Whole school approach to oral health

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.