oral Health 2021;13:319 Girasek E, Eke E, Szócska M. Analysis of a survey on young doctors' willingness to work in rural Hungary. Human resources for health 2010;8:1-6 Sun X, Bernabé E, Liu X, Zheng S, Gallagher JE. Meeting the oral health needs of 12-year-olds in China: Human resources for oral health. BMC Public Health2017;17:1-12 Peres MA, Macpherson LM, Weyant RJ, Daly B, Venturelli R, Mathur MR, et al. Oral diseases: a global public health challenge. The Lancet 2019;394:249-60 Crocombe L, Godwin D, Hoang H, Bell E, Blizzard L. Dental practitioners: Rural work movements 2016 Carrasco-Labra A, Brignardello-Petersen R, Glick M, Guyatt GH, Neumann I, Azarpazhooh A. A practical approach to evidence-based dentistry: VII: how to use patient management recommendations from clinical practice guidelines. The Journal of the American Dental Association 2015;146:327-36 Jakab M, Akkazieva B, Habicht J. Can people afford to pay for health care? New evidence on financial protection in Kyrgyzstan 2018 Righolt A, Jevdjevic M, Marcenes W, Listl S. Global-, regional-, and country-level economic impacts of dental diseases in 2015. Journal of dental research 2018;97(5):501-7 Hakeem N-E, Eshwar S, Srivastava B, Jain V. Micro-health insurance in dentistry: the road less travelled2019 Nahvi M, Zarei E, Marzban S, Jahanmehr N. Utilization of dental services and its out-of-pocket payments: a study in dental clinics of Ramsar. Journal of Mashhad Dental School 2017;41:171-82 Northridge ME, Kumar A, Kaur R. Disparities in access to oral health care. Annual review of public health 2020;41:513 Jin L, Lamster I, Greenspan J, Pitts N, Scully C, Warnakulasuriya S. Global burden of oral diseases: emerging concepts, management and interplay with systemic health. Oral diseases2016;22:609-19 Koeleman PM, Koole GM. Optimal outpatient appointment scheduling with emergency arrivals and general service times. IIE Transactions on Healthcare Systems Engineering 2012;2:14-30 Mosadeghrad AM. Essentials of healthcare organization and management. Tehran: Dibagran 2015 [Persian] WHO. Increasing access to health workers in remote and rural areas through improved retention: global policy recommendations: World Health Organization 2010 Weltgesundheitsorganisation. WHO guideline on health workforce development, attraction, recruitment and retention in rural and remote areas: World Health Organization 2021 Suphanchaimat R, Cetthakrikul N, Dalliston A, Putthasri W. The impact of rural-exposure strategies on the intention of dental students and dental graduates to practice in rural areas: a systematic review and meta-analysis. Advances in Medical Education and Practice 2016;7:623 Kulig JC, Stewart N, Penz K, Forbes D, Morgan D, Emerson P. Work setting, community attachment, and satisfaction among rural and remote nurses. Public Health Nursing 2009;26:430-9 Al‐Banyan R, Echeverri E, Narendran S, Keene H. Oral health survey of 5–12‐year‐old children of National Guard employees in Riyadh, Saudi Arabia. International Journal of Paediatric Dentistry2000;10:39-45 Motohashi M, Nakajima I, Aboshi H, Honda K, Yanagisawa M, Miyata T, et al. The oral health of children in a rural area of the Lao People's Democratic Republic. Journal of Oral Science 2009;51:131-5 Al‐Haddad K, Al‐Hebshi N, Al‐Ak’hali M. Oral health status and treatment needs among school children in Sana’a City, Yemen. International journal of dental hygiene 2010;8:80-5 Moher D, Stewart L, Shekelle P. All in the family: systematic reviews, rapid reviews, scoping reviews, realist reviews, and more. Systematic reviews 2015;4:1-2 Arksey H, O'Malley L. Scoping studies: towards a methodological framework. International journal of social research methodology 2005;8:19-32 Daudt HM, van Mossel C, Scott SJ. Enhancing the scoping study methodology: a large, inter-professional team’s experience with Arksey and O’Malley’s framework. BMC medical research methodology 2013;13:1-9 Makhija SK, Gilbert GH, Boykin MJ, Litaker MS, Allman RM, Baker PS, et al. The Relationship between Sociodemographic Factors and Oral Health–Related Quality of Life in Dentate and Edentulous Community‐Dwelling Older Adults. Journal of the american geriatrics society2006;54:1701-12 Mosadeghrad AM. Health strengthening plan, a supplement to Iran health transformation plan. Tehran University Medical Journal TUMS Publications 2019;77:537-8 Bayne A, Knudson A, Garg A, Kassahun M. Promising practices to improve access to oral health care in rural communities. Rural Eval Brief 2013;7:1-6 Additional Declarations No competing interests reported. Cite Share Download PDF Status: Under Review Version 1 posted Editorial decision: Revision requested 14 Jul, 2025 Reviews received at journal 09 Jul, 2025 Reviews received at journal 01 Jul, 2025 Reviewers agreed at journal 01 Jul, 2025 Reviewers agreed at journal 27 Jun, 2025 Reviewers agreed at journal 20 Jun, 2025 Reviews received at journal 19 Jun, 2025 Reviewers agreed at journal 18 Jun, 2025 Reviewers invited by journal 18 Jun, 2025 Editor invited by journal 23 May, 2025 Editor assigned by journal 28 Apr, 2025 Submission checks completed at journal 28 Apr, 2025 First submitted to journal 27 Apr, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. 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longevity of dentists by year of publication\u003c/p\u003e","description":"","filename":"2.png","url":"https://assets-eu.researchsquare.com/files/rs-6541879/v1/0cea32d720cfc88554225dd9.png"},{"id":85046543,"identity":"9efc9f99-ee3d-48a2-bfdf-e86721d73302","added_by":"auto","created_at":"2025-06-20 10:25:42","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":97000,"visible":true,"origin":"","legend":"\u003cp\u003eFrequency distribution of articles on strategies for dentists to remain in disadvantaged areas of the world\u003c/p\u003e","description":"","filename":"3.png","url":"https://assets-eu.researchsquare.com/files/rs-6541879/v1/e60c64c99b62b4259abc6441.png"},{"id":85045706,"identity":"dce80b1a-52dd-4d5a-9a22-2a006e6ec7cf","added_by":"auto","created_at":"2025-06-20 10:17:42","extension":"png","order_by":4,"title":"Figure 4","display":"","copyAsset":false,"role":"figure","size":13580,"visible":true,"origin":"","legend":"\u003cp\u003eFrequency distribution of strategies for dentists' retention in deprived areas in terms of scope\u003c/p\u003e","description":"","filename":"4.png","url":"https://assets-eu.researchsquare.com/files/rs-6541879/v1/0517150a4a7f26eafffd558c.png"},{"id":85045709,"identity":"1d49b34e-70b8-4341-96aa-1dcd28a6f085","added_by":"auto","created_at":"2025-06-20 10:17:42","extension":"png","order_by":5,"title":"Figure 5","display":"","copyAsset":false,"role":"figure","size":26866,"visible":true,"origin":"","legend":"\u003cp\u003eFrequency distribution of strategies for dentists' retention in deprived areas\u003c/p\u003e","description":"","filename":"5.png","url":"https://assets-eu.researchsquare.com/files/rs-6541879/v1/7816baf8f152daf9874a1e73.png"},{"id":85047943,"identity":"b799f393-b5d4-405c-894a-94ac5700deae","added_by":"auto","created_at":"2025-06-20 10:49:43","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":897912,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-6541879/v1/6de59053-081b-4f48-990e-a1139622deb9.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Strategies for attracting and retaining dentists in deprived areas: A scoping review","fulltext":[{"header":"Introduction","content":"\u003cp\u003eHealth and medical organizations are responsible for providing diagnostic, therapeutic, and rehabilitation services to the community. The effective and efficient execution of these tasks depends on skilled human resources who are knowledgeable, motivated, and committed. Human resources are considered the main factor for the success of organizations [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. In most countries, about 10% of all government employees are dedicated to the health sector [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. A sufficient number of skilled workers with equitable distribution will significantly contribute to achieving health goals and outcomes. According to the World Health Organization (WHO), all countries should have approximately 2.28 doctors, nurses, and midwives per thousand population to ensure desirable health outcomes for their population [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eMore than half of the world's population lives in poverty and in rural areas [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. Economic and social deprivation, poverty, unhealthy lifestyles, and the emergence of diseases have led to an increased demand for health services worldwide, especially in rural areas [\u003cspan additionalcitationids=\"CR7\" citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. Therefore, it is expected that more health professionals will work in such areas. Studies show that only a quarter of health workers operate in deprived areas [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. Health service coverage in rural areas is weak [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. In most developed and developing countries, a lower level of health service coverage in rural and deprived regions has been reported [\u003cspan additionalcitationids=\"CR12\" citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]. Patients in deprived and remote areas often have to travel long distances to access health services and may also experience delays in treatment.