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Nurseries urged to set up tooth brushing schemes to tackle tooth decay

Article By: Sue Learner, News Editor

Thousands of young children are admitted to hospital every year to have rotten teeth removed, yet tooth decay can so easily be prevented.

In a bid to stem the flow of hospital admissions, the National Institute for Health and Care Excellence (NICE) recently called for nurseries and schools to take on more of a role in tackling poor oral hygiene.

NICE suggested that local authorities consider supervised tooth-brushing and fluoride varnishing programmes in nurseries and primary schools in areas where children are at high risk of poor oral health.

Scotland and Wales already do this but it seems England is lagging behind on tackling tooth decay.


Tooth decay in children is caused by a range of factors including diet and a failure to brush their teeth properly. However, one of the major factors is fizzy drinks and sugary, acidic fruit juices.

All nurseries are advised to only offer children water and milk to drink. However some still do offer fruit juice, despite it having a high sugar content and being acidic which can wear away the enamel and cause tooth decay.

Dr Sandra White, director of Dental Public Health at Public Health England, says: “Tooth decay is the most common oral disease affecting children and young people in England, yet it is largely preventable. Whilst children’s oral health has improved over the past 40 years, one in eight (12 per cent) three-year-olds have suffered from the disease which can be very painful and even result in a child having teeth removed under general anaesthetic.

“Oral health is everyone’s responsibility and by expanding oral health education to the wider community so that nurseries, children’s centres and primary schools all play a role we can reduce dental decay and ultimately improve the oral health of the local population.”

Some nurseries, already under their own initiative, carry out supervised tooth brushing sessions. Queensbrook Children’s Nursery in Bolton decided to do this because ‘children may not be brushing at home, especially if both parents work. Sometimes the only time children brush their teeth is at nursery.’ Queensbrook nursery staff are strong advocates of toothbrushing in the nursery due to the belief that good dental habits developed at an early age will be carried through to adulthood.

However this is certainly not the norm in England and it seems to only be carried out on a larger scale when governments get involved, as in Scotland and Wales, where toothbrushing programmes have been introduced.


Supervised tooth brushing schemes are already part of the daily routine for all nurseries in Scotland, with a report finding the initiative has saved more than £6m in dental costs.

The programme run by Childsmile was set up in 2001 and costs around £1.8m a year. A study carried out by the University of Glasgow found that in the decade since it began the cost of treating dental disease fell by over 50 per cent.

A number of nurseries and schools in targeted areas also provide fluoride varnish and toothbrushing in primary one and two.


Wales has a national oral health improvement programme called Designed to Smile which offers toothbrushing and fluoride varnish programmes for young children in areas in nurseries and schools where they have high levels of tooth decay.

This was set up with a £12m investment in 2009. Chief dental officer for Wales, David Thomas says: “While it is still too early to gauge the full impact of Designed to Smile, there has been some encouraging progress. Across all social groups, dental disease levels in children are decreasing. This contrasts with previous dental surveys, when reductions in levels of tooth decay were usually associated with widening inequality.

“Crucially, we are seeing fewer children experiencing decay, not just a reduction in the number of teeth affected among those children with tooth decay.

“The dental health of children in Wales is amongst the worst in the United Kingdom. Daily tooth brushing with fluoride toothpaste is an effective means of helping to prevent tooth decay however, for many children cleaning their teeth or having their teeth cleaned does not form part of their daily routine.”

Stop the Rot

Back in 2006, Graham Wilding, a dentist from Lancashire set up the campaign Stop the Rot, encouraging nursery schools to ditch unhealthy food and sugary drinks and get children brushing their teeth after lunch.

Nurseries to the scheme are listed on the campaign's website, enabling parents to choose tooth-friendly child care.

Sarah Steel, managing director at the Old Station Nursery chain, which is a member of ‘Stop the Rot’ campaign says: “At nursery, we continue to promote good dental health with the children, keeping sugar intake to a minimum and offering milk or water at snack times. The experts advise that juice is never given from a bottle, as this is particularly harmful to teeth and it is in the mouth for so long, causing real damage.” Staff also support parents if their child still likes drinking from a bottle past the one year old point, with help and advice in moving on to a ‘sippy’ cup and then a normal cup.

Brush-Baby Ltd

Brush-Baby Ltd specialises in early years toothcare. Frustrated at the lack of dental-care products available on the dental market for her baby daughter, founder Dominique Tillen has designed and developed her own range of dentist-endorsed products. They cater for the gum and toothcare needs of babies, toddlers and children from newborn to six years of age.

She says: “With record numbers of children under the age of five with some form of tooth decay, a more baby and child-centred approach is needed.”

Some believe that because a child’s first teeth are referred to as baby teeth, caring for them is not vital as they will fall out anyway.

However Ms Tillen says: “Although not 'forever' teeth, baby teeth are important during a child's formative years for speech development, eating habits, facial appearance and they set a precedent of spacing for adult teeth in later life.”

Tips for nurseries running toothbrushing sessions

She advises nurseries who do run toothbrushing sessions for the children to lead by example.

“Children love to copy ad if they see you enjoying caring for your own teeth, they are more likely to do the same.

“Remember, young children cannot clean their own teeth and you'll have to do it for them. All children under three years of age should have their teeth brushed by an adult.”

How to brush teeth

• Hold the toothbrush at a 45 degree angle to the teeth

• Point the bristles to were the gums and teeth meet

• Use gentle circles. Do NOT scrub. Clean every surface of every tooth.

Which toothbrush?

• Choose a brush that is soft, with rounded bristles and is the correct size for the child's mouth.

• Children can be 'hard' on toothbrushes and if the bristles get bent or worn down, they won't do a good job and may hurt the child's gums.

• Replace the toothbrush when 'worn' or once every 3-4 months.

• Electric toothbrushes are also a good option, compensating for children’s inability to make 'circles' when learning to brush their teeth.

Which toothpaste?

• Use a children's toothpaste with fluoride and xylitol in a flavour that they can enjoy.

• Choose a low-foaming (so there there's more action and less froth!) palatable toothpaste

• Avoid strong minty flavours as young children cannot spit out properly, and the mint flavour can produce a burning sensation if held in the mouth.

• After brushing, spit out toothpaste, but don't rinse. In this way, the fluoride and xylitol can stay next to the teeth and continue the job of protecting them.

For more information on Brush-Baby Ltd go to and nurseries and parents wanting to find out more about Stop the Rot campaign can go to


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