Oral Hygiene
Promoting oral health in early years is essential to protecting young teeth and establishing good habits. It is also a requirement of the EYFS guidelines: “All settings must promote the good health, including oral health, of children attending the setting.”
Oral health is important, even with baby teeth, because children’s baby teeth:
- help them to bite and chew
- support speech and language development
- help them feel confident when they smile
- make space for and help to guide adult teeth
Good oral health also keeps children free from toothache, infection and swollen gums.
There are three main themes in good dental health:
- Keep sugary and acidic food and drinks to mealtimes
- Brush teeth at least twice a day with a fluoride toothpaste
- Visit the dentist regularly
Tooth decay
Children need to form good oral health habits from an early age to help avoid tooth decay. Tooth decay happens when sugars from food and drinks interact with bacteria in tooth plaque. This results in acid production, causing holes in teeth known as cavities.
If children have tooth decay, they may have yellow, brown or black marks on their teeth. They may also complain about their teeth hurting, particularly when eating or drinking.
Tooth decay is largely preventable, but it’s still a serious problem among young children. The Office for Health Improvement and Disparities oral health survey of 5 year old children 2022 and Public Health England oral health survey of 3 year old children 2020 found that*:
- nearly a quarter of 5 year olds in England have tooth decay, affecting 3 to 4 teeth on average
- children from more deprived backgrounds are more likely to have tooth decay
- 11% of 3 year olds in England have visible tooth decay, affecting 3 teeth on average
Having decayed teeth removed is also the most common reason for surgery under a general anaesthetic for children aged 6 to 10. Almost 9 out of 10 hospital tooth extractions among children aged 0 to 5 years are due to preventable tooth decay and tooth extraction is still the most common hospital procedure in 6 to 10 year olds.
*The Office for Health Improvement and Disparities oral health survey of 5 year old children 2022 and Public Health England’s oral health survey of 3 year old children 2020 include statistics about oral health in the early years.
Looking after children’s oral health
There are several key steps that can be taken to promote good oral health in children.
Cutting down on sugars
Limit sugars children eat or drink, as well as how often they consume them can help to avoid tooth decay.
Free sugars include all sugar added to food and drinks by the manufacturer, cook or consumer.
They are found in foods like:
- cakes, biscuits and chocolates
- processed foods – like some jarred sauces, jams and breakfast cereals
- some flavoured yoghurts
They are also found in natural products like:
- honey and syrups
- fruit juices and purees
- smoothies
Free sugars are not found in:
- whole fruit and vegetables
- plain, unflavoured milk and yoghurt
- water
When it comes to children’s oral health, water and milk are the only safe drinks to give children. Fruit juices and smoothies should not form part of a young child’s daily diet.
As well as limiting the amount of free sugars children eat or drink, ensure children only have food or drinks that contain sugar at mealtimes. As the more often their teeth come into contact with sugar, the more likely they will be to get tooth decay.
Consider snacks and drinks that are provided in between meals – are they tooth friendly? Visit the Early Years downloads page for tooth friendly and tooth unfriendly information and posters.
Drinking bottles and cups
What children drink from can impact their oral health.
You should only give babies bottles of breast milk, formula milk, or boiled water that has cooled down.
From as young as 6 months old, you can offer babies drinks in open-top cups. These are cups with no lids, which spill if knocked over. These cups can help children develop their sipping skills. This strengthens their face muscles, which helps them to bite, chew and talk.
When introducing open-top cups, start with smaller cups or those with handles. These are easier for babies to grip. Offer a small amount of water at first, and gradually increase this over time.
You may need to show babies how to use the cup and help them to hold it at first. Some babies may need to use a sipping cup or beaker with a spout before they can use an open-top cup. If this is the case, you should make sure that the spout does not have a valve, that drinks can freely flow through it, and that babies do not need to suck.
From 12 months old onwards, you should encourage children to have all drinks in open-top cups. From this point, avoid using any bottles or cups that need children to suck, like those with soft teats or valves.
This useful NHS video explains how and when to move babies from bottles to cups and why it is important. NHS video on baby bottles and cups
Brushing teeth
As soon as a child’s teeth start to come through, tooth brushing should start to.
For effective tooth brushing:
- use a fluoride toothpaste that contains at least 1000 parts per million (ppm) of fluoride – you can find this information on the packaging
- use a smear of toothpaste for children under 3, and a pea sized amount for those aged 3 to 6
- brush in circles for around 2 minutes, making sure to cover the whole of each tooth
- brush twice a day, including once just before bed – this allows the fluoride to keep working while children sleep
- children should spit, not rinse, after brushing – this avoids washing away the fluoride
- adults should help children to brush their teeth until they are 7 years old to make sure they are brushing properly
The looking after your baby’s teeth NHS page explains how to brush and care for babies’ and young children’s teeth.
How to promote good oral health in your setting
You can decide how you promote oral health based on what works best in your setting. Ideally, you should link oral health to other key topics, like self-care, healthy eating, and physical development.
Being playful with children can help to promote good oral health. There are a number of activities you can use to teach them about tooth brushing and care.
Dentist role play
Try setting up a dentist role play in your setting. This familiarises children with the dentist’s environment, equipment and processes.
Practise tooth brushing on dolls and toys
You can show children how to do this yourself first to model effective tooth brushing.
Brush model teeth
Use a set of model teeth or a laminated picture, and add playdough, marker pen or tissue paper to represent tooth plaque. Encourage the children to use a toothbrush to remove the ‘plaque’.
Stories and discussion
Read stories with children about teeth and smiles. These can cover important topics like visiting the dentist and brushing teeth. Also discuss foods and drinks that do and do not help to grow healthy, strong teeth with children.
Visits with dentists
Contact your local dental surgery and ask them if it is possible to show the children around. This will help familiarise the children with the environment and equipment dentists use. Also invite a member of the dental team to your setting to talk about their job and the importance of good oral health.
Supervised tooth brushing programmes
This toolkit by Public Health England gives more information on how to set up supervised tooth brushing programmes.
Supervised tooth brushing may be suitable in your setting. These programmes have been found to prevent tooth decay by teaching children how to brush their teeth and encourage tooth brushing routines at home. Children also benefit from brushing their teeth with fluoride toothpaste once a day while at their early years setting. This is especially important for those children who may not regularly brush their teeth at home.
There are different schemes that support supervised tooth brushing. Speak to your local authority to see what may be on offer in your local area. Speak to your find your local authority. Who maybe able to offer support to introduce supervised tooth brushing in your setting.
This supervised tooth brushing video from Early Start Nutrition shows a session in action.