\u003c/p\u003e \u003cp\u003eThe imbalance in the distribution of health workers within countries has become a serious and common challenge. This can lead to shortages and challenges in underprivileged and less developed areas, ultimately reducing access to health services [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. Rural communities face challenges in recruiting and retaining health providers [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]. Retaining health workers in deprived and remote areas is crucial for various reasons, including continuity of health services, maintaining optimal health performance, and allowing for the enhancement of knowledge and skills among employees [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]. Among health workers, dentists play a vital role in improving community health.\u003c/p\u003e \u003cp\u003eIn 2015, the WHO reported that the global dental workforce amounted to approximately 1.5\u0026nbsp;million people, with 80% being dentists, while the rest were oral health professionals and dental technicians [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]. However, the migration of dentists from rural and less developed areas to affluent and developed regions has raised significant concerns for policymakers and health managers. The disproportionate distribution of dentists can disrupt the functioning and stability of the health system. In many rural and underdeveloped areas, the shortage of dentists is a long-standing challenge that has serious implications for the quality and quantity of oral health services, as well as limiting people's access to these services in these regions [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThe prevalence of oral diseases worldwide, especially in rural areas, is increasing [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]. Oral diseases affect nearly 3.5\u0026nbsp;billion people globally [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]. Poor oral hygiene is a significant factor in the development of many diseases, including diabetes, low birth weight, preterm birth, arthritis, heart problems, and respiratory diseases, impacting individuals' quality of life. Besides low fluoride exposure, various factors such as inadequate hygiene, poor diet, tobacco use, and lack of access to oral health services contribute to these problems. Unlike medical services, the vast majority of dental services are provided in the private sector, and their costs are borne directly by patients. Oral health is poorer in rural areas compared to urban areas. Although oral health has improved in recent years, the gap in oral health outcomes between rural and urban populations has not diminished. This gap is due to multiple factors, such as poor access to dental care, individual attitudes, socioeconomic status, and exposure to fluoride water. Furthermore, issues related to the recruitment and retention of dentists have led to poor oral health outcomes in rural communities [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eInequality within and between countries regarding dental health care is a common issue and may be attributed to restricted coverage of dental benefits and disparities among households in terms of coverage [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e]. The overall global cost estimate for oral diseases in 2015 increased by about 23.2% compared to 2010 [\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e, \u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e]. Additionally, developed countries allocate about 5 to 10 percent of health sector expenditures annually [\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eMany African, Asian, and Latin American countries face a shortage of oral health personnel, and the capacity of these systems is largely limited to pain relief or emergency care. In Africa, the dentist-to-population ratio is 1:150,000 compared to 1:2,000 in most industrialized countries [\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e]. On the other hand, the number of dentists and graduates in dental studies in developing countries is on the rise [\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e]. Iran has many rural and desert areas, most of which have poor facilities. Medical and dental care in these areas is in a critical state. In addressing this issue, policymakers and managers are paying special attention to these regions. Addressing the challenges of deprived and remote areas is among the general policies of the Ministry of Health and Medical Education [\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e]. Although the number of graduates from medical universities in Iran is increasing, studies conducted in impoverished and deprived areas of Iran indicate a severe shortage of healthcare workforce relative to the population in these areas due to the migration of health specialists to urban areas. Consequently, rural areas face an unequal distribution of human healthcare resources, particularly among dentists [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eUnder these circumstances, policymakers and health system managers must shift their focus toward effective workforce management and pay greater attention to the quality of work life and the needs of their employees. Human resource management is essential as one of the important and specialized functions of management for the success of any health system. Its aim is to ensure the effective and efficient employment of human resources within the organization to achieve organizational goals. Functions of human resource management include workforce planning, acquiring necessary human resources at minimal cost, developing and enhancing employees' talents and skills, retaining the workforce, fostering positive relationships among them, meeting the reasonable needs of employees, performance evaluation, compensating employees, and ensuring their reasonable satisfaction [\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThe WHO has proposed 17 recommendations to improve the recruitment and retention of health workers in deprived and remote areas [\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e], including enrolling rural students in health worker training programs, locating health worker training sites near rural areas, taking students from health worker training programs to rural and remote areas, aligning health worker training with the health needs of rural communities, facilitating continuous education for health workers in rural and remote areas, expanding the scope of health workers\u0026rsquo; activities in rural areas to meet the needs of these communities, broadening the professions of health workers to address the health needs of rural communities, ensuring that mandatory service agreements come with appropriate rights, supports, and incentives, providing educational subsidies for health workers in rural and deprived areas, offering incentive packages for recruitment and retention, improving living conditions in rural and deprived areas, ensuring workplace safety in rural and deprived health facilities, guaranteeing decent work for health workers in rural and deprived areas, establishing and promoting support networks for health workforce, developing and enhancing career pathways for rural and deprived health workers, and facilitating knowledge exchange among health workers and elevating the status of rural health educators [\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eDentists are one of the health workforce groups for which there is limited information. This is despite the fact that oral diseases represent a major health issue worldwide [\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e, \u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e]. The burden of oral diseases on marginalized populations is significant in both developing and developed countries [\u003cspan additionalcitationids=\"CR36\" citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e]. Therefore, this study aims to identify strategies for the retention and attraction of dentists in deprived and remote areas.