Oral health in the early years: promoting healthy smiles for life

Good oral health in young children is much more than just teaching them how to brush their teeth. Healthy mouths support so much more growing up, such as eating, communication, confidence and overall well-being, while poor oral health can lead to pain, infection, fillings, missed learning opportunities, and in many cases, hospital treatment.    

 

The facts:

The latest evidence on children’s dental health in England shows clearly why this is such a priority for early years settings. The most up to date national data comes from the 2024 National Dental Epidemiology Programme (NDEP) survey of 5-year-olds in England. Key findings include: 

• 26.9% of 5yearolds had enamel and/or dentinal decay – more than 1 in 4 children 

• 22.4% had dentinal decay (the more serious form) 

• Children with decay had an average of 3.5 affected teeth 

• A high proportion of decayed teeth remain untreated, and 1.8 per cent of 5-year-olds had one or more primary teeth extracted because of decay 

• Tooth decay remains the leading cause of hospital admissions for children aged 5–9 years in England 

Even in these figures, there is strong regional variation with the lowest decay in the East of England (23.3%) and the highest in the North West (36.8%). Deprivation has been identified as a major factor, with children in the most deprived areas having 32.2% had decay - nearly 1 in every 3 children. Although bleak, these figures show a slight improvement from the previous 2022 survey (23.7% dentinal decay), but the inequalities identified remain stark.   

Statutory guidance and Ofsted’s focus 

Under the statutory Early Years Foundation Stage (EYFS), providers are required to “promote the good health, including oral health, of children attending the setting.” This applies in conjunction with other safeguarding and welfare responsibilities, meaning that oral health is now a core part of promoting health and well-being. 

Recent discussions in the early years sector and insights from monitoring agencies have highlighted the importance of embedding oral health routines and awareness into daily practice so that children are supported to develop good habits from the start. This means looking at your everyday practice rather than having a one-off focus on the subject.    

Why oral health matters: Tooth decay remains a significant public health issue for young children, but tooth decay is largely preventable.  

Poor oral health can affect children’s ability to: 

• Chew and eat comfortably, which impacts diet and nutrition 

• Communicate clearly due to pain or discomfort 

• Sleep and concentrate in learning settings 

• Feel confident socially and emotionally 

Establishing healthy routines early helps prevent these issues and supports children’s overall development.   

What causes poor oral health? 

Tooth decay is caused by the interaction between sugar, bacteria and teeth. Frequent exposure to sugary foods and drinks creates acid in dental plaque, which gradually erodes tooth enamel and leads to cavities. Reducing sugar exposure and supporting good oral hygiene are therefore key to prevention. Early years practitioners are in a unique position to help children and families build lifelong healthy habits.  

Here are some practical, evidence-based ways to do this:   

1. Make oral health part of your health routines

Oral health can be woven into everyday practice alongside handwashing, healthy eating and physical movement. This could include: 

• Talking about brushing teeth during daily routines 

• Celebrating “toothbrushing time” as part of hygiene routines 

• Introducing stories and books that normalise dental care and dentist visits 

• Supervising dental hygiene 

  2. Educate children about good habits

Help children understand why clean teeth matter through: 

• Age-appropriate discussions about food, drinks and sugar 

• Interactive activities that show how brushing removes plaque 

• Role play and social stories related to going to the dentist or caring for teeth 

  3. Engage with parents and carers 

When it comes to children’s health and well-being, parents are key partners in developing good habits and early years practitioners need to be committed to sharing evidence-based guidance sensitively, ensuring it informs rather than dictates. 

Share practical tips such as:

• Brush children’s teeth at least twice a day with fluoride toothpaste for at least 2 minutes 

• Use the correct amount and dose of fluoride toothpaste (For children under 3 years, use a smear of paste with 1350 –1500ppm of fluoride; for children 3 years and over, use a pea-sized amount of paste with 1350 –1500ppm of fluoride 

• After cleaning, spit, don’t rinse to allow the fluoride to work 

• Give water or milk as the main drinks and limit sugary snacks 

• Encourage visits to a dentist as soon as possible after the first tooth appears 

  4. Reduce sugary foods and drinks in settings

Review your food and drink policies to:

• Limit sugary foods and high-sugar drinks to mealtimes only, not as snacks 

• Offer water and milk as the ‘safer’ drink options 

• Work with families to align healthy eating messages between home and setting 

  5. Bring oral health to life in creative ways

Create hands-on experiences for your children such as: 

• Visits from local dentists or dental hygienists 

• Virtual tours of a dental practice 

• Arts and crafts based on teeth and oral health themes 

• Stories about teeth and the importance of oral health. You can find a useful list of early years books here 

  6. Join wider programmes

Government-backed schemes such as the supervised toothbrushing programme are being rolled out in many early years settings, with support and resources to help children develop daily brushing habits. In most cases, settings can benefit from free toothbrushes and toothpaste, through Local Authority schemes, although settings can also set up their own routines.    

According to the Department for Education’s guidance on supervised tooth brushing:

• Children brush their own teeth as a group activity 

• Staff supervise, encourage correct technique, and ensure hygiene 

• It is designed to be fun and enjoyable, often using songs or timers 

• Toothbrushes are individually labelled and stored hygienically 

• A small amount of toothpaste is dispensed safely for each child 

• Children rinse their brush and return it to their labelled slot 

Other awareness campaigns you can get involved with include National Smile Month (May 13 – June 13) and National Tooth Fairy Day (February 28) so there are plenty of opportunities to focus on improving oral health.    

We love it when children smile and are happy, so let’s do everything within our power to give them the health and confidence to do just that.     

 

References and more information:
National Dental Epidemiology Programme (NDEP) for England: oral health survey of 5 year old schoolchildren 2024
Thames Valley NHS oral health in early years guide Supervised Toothbrushing Scheme – Gov.uk
HOME | Supervised Toothbrushing Toolkit

Other articles:
The Importance of Oral Hygiene in Early years. 4 Simple Ways To Boost Oral Health In Early Years Settings
EYFS Changes: Safeguarding and Oral Health