Whole school approach to oral health

Click on the links to access information, guidance and resources that can be applied to a whole-school approach, including an audit and action planning tool.

Try these 'quick wins' before thinking about anything else to get you started and see the difference you could make.

1. Review your curriculum coverage to check that oral health is being appropriately covered! Check the statutory guidance around physical health and mental wellbeing.

2. Organise for your staff to complete training.

3. Share some of these signposting links with your families as part of your next newsletter or on your website!

Audit tool

Use this whole-school / setting approach audit and action planning tool (Word doc) [940KB] to identify areas of good practice and identify areas for improvement. The tool will provide you with guidance and resources for every area to ensure you achieve a measurable impact. If you need any bespoke support and guidance, we are happy to help and can be contacted at inclusionandsend@norfok.gov.uk.

Oral health is a key part of overall health and can contribute to 'school readiness', meaning children and young people (CYP) are more likely to flourish at school.

Tooth decay is the most common oral disease affecting CYP in England, yet it is largely preventable.  If a CYP does not feel well, this will impact on their ability to learn and develop throughout their education. Oral health is therefore an important aspect of overall health and key to a CYP being able to engage in their education setting.

Early years

The promotion of good health including oral health is a requirement of the Early Years Foundation Stage (EYFS) Statutory Framework (2024).  There is strong evidence that oral health interventions and supportive policy in early years settings can effectively reduce CYP dental decay and helps to build sustainable oral hygiene behaviours in families that will assist in protecting CYP teeth throughout childhood.

• Public health NICE guidance outlines that all early years services should provide oral health information and advice and provide additional tailored information and advice for groups at high risk of poor oral health (see recommendation 13-14) and makes additional recommendations for nurseries.   
• Dental Health Care provide a checklist for Early Years to review how they are supporting oral health.
• This oral health guidance for early years provides a case study linked to setting up a supervised toothbrushing programme and many useful resources.

Primary and secondary schools

NICE guidance promotes schools raising awareness of the importance of oral health, as part of a 'whole-school' approach. Recommendation 17 provides key actions for primary schools and recommendation 21 provides key actions for secondary schools. Key actions which span across all phases include:

• Ensuring, wherever possible, that all school policies and procedures promote and protect oral health (for example, policies on diet and nutrition, health and safety and anti-bullying should include oral health).
• Ensuring opportunities are found in the curriculum to teach the importance of maintaining good oral health and highlighting how it links with appearance and self-esteem. This should use age and stage appropriate information, adapted to meet local needs and based on the 'advice for patients' in the Office for Health Improvement and Disparities' toolkit for delivering better oral health.

• Making plain drinking water available for free and encouraging children to bring refillable water bottles to school.
• Providing a choice of sugar-free food, drinks (water and milk) and snacks (for example, fresh fruit). These should also be provided in any vending machines.

Ensure that your environment displays and promotes evidence-based, age and stage appropriate oral health information for parents, carers and CYP, this should include details of how to access local dental services and should be relevant to your school's needs. These posters can be displayed to support with this:

• Toothbrushing guide for children aged 3+
• Tooth friendly and unfriendly snacks and drinks
• The Eatwell Guide

Ensure your school promotes and displays information to support National Oral Health Campaigns. These may include National Smile Month sponsored by the Oral Health Foundation, Change4life Top Tips for Teeth and Give Up Loving Pop (GULP) Kind to Teeth Campaign which aims to raise awareness of the risks associated with the consumption of sugary drinks in young children and promote milk and water.

Supervised toothbrushing programmes

Supervised toothbrushing programmes can work extremely well in settings where children are at high risk of poor oral health (see recommendations 15, 18 and 19 in the NICE guidance).

1. If you would like to find out more information about setting this up in your school, contact Community Dental Services on ohp.norfolk@cds-cic.co.uk.
2. Public Health England have developed a toolkit to support supervised toothbrushing programmes in schools.
3. Different models of supervised toothbrushing can be used dependent on the school or setting in which the programme will take place. Two models are commonly used in the UK - toothbrushing in dry areas (dry model) or toothbrushing at a sink (wet model) - the Public Health toolkit outlines these models in Appendix 1.
4. This case study shows how one primary school set up the programme.

Leaders, managers and governors should:

• Understand the importance of taking a whole school / setting approach to promoting good oral health. They should also recognise the negative impact of poor oral health on children and young people's (CYP) health and wellbeing, not only through the pain caused and the need to remove decayed teeth, but affecting the ability to speak, eat, smile and socialise.
• Understand that interventions in schools and settings are effective in reducing dental decay and promoting long term oral health in CYP.
• Identify a member of staff who could be trained to become an oral health champion whose role it is to promote and protect CYP's oral health.
• Ensure that the lunches and other food and drink provided meets the appropriate food standards. The Department for Education provides guidance on School food in England.
• Have a clear understanding of how poor oral health can be an indicator of neglect in some cases and know how to approach any concerns appropriately. The Norfolk Safeguarding Children Partnership provides a definition of medical neglect through their 2023 strategy including the importance of establishing a better understanding between poverty and neglect.