\u003c/p\u003e"},{"header":"Materials and Methods","content":"\u003cp\u003eThe present study was conducted using the Scoping Review method. The scoping review is a type of secondary study that collects and synthesizes a wide range of evidence with the aim of conveying the extent and depth of a topic [\u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e]. Researchers can use scoping reviews as a preliminary study to assess the volume, scope, and nature of research activities. Additionally, these researchers can identify gaps in the existing literature [\u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e]. A scoping review can provide an opportunity to identify key concepts.\u003c/p\u003e \u003cp\u003eIn this research, the protocol developed by Arskey and O'Malley was employed for conducting the scoping review, which includes six stages: identifying the research question, identifying relevant studies, selecting studies, charting data, collecting, summarizing, and reporting results, and finally, optional consultation regarding the findings [\u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e]. The research questions for this scoping review were: \"What strategies exist for attracting and retaining dentists?\" and \"Which strategies are most commonly used to increase the recruitment and retention of dentists?\"\u003c/p\u003e \u003cp\u003eThis study focused on published research in Persian and English identifying strategies for attracting and retaining dentists in deprived areas. Searches were conducted using appropriate keywords in both English and Persian, including \"strategies,\" \"solution,\" \"dentists,\" \"sustainability,\" \"recruitment,\" \"retention,\" \"poor areas,\" \"deprived areas,\" \"remote rural areas\". These keywords were searched in combination and separately in the English electronic databases \"PubMed,\" \"Scopus,\" \"Wiley,\" \"ScienceDirect,\" \"Emerald,\" \"Springer,\" \"Web of Science,\" and in the Persian electronic databases \"SID\" and \"Magiran\" (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). Additionally, the \"Google Scholar\" search engine was also used to ensure access to relevant studies. Retrieved studies were imported into EndNote \u0026times;9 software.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eSearch strategy and number of studies obtained from the databases reviewed\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"3\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDatabase\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eKeywords and search strategy\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eIdentified studies\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePubMed\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e((\"strategie\"[All Fields] OR \"strategies\"[All Fields] OR \"strategy\"[All Fields] OR \"strategy s\"[All Fields] OR (\"pharmaceutical solutions\"[Pharmacological Action] OR \"solutions\"[MeSH Terms] OR \"solutions\"[All Fields] OR \"solution\"[All Fields] OR \"pharmaceutical solutions\"[MeSH Terms] OR (\"pharmaceutical\"[All Fields] AND \"solutions\"[All Fields]) OR \"pharmaceutical solutions\"[All Fields] OR \"solutal\"[All Fields] OR \"solute\"[All Fields] OR \"solute s\"[All Fields] OR \"soluted\"[All Fields] OR \"solutes\"[All Fields] OR \"solution s\"[All Fields])) AND (\"sustain\"[All Fields] OR \"sustainability\"[All Fields] OR \"sustainable\"[All Fields] OR \"sustainably\"[All Fields] OR \"sustained\"[All Fields] OR \"sustaining\"[All Fields] OR \"sustainment\"[All Fields] OR \"sustains\"[All Fields] OR (\"retention, psychology\"[MeSH Terms] OR (\"retention\"[All Fields] AND \"psychology\"[All Fields]) OR \"psychology retention\"[All Fields] OR \"retention\"[All Fields] OR \"retentions\"[All Fields] OR \"retentive\"[All Fields] OR \"retentiveness\"[All Fields]) OR (\"recruit\"[All Fields] OR \"recruited\"[All Fields] OR \"recruiter\"[All Fields] OR \"recruiters\"[All Fields] OR \"recruiting\"[All Fields] OR \"recruitment\"[All Fields] OR \"recruitments\"[All Fields] OR \"recruits\"[All Fields])) AND (\"dentist s\"[All Fields] OR \"dentists\"[MeSH Terms] OR \"dentists\"[All Fields] OR \"dentist\"[All Fields]) AND (((\"poverty\"[MeSH Terms] OR \"poverty\"[All Fields] OR \"poor\"[All Fields]) AND (\"area s\"[All Fields] OR \"areas\"[All Fields])) OR ((\"deprival\"[All Fields] OR \"deprivation\"[All Fields] OR \"deprivations\"[All Fields] OR \"deprive\"[All Fields] OR \"deprived\"[All Fields] OR \"deprives\"[All Fields] OR \"depriving\"[All Fields]) AND (\"area s\"[All Fields] OR \"areas\"[All Fields])))) AND (1000/1/1:2024/1/20[pdat])\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWiley\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\"(strategies OR solution) AND (sustainability OR retention OR recruitment) AND dentists AND (poor areas OR deprived areas)\" Open Access filter 1897\u0026ndash;2022 filter\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e140\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWeb of Science\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e((ALL=(deprived areas )) AND ALL=(dentists)) Refined By: Languages: English\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e34\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eScopus\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eALL ( strategies OR solution ) AND ALL ( sustainability OR retention OR recruitment ) AND ALL ( dentists ) AND ALL ( poor AND areas OR deprived AND areas OR \"remote rural areas\" ) AND ( LIMIT-TO ( PUBSTAGE, \"final\" ) ) AND ( LIMIT-TO ( OA, \"all\" ) ) AND ( LIMIT-TO ( LANGUAGE, \"English\" ) )\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e66\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSpringer\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e'(strategies OR solution) AND (sustainability OR retention OR recruitment) AND dentists AND (poor areas OR deprived areas OR \"remote rural areas\")'\u003c/p\u003e \u003cp\u003ewithin Dentistry Remove this filter English Remove this filter\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e435\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eScience Direct\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e(strategies OR solution) AND (sustainability OR retention OR recruitment) AND dentists AND (poor areas OR deprived areas OR \"remote rural areas\")\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e(5168( 11pages reviewed)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEmerald\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e(strategies OR solution) AND (sustainability OR retention OR recruitment) AND dentists AND (poor areas OR deprived areas OR \"remote rural areas\") Only Open Access\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e11\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGoogle scholar\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e(strategies OR solution) AND dentists AND (deprived areas) AND (sustainability OR retention OR recruitment)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e18100 (8 pages reviewed)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMagIran\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003edentists AND deprived areas\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSID\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003edentists\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e9\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBibliography of the included papers\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFinal studies\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e23958\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eThe inclusion criteria for the study encompassed all research conducted on strategies to attract and retain dentists in deprived areas up to January 20, 2024. The exclusion criteria included studies published in languages other than Persian and English, studies published after January 20, 2024, and scientific resources lacking full text. Three of the authors were primarily responsible for screening the studies, and in case of any issues, a fourth author was consulted for discussion and consensus.