Background: Torture, abuse and dental phobia are often precursors to developing a pathological relationship with dental care due to elevated anxiety and the risk for re-traumatisation. Consequently, this patient group tends to avoid dental services, leaving them with severe tooth decay that affects both their general and psychosocial health. Norwegian dental services have implemented a specific dental service targeting this patient group, aiming to both alleviate their dental anxiety and restore their oral health. The outcomes of this service have been positive, but for this model to be transferrable to other national contexts, it is necessary not just to understand whether the service works, but also how and why it works. Therefore, this study developed theories on how the structure of the service alleviates dental anxiety and restores patients’ oral health. Although developed specifically in a Norwegian context, these theories may be applicable to other national and international contexts. Methods: This realist evaluation comprised sequential, multiple methods encompassing a review of service and policy documentation (n=12), followed by realist interviews with service developers and deliverers (n=12). Guided by a retroductive approach consisting of coding, cataloguing and configuring through content analyses and context-mechanism-outcome (CMO) heuristics, the analyses generated four programme theories.Results: First, the state-subsidised dental service affects service access and service uptake. Second, this service can be adapted and tailored to regional resources to meet the needs of the heterogenous patient group. Third, regional service teams are cohesive because of a lack of national communication and cooperative practice. Fourth, the complexity of migration processes and poor dissemination practices leads to poor recruitment of torture survivors to the service. Conclusions: The service follows a hybrid bottom-up, top-down approach, allowing teams to practise discretion and tailor their approach to meet individual needs. With its bi-dimensional structure, the service reaches a patient population that would otherwise avoid dental services. Service uptake is beneficial as patients report experiencing improved quality of life. However, the service is struggling to reach torture survivors, which may be attributable to multiple contextual factors. More research is therefore required to understand the lack of service uptake among torture survivors.