Working with other partners

• The Norfolk Healthy Child Services provide professional advice and intervention from health professionals related to oral health promotion for CYP from 0-19 years (25 SEND).
• Through Just One Norfolk (the online resource for the Norfolk Healthy Child Services), health visitors, school nurses and their teams, provide support and information on infant feeding, teething, teeth and toothbrushing. Additional access to advice from healthcare professionals for early years oral health, diet and nutrition to support healthy mouths and children's teeth can be obtained by ringing 0300 300 0123. Further detailed support, information and advice is also provided online for older CYP.
• The Norfolk Family Hubs and Start for Life offer is being developed. When implemented, this support will include advice around infant feeding, family food and parenting approaches to healthy teeth. There will be oral health 'Champions' across the hubs to promote oral health at community level.

Wherever possible, all policies and procedures should promote and protect oral health, including policies on diet and nutrition, health and safety and anti-bullying.

Some schools and settings may choose to develop a policy specific to oral health. This could outline:

• The importance of promoting good oral health and the negative impact of poor oral health including on physical health, development, and wellbeing.
• How your vision and values ensure that oral health is a key health and wellbeing priority.
• How your routines support good oral health including how healthy snacks and fresh water will be available throughout the day, how healthy lunchboxes are encouraged and how occasions such as birthdays will be celebrated in a healthy, tooth friendly way. Dental Health Care provides policy guidance on celebrations and how to communicate with families about bringing in tooth friendly treats, such as fresh fruit.
• How good oral health, diet, nutrition and the importance of visiting the dentist will be covered through the curriculum.
• How information is shared regularly with families via social media, websites, newsletters, posters and through policy to support good oral health routines at home.

Safeguarding policies and procedures should recognise that poor oral health can be an indicator of neglect in some cases. Staff should feel confident to raise any concerns with the safeguarding lead who can take appropriate next steps. Find further information about types of neglect from the NSPCC and in Keeping Children Safe in Education.

Guidance and legislation

• Oral health: local authorities and partners - Guidance overview (NICE)
• Keeping Children Safe in Education (DfE)
• Oral health - Help for early years providers (DfE)

There is lots of useful advice and guidance including many videos available online which are designed to help CYP understand why it is important to brush their teeth, depending on age and stage:

• Community Dental Services provide a range of videos including 'Peppa Pig at the Dentist'
• Hey Duggee - The Tooth Brushing Badge
• Bluey and Stickbird 2 Minute Toothbrush timer with tooth brushing guide
• Brush DJ is an app which helps to make teeth brushing fun.
• Teeth Team has activities, games, videos and 'dental superheroes' for different age ranges.
• Advice for teens' teeth from the Oral Health Foundation
• 3 tips for healthy teeth from Health for Teens
• Facts around tooth decay from Health For Teens

Supervised toothbrushing programme

Some CYP may be at higher risk of poor oral health or may need to be supported to maintain good oral health. Schools and settings can provide a suitable supportive environment for CYP to take part in a supervised toothbrushing programme, teaching them to brush their teeth from a young age and encouraging support for home brushing.

• If you would like to find out more information about setting this up, contact Community Dental Services on ohp.norfolk@cds-cic.co.uk.
• Public Health England have developed a toolkit to support supervised toothbrushing programmes in schools.

Responding to concerns around an individual CYP

It is important to note that if there are persistent concerns regarding a CYP's oral health, possibly coupled with wider factors that suggest there is a safeguarding concern then you should follow your usual procedures and speak to your safeguarding lead, in line with guidance from the DfE's Keeping Children Safe in Education, who can take the appropriate next steps.

We must also be mindful of the impact of vaping or smoking on our CYP's oral health. See our guidance and further signposting around vaping  The government's plan to create a smokefree generation is something for staff to be aware of.

NICE guidelines recommend providing opportunities for staff to talk with families about, and involve them in, improving their children's oral health. For example, opportunities might arise at parents' evenings, open days or by encouraging parents and carers to get involved in developing the school food and drinks policy.

You could also consider setting up drop-ins or open sessions, with health practitioners wherever possible, which provide demonstrations around toothbrushing and nutrition (these could be face to face or online). These types of activities can stimulate meaningful engagement for families and communicate your commitment to good oral health.

Supportive signposting for families

• Just One Norfolk provides lots of information and guidance for families around oral health including on toothbrushes and toothpaste, young children's teeth, older children and teenager's teeth, oral health for children with additional needs and visiting the dentist.
• The British Society of Paediatric Dentistry has put together a A Practical Guide to Children's Teeth which can be shared with families and is available in other languages too.
• Community Dental Services provides many videos for sharing with families.
• Colgate has developed educational resources, including a 'Parent Take-Home Oral Care Brochure' which can be printed off and shared with families, and a 'Brush Your Way to a Day of Bright Smiles'board game, and they have a collection of FAQs directly from families.
• Dental HealthCare shares advice on how to brush teeth well, resources such as brushing charts for home, and videos from Dr Ranj on looking after your child's teeth in different age groups.
• Nutrition advice from Community Dental Services
• Milk.co.uk provides downloadable guidance, recipes and meal planners around healthy eating and teeth for different aged CYP.