\u003c/p\u003e \u003cp\u003eIn total, 23,958 articles were extracted from the databases. After eliminating duplicates and articles that lacked full text, 23,885 studies remained for title and abstract review. Among these, 23,817 cases were removed following the title and abstract review. A total of 68 articles related to strategies for attracting and retaining dentists in deprived areas were obtained at this stage. After a thorough examination of the remaining articles, 46 were excluded due to their irrelevance to the sustainability of dentists in deprived areas. Two additional articles were found by reviewing the references of the articles. Ultimately, 25 research articles relevant to strategies for attracting and retaining dentists in deprived areas were included (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eA data extraction form was used, which included sections for author details, journal name, year of publication, country of study, study aims, sample size, research type, method of data collection, strategies, findings, and conclusions. A framework analysis approach was utilized for analyzing the qualitative data of this study [\u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e41\u003c/span\u003e]. Version 10 of MAXQDA software was used for data analysis. All ethical considerations relevant to review studies were adhered to in this research. Researchers did not allow their personal opinions to influence the data collection, analysis, and reporting stages.\u003c/p\u003e "},{"header":"Findings","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003cp\u003eA total of 25 articles focused on strategies for attracting and retaining dentists in deprived areas were published between November 2004 and January 20, 2024 (see Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e). All published articles were in English (100%). The majority of the articles were published in the International Dental Journal (6 articles). The largest sample size was 821 dentists in one quantitative study, while the smallest sample size pertained to a review study that included 7 articles.\u003c/p\u003e \u003cp\u003eThe studies comprised predominantly of reviews (11 cases), quantitative studies (5 cases), qualitative studies (7 cases), and mixed methods (2 cases). In the review studies, databases were utilized to extract relevant articles (11 cases), while qualitative studies employed semi-structured interviews (8 cases). In the quantitative studies, information was collected through questionnaires (8 cases) and focus groups (1 case). The majority of the articles reviewed were published in 2016 (4 cases) (Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eThe studies on strategies for retaining dentists in deprived areas were conducted across 9 countries (Australia, Iran, the United States, Scotland, Wales, Turkey, England, South Africa, and Thailand). Approximately 13% of the research was conducted in North America (USA), 13% in Asia (Iran and Thailand), 18% in Europe (Wales, Scotland, England, and Turkey), 51% in the Pacific region (Australia), and about 5% in Africa (South Africa) (Fig.\u0026nbsp;\u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e3\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eA total of 62 strategies for attracting and retaining dentists in deprived areas were identified. These strategies were categorized into six groups: governance and leadership, financing, human resources, technology, equipment and medications, information systems, and service delivery (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eStrategies for attracting and retaining dentists in disadvantaged areas\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"2\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBuilding blocks\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eStrategies for dentists to remain in underserved areas (frequency)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eGovernance and Leadership\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1. Developing dental care policies based on the popular culture of the people (1)\u003c/p\u003e \u003cp\u003e2. Implementing supportive and participatory management styles (3)\u003c/p\u003e \u003cp\u003e3. Formulating transparent and flexible programs suitable for current conditions (1)\u003c/p\u003e \u003cp\u003e4. Organizing supportive and constructive programs for young dentists (1)\u003c/p\u003e \u003cp\u003e5. Increasing intersectoral collaboration (1)\u003c/p\u003e \u003cp\u003e6. Integrating oral healthcare into primary healthcare services (3)\u003c/p\u003e \u003cp\u003e7. Monitoring the performance of dentists in remote areas (1)\u003c/p\u003e \u003cp\u003e8. Recognizing the efforts of dentists in remote areas (1)\u003c/p\u003e \u003cp\u003e9. Increasing the capacity to accept local students in dental and oral health programs (1)\u003c/p\u003e \u003cp\u003e10. Developing diverse career programs for dentists (2)\u003c/p\u003e \u003cp\u003e11. Providing professional development opportunities and enhancing ongoing independence for dentists in remote areas (5)\u003c/p\u003e \u003cp\u003e12. Promoting managerial competencies and skills among managers in this field (3)\u003c/p\u003e \u003cp\u003e13. Using credible research evidence to improve the oral health of rural populations and retain dentists in villages (1)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eFinancing\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1. Equitable distribution of resources and budgets allocated for health and medical services in villages and cities (1)\u003c/p\u003e \u003cp\u003e2. Financial support policies for dentists through incentives such as housing loans or loan forgiveness (5)\u003c/p\u003e \u003cp\u003e3. Securing financial resources and loan facilities for volunteer staff (1)\u003c/p\u003e \u003cp\u003e4. Establishing a reward system for dentists committed to service (1)\u003c/p\u003e \u003cp\u003e5. Signing long-term contracts with significant financial advantages (2)\u003c/p\u003e \u003cp\u003e6. Providing incentive insurance for dentists in remote areas, such as life insurance, health insurance, malpractice coverage, licensing fees reimbursement, and retirement insurance (1)\u003c/p\u003e \u003cp\u003e7. Paying salaries through various methods, such as daily wages with bonuses (1)\u003c/p\u003e \u003cp\u003e8. Offering financial aid and discounts on dental services for rural residents to increase demand (2)\u003c/p\u003e \u003cp\u003e9. Evaluating the cost-effectiveness of financial assistance for accessing dental services for rural residents (1)\u003c/p\u003e \u003cp\u003e10. Equitable allocation of financial resources among male and female employees working in villages (1)\u003c/p\u003e \u003cp\u003e11. Providing financial and educational support for local rural students (1)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eHuman Resources\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1. Equitable distribution of human resources to reduce workload in rural areas (4)\u003c/p\u003e \u003cp\u003e2. Targeted training that encompasses all aspects of oral healthcare (1)\u003c/p\u003e \u003cp\u003e3. Hiring and training graduates to practice practical skills in villages (1)\u003c/p\u003e \u003cp\u003e4. Employing young educated individuals and young families in rural areas (1)\u003c/p\u003e \u003cp\u003e5. Collaborating between rural dental service centers and provincial dental schools (1)\u003c/p\u003e \u003cp\u003e6. Encouraging graduates to serve in rural areas (1)\u003c/p\u003e \u003cp\u003e7. Granting voluntary leave rights to rural staff (1)\u003c/p\u003e \u003cp\u003e8. Providing bonuses to employees who recruit staff (1)\u003c/p\u003e \u003cp\u003e9. Hiring local rural students, especially female students (2)\u003c/p\u003e \u003cp\u003e10. Improving the content and training programs for dentists (1)\u003c/p\u003e \u003cp\u003e11. Facilitating mentorship and networking for less experienced dentists with support from senior dentists and professional associations (1)\u003c/p\u003e \u003cp\u003e12. Granting dentists the authority to purchase practices in villages (1)\u003c/p\u003e \u003cp\u003e13. Allowing leave and missions for dentists working in rural areas for further education and research (1)\u003c/p\u003e \u003cp\u003e14. Reforming organizational structures and supporting human resource relocation plans (1)\u003c/p\u003e \u003cp\u003e15. Providing bonuses for entering and remaining in job positions in rural areas (1)\u003c/p\u003e \u003cp\u003e16. Establishing specific limitations and conditions for the graduate