Oral Health

Dental decay is one of the most common preventable childhood diseases and tooth extractions are the biggest reason children are admitted to hospital for general anaesthetics in the UK.

Promoting oral health is now a statutory duty under the new EYFS for all early years settings and schools

What does the statutory framework for the early years foundation Stage say about oral health?

There has been a change in the safeguarding and welfare section of the EYFS, promoting children’s oral health

Section 3 – The safeguarding and welfare requirements


p32 3.45. The provider must promote the good health, including the oral health, of children attending the setting. They must have a procedure, discussed with parents and/or carers, for responding to children who are ill or infectious, take necessary steps to prevent the spread of infection, and take appropriate action if children are ill.

Resources to support the promotion of oral health

Public Health England have developed a quick guide to a healthy mouth in children and a Toolkit for Prevention to help prevent tooth decay. Supervised toothbrushing is encouraged and supported for early years settings. Further information about childhood oral health and early years foundation stage, can be found on the EYFS oral health information page.

Caring for teeth: children aged 0-3 years

Start brushing a baby’s teeth with fluoride toothpaste as soon as the first milk tooth breaks through or at the introduction of solid foods whichever is earliest.

  • Breast feeding provides the best nutrition for babies
  • From six months of age infants should be introduced to drinking from a free-flow cup, and from age one year feeding from a bottle should be discouraged
  • Sugar should not be added to weaning foods or drinks
  • Parents/carers should brush or supervise toothbrushing
  • Brush last thing at night and on one other occasion
  • It is good practice to use only a smear of toothpaste
  • Sugar-free medicines should be recommended amount

NHS advice on toothbrushing for children

  • Dental checks by 1 – find your local Dentist
  • Brush at least twice daily, with a fluoridated toothpaste
  • Brush last thing at night and at least on one other occasion
  • Brushing should be supervised by a parent/carer
  • It is good practice to use only a pea size amount
  • Spit out after brushing and do not rinse, to maintain fluoride concentration levels
  • The frequency and amount of sugary food and drinks should be reduced
  • Sugar-free medicines should be recommended amount


Caring for the teeth: children aged 3-6 years

Supervised toothbrushing is not a requirement but daily supervised toothbrushing with a fluoride toothpaste in early years and nursery school settings is an effective way to reduce tooth decay. Early years settings can provide a suitable supportive environment for children to take part in daily supervised toothbrushing, teaching them to brush their teeth from a young age and encourage support for brushing at home.

Guidance for setup:


Brush for about two minutes twice a day:

  • before bedtime
  • one other time during the day

Supervise tooth brushing until a child is 7 or 8 years old:

  • by brushing their teeth, yourself

if they brush their own teeth, by watching how they do it

  • After age 7 or 8, watch them now and again to make sure they brush properly and for about 2 minutes

Top Tips for Teeth!

Use fluoride toothpaste. This helps to prevent and control tooth decay.

  • No need to buy special “children’s toothpaste” brands- some of them don’t have enough fluoride in them to prevent tooth decay
  • Children can use family toothpaste, as long as it contains 1,350-1,500 ppm fluoride (ask your dentist if you’re unsure)
  • Encourage spitting out excess toothpaste
  • Do not to rinse with lots of water- rinsing with water after tooth brushing can wash away the fluoride and make it less effective

The more often a child has sugary or acidic foods or drinks, the more likely they are to have decay therefore:

  • Limit sugary and acidic foods: squash, fizzy drinks, juice drinks as these contain sugar and have limited nutritional value
  • Offer water or milk to drink
  • Snacks for children: stick to foods that do not harm teeth such as vegetables, cheese, and fruit
  • Aim to introduce drinking from a free-flow cup from six months of age and stop feeding from a bottle from 12 months of age
  • Avoid cups with valves
  • If fruit juice is offered dilute one-part juice to one-part water and only offer in an open or free flowing lidded cup
  • Low sugar / no added sugar / sugar free drinks although these have less sugar they contain citric acid which is equally harmful to children’s teeth.

Further resources and information