Additional needs signposting

• A Parents' Guide to oral health and dental care for children with a learning disability, autism or both
• Information and tips for maintaining oral health in children with autism
• Guidance on How to support children with sensitivity to food

If you feel a family would benefit from support from a Family Hub, then please refer them through this 'Request for Support Early Help Information and Consent' form. Families can also refer themselves or visit their local family hub.

General resources

• Colgate provides a range of educational resources including songs, raps and poems, activities including word matching and certificates.
• Community Dental Services shares several activities including dental snakes and ladders games and crosswords.
• The Oral Health Foundation provides fun activities in the 'puzzles and games' section.

Early Years

• Early Years activities should include dentist role play, practising tooth brushing on dolls and toys, brushing model teeth and stories / discussion.

Primary school

By the end of primary school, children and young people (CYP) should know:

• Health education:
  • What constitutes a healthy diet (including understanding calories and other nutritional content)
  • The characteristics of a poor diet and risks associated with unhealthy eating (including, for example, obesity and tooth decay) and other behaviours (e.g. the impact of alcohol on diet or health)
  • About dental health and the benefits of good oral hygiene and dental flossing, including regular check-ups at the dentist

High quality resources about oral health - Primary

• Colgate has several resources, including a story to download called 'This Is My Bright Smile Emergent Reader' where early readers can learn about basic oral health.
• The Oral Health Foundation provides lesson plans and resources for Early Years' Education to KS2.
• Public Health England's (PHE) School Zone has several resources, including:
  • A PowerPoint presentation that uses a simple science experiment for KS1 and KS2 to introduce the idea of how sugary drinks can affect teeth.
  • An interactive and engaging presentation that teaches KS1 pupils how to choose healthier snacks. 
  • A KS1 Food Detectives Toolkit which includes a lesson plan, extension activities and a homework task.
• These resources from Wiltshire Healthy Schools include dental health workbooks for Years 1-6.
• The Aquafresh Schools Club helps children to learn about the importance of oral health through engaging resources and a creative writing competition!

Secondary school

By the end of secondary school, CYP should know:

• Health education:
  • How to maintain healthy eating and the links between a poor diet and health risks, including tooth decay and cancer
  • About dental health and the benefits of good oral hygiene and dental flossing, including healthy eating and regular check-ups at the dentist

High quality resources about oral health - Secondary

• BRIGHT dental health lesson plan (PSHE Association) aims to develop students' understanding and knowledge about the importance of tooth brushing with fluoride toothpaste as a method to prevent dental caries.

NHS provides a bite-size e-learning session that gives an overview of child oral health - including key evidence, data and signposting to trusted resources to help prevent illness, protect health and promote wellbeing.

You can also contact Norfolk and Waveney Oral Health Improvement to find out more about the support they offer to schools.

Make sure that any concerns about a CYP's oral health are recorded so that any patterns which may emerge are identified and further steps can be taken if necessary.

Parental consent should be obtained and recorded before any toothbrushing activities are undertaken as well as recording any allergies.

If your school or setting partakes in a supervised toothbrushing programme, then any measures taken around infection control should be clearly recorded.

I have a child or young person (CYP) who has poor oral health, what can I do?

If you have worries around a CYP's oral health, there are several things you can do to help. There is a flowchart within the oral health padlet which suggests key steps to take, which include:

• Activities at a whole cohort / school / setting level
• Support and signposting for the individual CYP
• Support and signposting for the family

How do we fit a supervised toothbrushing programme into the day?

It is important to recognise how important this intervention can be for some CYP in most need and the 'evidence tells us that brushing each day at school over a two year period is effective for preventing tooth decay and can establish life-long behaviour to promote oral health'.

As part of the programme, toothbrushing should take place just once a day 'at a time which is most suitable for each setting' as recommended in public health guidance.

What about cross contamination linked to storing toothbrushes at our school or setting?

See further guidance regarding infection prevention and control in Public Health England's (PHE) Improving oral health toolkit (publishing.service.gov.uk) on page 12 and in Appendix 7.

Public health guidance outlines that 'quality and safety procedures should be implemented by all settings taking part in supervised toothbrushing programmes. To provide clarity with regard to responsibilities within the programme a model agreement (see Appendix 3 - Example Model Agreement Form in 'Improving oral health' above) between the supervised toothbrushing setting and partners should be agreed.'

We know that vaping can make poor oral health even worse. What can we do if one of our CYP starts to vape?

Please see our separate guidance on vaping linked to a whole school approach including signposting for CYP, as well as step by step guidance on how to respond to a vaping incident.