studies of urban dentists (1)\u003c/p\u003e \u003cp\u003e17. Organizing practical training programs and clinical rotations for rural students in village settings (1)\u003c/p\u003e \u003cp\u003e18. Providing job, educational, and related resources for dentists\u0026rsquo; spouses (3)\u003c/p\u003e \u003cp\u003e19. Strengthening educational frameworks in rural schools for the children of specialists (3)\u003c/p\u003e \u003cp\u003e20. Intersectoral collaboration with education departments to develop educational systems in villages (3)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eTechnology, Equipment and Medicine\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1. Increasing rural residents\u0026rsquo; access to dental services by enhancing tele-dentistry infrastructures (4)\u003c/p\u003e \u003cp\u003e2. Developing internet infrastructure and telephone triage systems (1)\u003c/p\u003e \u003cp\u003e3. Strengthening village infrastructure to enhance motivation among dental staff (5)\u003c/p\u003e \u003cp\u003e4. Evaluating the cost-effectiveness of new dental treatments for rural residents compared to previous treatments (1)\u003c/p\u003e \u003cp\u003e5. Developing transportation facilities to the workplace (4)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eInformation Systems\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1. Collecting epidemiological data on oral health in rural populations (1)\u003c/p\u003e \u003cp\u003e2. Developing research on the cost-effectiveness of tele-dental services (1)\u003c/p\u003e \u003cp\u003e3. Developing marketing services and using evidence-based strategies to enhance social connectedness (1)\u003c/p\u003e \u003cp\u003e4. Establishing managed clinical networks for dental specialties to reach rural and remote areas (1)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eHealth Service Delivery\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1. Utilizing less skilled staff in rural areas due to easier recruitment (1)\u003c/p\u003e \u003cp\u003e2. Providing opportunities for participation in service projects and partnering with the community of dentists in remote areas (1)\u003c/p\u003e \u003cp\u003e3. Encouraging interdisciplinary collaboration and employing health assistants in this field (1)\u003c/p\u003e \u003cp\u003e4. Creating opportunities for collaboration with the private sector to exchange work experiences and personnel transfer (1)\u003c/p\u003e \u003cp\u003e5. Developing alternative service delivery systems (such as partnerships with the private sector, contracts with private entities for profit or nonprofit) (1)\u003c/p\u003e \u003cp\u003e6. Collaborating with and supporting dental clinics in adjacent urban areas (1)\u003c/p\u003e \u003cp\u003e7. Using incentives and providing mandatory service for dental graduates in a combined approach (1)\u003c/p\u003e \u003cp\u003e8. Distributing human resources in remote areas with a commitment and guarantee from them at the beginning of their service (2)\u003c/p\u003e \u003cp\u003e9. Flexibility in working hours and workloads for young staff (1)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eThe majority of strategies were related to human resources (20 cases), governance and leadership (13 cases), financing (11 cases), health service delivery (9 cases), technology, equipment and medications (5 cases), and information systems (4 cases) (Fig.\u0026nbsp;\u003cspan refid=\"Fig4\" class=\"InternalRef\"\u003e4\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eThe frequency of the strategies with the highest occurrence is illustrated in Fig.\u0026nbsp;\u003cspan refid=\"Fig5\" class=\"InternalRef\"\u003e5\u003c/span\u003e. The most frequently mentioned strategies include: Providing professional development and continuously increasing autonomy for dentists in remote areas (5 cases), Financial support policies for dentists, including incentives such as housing loans or loan forgiveness (5 cases), Strengthening rural infrastructure to enhance and motivate dental staff (5 cases), Improving rural access to dental services by enhancing tele-dentistry infrastructure (4 cases), Developing transportation facilities to work locations (4 cases), Fair distribution of human resources to reduce workload in rural areas (4 cases), Providing job, educational, and relevant equipment opportunities for dentists' spouses (3 cases), Intersectoral collaboration with educational affairs to develop educational systems in villages (3 cases), Strengthening educational structures in rural schools for the children of specialists (3 cases).\u003c/p\u003e\u003c/div\u003e"},{"header":"Discussion and Conclusion","content":"\u003cp\u003eThis study aimed to identify strategies for attracting and retaining dentists in deprived and remote areas. A total of 62 strategies were identified regarding the recruitment and retention of dentists in these regions, categorized into six groups: governance and leadership, financing, human resources, technology, equipment and medications, information systems, and service delivery.\u003c/p\u003e \u003cp\u003eThe governance and leadership category addresses issues related to legislation, policy-making, planning, stewardship, communication, coordination of national policies and local responses, intersectoral collaboration, and monitoring and evaluation [\u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e42\u003c/span\u003e]. Legislation and regulation are crucial for establishing coordination and strengthening intersectoral collaboration, ensuring the necessary resources for the health sector, modifying the work methods of health personnel, managing human resources, and ensuring public access to health services\u0026mdash;all of which require strong governance and leadership. Health sector policies will not be effectively implemented without the participation and collaboration of other government organizations. Policymakers and senior health system leaders must establish good relationships with other politicians and senior officials and utilize appropriate tools to influence national and local policies. They should develop clear plans for allocating government resources to the health system, particularly for hiring healthcare workers, especially dentists, in deprived and remote areas. Transparent strategies for workforce management in these regions should be developed, ensuring coherence and consideration of the interrelations between health and the economy. Political, social, and economic factors significantly impact the health system; thus, enhancing intersectoral collaboration in providing health services will lead to integrated service delivery and better outcomes. Improving communication between dental providers and primary healthcare providers can increase referral rates between dental clinics and health centers and facilitate intersectoral collaborations [\u003cspan citationid=\"CR43\" class=\"CitationRef\"\u003e43\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eEffective management of the health workforce in deprived and remote areas requires political and financial commitments. Therefore, political leaders play a crucial role in mobilizing resources in these areas. The government can address this shortage by employing oral health workers in rural and remote areas. The employment of oral health workers in these regions can be particularly effective [\u003cspan citationid=\"CR44\" class=\"CitationRef\"\u003e44\u003c/span\u003e]. An analysis of patient records in practices in Wales indicated that at least one-third of routine dental care in primary care could be provided by hygienists and therapists [\u003cspan citationid=\"CR45\" class=\"CitationRef\"\u003e45\u003c/span\u003e]. The WHO has developed a program aimed at retaining health personnel in deprived and rural areas. This program provides a list of factors that influence the improvement of staff recruitment and retention, including education, laws and regulations, financial incentives, and professional and personal support [\u003cspan citationid=\"CR46\" class=\"CitationRef\"\u003e46\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eLegislators and health officials should formulate policies to reduce the shortage of dentists in remote and deprived areas and improve access for these populations. These policies should consider physical barriers to accessing dental services, funding oral health services, increasing the number of health workers, and establishing comprehensive oral health services in primary care. The provision of appropriate and comprehensive dental services to meet clinical needs and improve