The state of Kerala, India is well known for its health indicators comparable to even developed countries but oral health is often a neglected entity in health policy making. Oral diseases are emerging as a significant public health problem in many countries. Epidemiological studies in Kerala report high prevalence of oral diseases. Understanding the complexities of oral health systems would provide baseline data to convince policy makers in prioritizing oral health. Thus, an analysis of the existing oral health system in Kerala was undertaken. The state has a dentist-population ratio of 1: 2200 which is well within the prescribed ratio by WHO (1: 7500). In contrast, only 2% of dentists in Kerala work with the government sector which caters to 0.6 of the approximately 33.4 million population. There is no oral care in first contact levels like primary health centers. Service delivery is chiefly through the private sector and payment for dental care is predominantly through out-of-pocket expenditure. Strength, weakness, opportunity and threats (SWOT) analysis for the existing oral health system of Kerala is also proposed.