access in these areas, particularly in deprived and remote regions, is essential [\u003cspan citationid=\"CR47\" class=\"CitationRef\"\u003e47\u003c/span\u003e, \u003cspan citationid=\"CR48\" class=\"CitationRef\"\u003e48\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eStrengthening the healthcare workforce [\u003cspan citationid=\"CR49\" class=\"CitationRef\"\u003e49\u003c/span\u003e], access to insurance and coverage [\u003cspan citationid=\"CR50\" class=\"CitationRef\"\u003e50\u003c/span\u003e], and tele-dentistry [\u003cspan citationid=\"CR51\" class=\"CitationRef\"\u003e51\u003c/span\u003e] are common approaches to enhance oral health services in rural communities. Tele-dentistry encompasses a wide range of dental services, including video consultations, sharing images and records among healthcare providers, conducting training sessions, and managing patients' oral health. It serves as an emerging tool to connect rural and non-rural residents with dental care. Although challenges such as reimbursement issues, quality of care, and patient safety exist, tele-dentistry can increase the capacity of practices for disease screening and connect patients to necessary care [\u003cspan citationid=\"CR52\" class=\"CitationRef\"\u003e52\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eAnother government strategy to overcome geographical challenges in rural areas involves providing oral health care through mobile dental services [\u003cspan citationid=\"CR51\" class=\"CitationRef\"\u003e51\u003c/span\u003e]. This service allows a mobile dental clinic to offer oral health services up to 30 miles from the fixed clinic location [\u003cspan citationid=\"CR52\" class=\"CitationRef\"\u003e52\u003c/span\u003e]. The use of low-interest loans can facilitate the attraction and retention of dentists in deprived and remote areas. Additionally, such loans can support oral health workers and dentists during their studies to encourage them to settle in these remote and rural areas [\u003cspan citationid=\"CR52\" class=\"CitationRef\"\u003e52\u003c/span\u003e, \u003cspan citationid=\"CR50\" class=\"CitationRef\"\u003e50\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThe financing block addresses the collecting, pooling, and purchasing of health services [\u003cspan citationid=\"CR53\" class=\"CitationRef\"\u003e53\u003c/span\u003e]. Adequate budget allocation for attracting and retaining dentists plays a significant role in improving access to healthcare services in rural and remote areas. In Iran, most dental services are provided by the private sector, with over 90% of dentists practicing in this domain [\u003cspan citationid=\"CR54\" class=\"CitationRef\"\u003e54\u003c/span\u003e]. Moreover, dental services in Iran are not covered by government health insurance, with nearly 20% of total dental service costs falling under the public health system [\u003cspan citationid=\"CR55\" class=\"CitationRef\"\u003e55\u003c/span\u003e]. Equitable access to dental care enhances public health and potentially reduces healthcare costs. However, achieving affordable, accessible, and optimal oral health care is considered an economic challenge in many countries [\u003cspan additionalcitationids=\"CR57\" citationid=\"CR56\" class=\"CitationRef\"\u003e56\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR58\" class=\"CitationRef\"\u003e58\u003c/span\u003e]. A study in Australia conducted in 2019 revealed that about two million people in the country defer dental visits each year due to costs and insurance coverage. Reducing inequalities should be considered in all aspects of oral healthcare, including resource allocation for dental care, actual uptake of dental services, quality of dental services, workforce in oral healthcare, and financing of dental care [\u003cspan additionalcitationids=\"CR60 CR61\" citationid=\"CR59\" class=\"CitationRef\"\u003e59\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR62\" class=\"CitationRef\"\u003e62\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThe quality of individuals' lives related to oral health varies with socio-economic status [\u003cspan citationid=\"CR63\" class=\"CitationRef\"\u003e63\u003c/span\u003e, \u003cspan citationid=\"CR64\" class=\"CitationRef\"\u003e64\u003c/span\u003e, \u003cspan citationid=\"CR47\" class=\"CitationRef\"\u003e47\u003c/span\u003e], education level [\u003cspan citationid=\"CR65\" class=\"CitationRef\"\u003e65\u003c/span\u003e, \u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e41\u003c/span\u003e], income [\u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e41\u003c/span\u003e], and regional deprivation [\u003cspan citationid=\"CR66\" class=\"CitationRef\"\u003e66\u003c/span\u003e, \u003cspan citationid=\"CR67\" class=\"CitationRef\"\u003e67\u003c/span\u003e, \u003cspan citationid=\"CR47\" class=\"CitationRef\"\u003e47\u003c/span\u003e]. The Health Resources and Services Administration (HRSA) and the Federal Office of Rural Health Policy (ORHP) in the United States provided financial assistance to rural communities to implement community-based oral health programs as part of the 330A Outreach Authority program. This program focuses on reducing healthcare and treatment inequalities and expanding health services in rural and remote areas [\u003cspan citationid=\"CR43\" class=\"CitationRef\"\u003e43\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThe human resources block of the health system includes workforce planning, recruitment, selection and hiring, training and empowerment of staff, managing employee relations, performance evaluation, and staff compensation. Health workers are the most crucial asset of any health system. Implementing any changes requires diligent, committed, and specialized staff [\u003cspan citationid=\"CR53\" class=\"CitationRef\"\u003e53\u003c/span\u003e]. Training, enhancing knowledge and skills, and protecting health workers, especially dentists in rural and remote areas, from physical and psychological harm are essential. To attract and retain dentists in rural and remote areas, the government can utilize educational, legal, regulatory, financial, and professional and personal support interventions. Actions such as establishing dental schools in deprived areas and enrolling local dental students [\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e], providing scholarships contingent on work in deprived regions, offering sustainable financial incentives (higher salaries and benefits, banking facilities, and tax exemptions) [\u003cspan citationid=\"CR49\" class=\"CitationRef\"\u003e49\u003c/span\u003e], ensuring accommodation and facilities for dentists [\u003cspan citationid=\"CR50\" class=\"CitationRef\"\u003e50\u003c/span\u003e], creating well-equipped and safe work environments, and implementing continuous professional development education programs are effective in retaining dentists in underserved areas.\u003c/p\u003e \u003cp\u003eMore than 530\u0026nbsp;million children suffer from dental caries, making it one of the most common chronic diseases in childhood worldwide [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]. While significant progress has been made in European countries compared to previous decades, the prevalence of caries is still associated with socio-economic deprivation in many European regions [\u003cspan citationid=\"CR68\" class=\"CitationRef\"\u003e68\u003c/span\u003e]. Epidemiological studies in England and Wales found that approximately 23% and 34% of five-year-old children, respectively, experienced dental caries [\u003cspan citationid=\"CR69\" class=\"CitationRef\"\u003e69\u003c/span\u003e, \u003cspan citationid=\"CR70\" class=\"CitationRef\"\u003e70\u003c/span\u003e]. To address any issue effectively, it is essential to tackle the root cause. In this regard, proper education about the benefits of oral health should be a fundamental part of every child\u0026rsquo;s education. Schools in rural and remote communities should instruct children on how to care for their oral health. Furthermore, campaigns that support and encourage dental professions in these communities should be established to help children develop an interest in maintaining healthy and strong teeth [\u003cspan citationid=\"CR71\" class=\"CitationRef\"\u003e71\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eOngoing and adequate training should be continually provided to dentists and oral health workers in rural and remote areas. Delivering quality dental health services requires training and educating the workforce in evidence-based practices.\u003c/p\u003e \u003cp\u003eThe block concerning equipment, supplies, medications, and vaccines in the health system involves needs assessment, purchasing, and maintenance of equipment and medications [\u003cspan citationid=\"CR53\" class=\"CitationRef\"\u003e53\u003c/span\u003e]. Strengthening the management and distribution systems for medical supplies, medications, and vaccines in primary healthcare must emphasize infrastructure improvement, particularly in underserved areas. Guidelines for the use of health equipment should be prepared and disseminated, and intersectoral coordination should be established to mobilize resources outside the health system while seeking support for the provision and production of medical supplies [\u003cspan citationid=\"CR72\" class=\"CitationRef\"\u003e72\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eAccurate, timely, and precise information must be collected from dentists and oral health workers to provide the necessary evidence for policymakers and health managers. Weaknesses in the primary healthcare information system lead to inadequate access to comprehensive information regarding needs, priorities, resources, performance, and quality of oral health services. The information management process includes components such as creating an information management system, data collection, data analysis, and utilization of information [\u003cspan citationid=\"CR53\" class=\"CitationRef\"\u003e53\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eDelivering safe, effective, and quality services is the primary goal of any health system. Managers must prioritize access to and ensuring the quality of dental services in rural and remote areas as one of the key objectives of healthcare. They should select appropriate strategies to achieve this goal while developing relevant laws and regulations [\u003cspan citationid=\"CR53\" class=\"CitationRef\"\u003e53\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eVarious strategies, such as educational, legal, regulatory, financial, and professional and personal support interventions, can be employed to improve dental care. Establishing dental schools in deprived areas and enrolling local dental students, offering scholarships contingent upon working in underserved areas, providing sustainable financial incentives (higher salaries and benefits, banking facilities, and tax exemptions), ensuring accommodation and facilities for dentists, creating well-equipped and safe working environments, and implementing continuous professional development training programs can significantly contribute to the retention of dentists in deprived areas.\u003c/p\u003e \u003cp\u003eImproving the living conditions of dentists in underserved regions, providing social and emotional support, ensuring quality education for their children, creating suitable working conditions for the dentists' spouses, and fostering a sense of belonging among them in the local community are also essential elements for effective retention strategies.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eConsent for publication:\u003c/strong\u003e Not applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and material\u003c/strong\u003e: The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e: The authors declare that they have no competing interests.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e: Research funding from Zabol University of Medical Sciences\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026apos; contributions\u003c/strong\u003e: MM and PI participated in the design of the study. PI, MS, Fk,MA, \u0026nbsp;and ZA undertook the literature review process. PI, \u0026nbsp; and MM developed and implemented the Delphi stage.\u003cstrong\u003e\u003cspan dir=\"RTL\"\u003e\u0026nbsp;\u003c/span\u003e\u003c/strong\u003eAll authors drafted the manuscript. All authors read and approved the final manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgments\u003c/strong\u003e: The authors would like to extend their most sincere gratitude and appreciation to the esteemed reviewers of the article.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eMosadeghrad AM, Afshari M. The impact of quality management on job satisfaction of operating theatre department employees of Valiasr Hospital in Tehran: A participatory action research. Journal of Health Based Research 2016;\u003cspan dir=\"RTL\"\u003e \u003c/span\u003e2:147-58\u003c/li\u003e\n\u003cli\u003eMohammadiaghdam N, Doshmangir L, Babaie J, Khabiri R, Ponnet K. 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Micro-health insurance in dentistry: the road less travelled 2019\u003c/li\u003e\n\u003cli\u003eNahvi M, Zarei E, Marzban S, Jahanmehr N. Utilization of dental services and its out-of-pocket payments: a study in dental clinics of Ramsar. Journal of Mashhad Dental School 2017;41:171-82\u003c/li\u003e\n\u003cli\u003eNorthridge ME, Kumar A, Kaur R. Disparities in access to oral health care. Annual review of public health 2020;41:513\u003c/li\u003e\n\u003cli\u003eJin L, Lamster I, Greenspan J, Pitts N, Scully C, Warnakulasuriya S. Global burden of oral diseases: emerging concepts, management and interplay with systemic health. Oral diseases2016;22:609-19\u003c/li\u003e\n\u003cli\u003eKoeleman PM, Koole GM. Optimal outpatient appointment scheduling with emergency arrivals and general service times. IIE Transactions on Healthcare Systems Engineering 2012;2:14-30\u003c/li\u003e\n\u003cli\u003eMosadeghrad AM, Afshari M. The impact of quality management on job satisfaction of operating theatre department employees of Valiasr Hospital in Tehran: A participatory action research. Journal of Health Based Research 2016;2:147-58\u003c/li\u003e\n\u003cli\u003eMohammadiaghdam N, Doshmangir L, Babaie J, Khabiri R, Ponnet K. Determining factors in the retention of physicians in rural and underdeveloped areas: a systematic review. BMC family practice 2020;21:1-23\u003c/li\u003e\n\u003cli\u003eWHO. The world health report 2006: working together for health: World Health Organization2006\u003c/li\u003e\n\u003cli\u003eCortez LR, Guerra EC, da Silveira NJD, Noro LRA. The retention of physicians to primary health care in Brazil: motivation and limitations from a qualitative perspective. BMC health services research 2019;19:1-12\u003c/li\u003e\n\u003cli\u003eEhsani-Chimeh E, Majdzadeh R, Delavari S, Gharebelagh MN, Rezaei S, Rad EH. 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Physician shortages in rural Vietnam: using a labor market approach to inform policy. Social science \u0026amp; medicine 2011;73:970-7\u003c/li\u003e\n\u003cli\u003eWeinhold I, Gurtner S. Understanding shortages of sufficient health care in rural areas. Health Policy 2014;118: 201-14\u003c/li\u003e\n\u003cli\u003eDieleman M, Harnmeijer JW. Improving health worker performance: in search of promising practices. Geneva: World Health Organization 2006;1:1-64\u003c/li\u003e\n\u003cli\u003eNair RD, Gohil DA, Reddy KVR, Mohammadnezhad M. Factors that influence the retention and turnover of dental professionals: Suggestion for Pacific nations. Journal of International Oral Health 2021;13:319\u003c/li\u003e\n\u003cli\u003eGirasek E, Eke E, Sz\u0026oacute;cska M. Analysis of a survey on young doctors\u0026apos; willingness to work in rural Hungary. Human resources for health 2010;8:1-6\u003c/li\u003e\n\u003cli\u003eSun X, Bernab\u0026eacute; E, Liu X, Zheng S, Gallagher JE. Meeting the oral health needs of 12-year-olds in China: Human resources for oral health. BMC Public Health2017;17:1-12\u003c/li\u003e\n\u003cli\u003ePeres MA, Macpherson LM, Weyant RJ, Daly B, Venturelli R, Mathur MR, et al. Oral diseases: a global public health challenge. The Lancet 2019;394:249-60\u003c/li\u003e\n\u003cli\u003eCrocombe L, Godwin D, Hoang H, Bell E, Blizzard L. Dental practitioners: Rural work movements 2016\u003c/li\u003e\n\u003cli\u003eCarrasco-Labra A, Brignardello-Petersen R, Glick M, Guyatt GH, Neumann I, Azarpazhooh A. A practical approach to evidence-based dentistry: VII: how to use patient management recommendations from clinical practice guidelines. The Journal of the American Dental Association 2015;146:327-36\u003c/li\u003e\n\u003cli\u003eJakab M, Akkazieva B, Habicht J. Can people afford to pay for health care? New evidence on financial protection in Kyrgyzstan 2018\u003c/li\u003e\n\u003cli\u003eRigholt A, Jevdjevic M, Marcenes W, Listl S. Global-, regional-, and country-level economic impacts of dental diseases in 2015. Journal of dental research 2018;97(5):501-7\u003c/li\u003e\n\u003cli\u003eHakeem N-E, Eshwar S, Srivastava B, Jain V. Micro-health insurance in dentistry: the road less travelled2019\u003c/li\u003e\n\u003cli\u003eNahvi M, Zarei E, Marzban S, Jahanmehr N. Utilization of dental services and its out-of-pocket payments: a study in dental clinics of Ramsar. Journal of Mashhad Dental School 2017;41:171-82\u003c/li\u003e\n\u003cli\u003eNorthridge ME, Kumar A, Kaur R. Disparities in access to oral health care. Annual review of public health 2020;41:513\u003c/li\u003e\n\u003cli\u003eJin L, Lamster I, Greenspan J, Pitts N, Scully C, Warnakulasuriya S. Global burden of oral diseases: emerging concepts, management and interplay with systemic health. Oral diseases2016;22:609-19\u003c/li\u003e\n\u003cli\u003eKoeleman PM, Koole GM. Optimal outpatient appointment scheduling with emergency arrivals and general service times. IIE Transactions on Healthcare Systems Engineering 2012;2:14-30\u003c/li\u003e\n\u003cli\u003eMosadeghrad AM. Essentials of healthcare organization and management. Tehran: Dibagran 2015 [Persian]\u003c/li\u003e\n\u003cli\u003eWHO. Increasing access to health workers in remote and rural areas through improved retention: global policy recommendations: World Health Organization 2010\u003c/li\u003e\n\u003cli\u003eWeltgesundheitsorganisation. WHO guideline on health workforce development, attraction, recruitment and retention in rural and remote areas: World Health Organization 2021\u003c/li\u003e\n\u003cli\u003eSuphanchaimat R, Cetthakrikul N, Dalliston A, Putthasri W. The impact of rural-exposure strategies on the intention of dental students and dental graduates to practice in rural areas: a systematic review and meta-analysis. Advances in Medical Education and Practice 2016;7:623\u003c/li\u003e\n\u003cli\u003eKulig JC, Stewart N, Penz K, Forbes D, Morgan D, Emerson P. Work setting, community attachment, and satisfaction among rural and remote nurses. Public Health Nursing 2009;26:430-9\u003c/li\u003e\n\u003cli\u003eAl‐Banyan R, Echeverri E, Narendran S, Keene H. Oral health survey of 5\u0026ndash;12‐year‐old children of National Guard employees in Riyadh, Saudi Arabia. International Journal of Paediatric Dentistry2000;10:39-45\u003c/li\u003e\n\u003cli\u003eMotohashi M, Nakajima I, Aboshi H, Honda K, Yanagisawa M, Miyata T, et al. The oral health of children in a rural area of the Lao People\u0026apos;s Democratic Republic. Journal of Oral Science 2009;51:131-5\u003c/li\u003e\n\u003cli\u003eAl‐Haddad K, Al‐Hebshi N, Al‐Ak\u0026rsquo;hali M. Oral health status and treatment needs among school children in Sana\u0026rsquo;a City, Yemen. International journal of dental hygiene 2010;8:80-5\u003c/li\u003e\n\u003cli\u003eMoher D, Stewart L, Shekelle P. All in the family: systematic reviews, rapid reviews, scoping reviews, realist reviews, and more. Systematic reviews 2015;4:1-2\u003c/li\u003e\n\u003cli\u003eArksey H, O\u0026apos;Malley L. Scoping studies: towards a methodological framework. International journal of social research methodology 2005;8:19-32\u003c/li\u003e\n\u003cli\u003eDaudt HM, van Mossel C, Scott SJ. Enhancing the scoping study methodology: a large, inter-professional team\u0026rsquo;s experience with Arksey and O\u0026rsquo;Malley\u0026rsquo;s framework. BMC medical research methodology 2013;13:1-9\u003c/li\u003e\n\u003cli\u003eMakhija SK, Gilbert GH, Boykin MJ, Litaker MS, Allman RM, Baker PS, et al. The Relationship between Sociodemographic Factors and Oral Health\u0026ndash;Related Quality of Life in Dentate and Edentulous Community‐Dwelling Older Adults. Journal of the american geriatrics society2006;54:1701-12\u003c/li\u003e\n\u003cli\u003eMosadeghrad AM. Health strengthening plan, a supplement to Iran health transformation plan. Tehran University Medical Journal TUMS Publications 2019;77:537-8\u003c/li\u003e\n\u003cli\u003eBayne A, Knudson A, Garg A, Kassahun M. Promising practices to improve access to oral health care in rural communities. Rural Eval Brief 2013;7:1-6\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-health-services-research","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bhsr","sideBox":"Learn more about [BMC Health Services Research](http://bmchealthservres.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/BHSR/default.aspx","title":"BMC Health Services Research","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Retaining, dentists, strategies, deprived areas","lastPublishedDoi":"10.21203/rs.3.rs-6541879/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-6541879/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eObjective (s)\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe shortage and improper distribution of dentists can prevent people from accessing oral and dental services, slow down the achievement of the Millennium Development Goals, and limit the achievement of desirable health outcomes. Therefore, this study aimed to identify strategies for attracting and retaining dentists in deprived areas.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study was carried out using a scoping review method. All published articles on strategies for attracting and retaining dentists in underprivileged areas until the end of January 2024 were searched and collected in 9 databases and search engine. 25 articles were analyzed using MAXQDA software.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAbout 62 strategies were identified for attracting and retaining dentists in deprived areas and classified. The most frequent strategies include providing platforms for professional development and increasing continuous independence for dentists in remote areas, financial support policies for dentists by creating incentives such as mortgages or loan forgiveness, strengthening the infrastructure of villages in order to develop and increase the motivation of employees. Dentistry was the equitable distribution of manpower to reduce the workload in rural areas, the development of rural access to dental services by strengthening remote dental infrastructure and the development of transportation facilities to the workplace.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eImplementation of effective interventions in financing, manpower, technology, equipment and medicine, information systems, service delivery and management and leadership lead to the attraction and retention of dentists in deprived areas. Therefore, health policy makers and managers should take appropriate measures for the attraction and retention of dentists in these areas.\u003c/p\u003e","manuscriptTitle":"Strategies for attracting and retaining dentists in deprived areas: A scoping review","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-06-20 10:17:38","doi":"10.21203/rs.3.rs-6541879/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2025-07-14T09:36:49+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-07-09T05:39:47+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-07-01T12:49:37+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"199938437448112436073511036945656032448","date":"2025-07-01T06:06:54+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"5855287965071406949179174279401849420","date":"2025-06-27T18:03:28+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"20757089618283414608103333194609247644","date":"2025-06-20T18:24:30+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-06-19T07:16:37+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"61959317568861764306449065097612725478","date":"2025-06-18T09:35:07+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-06-18T09:19:13+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2025-05-23T18:40:55+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-04-29T02:21:55+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-04-29T02:21:47+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Health Services Research","date":"2025-04-27T17:41:09+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-health-services-research","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bhsr","sideBox":"Learn more about [BMC Health Services Research](http://bmchealthservres.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/BHSR/default.aspx","title":"BMC Health Services Research","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"4e62bf00-75a8-4d93-be3d-7b61ba66cd53","owner":[],"postedDate":"June 20th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2025-08-07T16:23:17+00:00","versionOfRecord":[],"versionCreatedAt":"2025-06-20 10:17:38","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-6541879","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-6541879","identity":"rs-6541879","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}