Zara Smith, PACEY Advisor

‘Oral Health’ is explicitly referred to in Section 3 – The Safeguarding and the Welfare Requirement of the EYFS under Medicines, paragraph 3.45, because, whilst tooth decay is largely preventable, significant numbers of children aged 5 continue to have tooth decay and this can negatively impact them in several ways.

The recently published results of an oral health survey undertaken by the National Dental Epidemiology Programme¹ during the 2021 to 2022 school year showed that, across the UK, there was evidence of some level of dental decay in 29.3% of five-year-old children, with tooth extraction being the most common reason for a child under 6 to have a general anaesthetic.  It also showed that children living in the most deprived areas of the country were also 3 times more likely to have dental decay compared to those living in the least derived areas.

Sometimes parents mistakenly believe that dental decay in young children doesn’t matter as, they will lose their first teeth in a few years’ time. Not only are baby teeth important for children to be able to chew and eat a wide range of healthy nutritious foods, they have a central role in producing the correct sounds to form words, they are significant in ensuring that children are able to smile, laugh and engage with peers without feeling self-conscious, but they also have a vital role in keeping a space for their permanent adult teeth. Having baby teeth removed can result in the spaces not being kept open, which can mean that when permanent teeth come through, they are in the wrong place, ultimately requiring further painful treatment later in childhood such as braces.

As early years professionals we all have a role in supporting children and their families to make choices that will establish and maintain good oral health.

What is good oral health?

Good oral health is not only about effective tooth cleaning practices, but importantly is also about having a health balanced diet.  The main cause of tooth decay is the amount of sugar and acid in the diet.  Let’s look at these separately!

What makes for effective tooth cleaning?

Once the first tooth has started to erupt and appear, it is time to start cleaning teeth.  This is the ideal time to introduce and establish a strong daily routine.  Teeth should be cleaned twice a day, with a very small amount of toothpaste on an appropriate brush.  The toothbrush should not be wetted.  Once the child has finished cleaning their teeth, the mouth should not be rinsed, but the child should be encouraged to spit out any excess (if age appropriate).  This means that the fluoride in the toothpaste stays on the teeth to do its job!

There are lots of ‘child friendly’ toothpastes on the market and these are often quite expensive but there is absolutely no need for children to have a separate toothpaste.  A family toothpaste with fluoride at least 1000ppm (parts per million) is adequate of the youngest children and once a child turns three, they will need a toothpaste with fluoride at 1350ppm to 1500ppm.

Regular trips to the dentist are also important.  Most dentists will allow parents to take their children with them to their appointments and will start to introduce young children to the concept of having their mouth checked gently with their gloved finger.

Healthy foods and drinks

A healthy, balanced, nutritious diet is important to not only maintain a healthy, growing body and mind in children, but is also important to help maintain healthy teeth.  The ‘Example menus for early years settings in England’, published by the government in 2017 provide guidance on how to achieve a nutritionally balanced menu across both the day and the week.  The Second Part includes a large range of seasonal weekly menus.  Each weekly menu has a detailed recipe for each meal and snack, with appropriate portions sizes for the different age groups and allergy information.  I have used these for some time and they are really helpful.   Both the guidance and the example menus are available at: Example menus for early years settings in England – GOV.UK (www.gov.uk)

It has long been known that the regular consumption of sugary drinks is linked to dental decay.  There is growing evidence that sugar free-drink substitutes, whilst they may be lower in calories, can be equally harmful to teeth.  This is because they tend to have high levels of added acids such as citric acid, phosphoric acid, sodium citrate or tartrates which can cause dental erosion and damage teeth.  For the young children that we care for the healthiest choices are always milk and water.

Not only it is important to consider what the children drink, but it is also essential to consider how they drink.  There is wide choice in drinking beakers for young children, many of which are marketed as ‘non-spill’.  Whilst these are appealing as they can minimise mess, they are not appropriate for young children.  Non-spill beakers still require a child to ‘suck’, to extract the drink and this can result in liquids being in contact with teeth for longer periods.  If these are sweetened liquids this can result in dental decay.  Free-flow cups and bottle for very young children are the best choice.  Free flow or open cups should be introduced from about 6 months onwards, and whilst this may be messy to start with, children will learn to drink by sipping, rather than having to suck.  There is more advice available at the following NHS site:

Drinks and cups for babies and young children – NHS (www.nhs.uk)

What can we, as early years professionals do to help?

There is a lot of confusing and conflicting information available to parents about what is and isn’t healthy for young children.  As childcare professionals we are in a great position to be able to help parents navigate these challenges and point them in the right direction.  Sharing your healthy menus and talking to parents about why you provide the meals and snacks you do is a great starting point.  But what if children bring a packed lunch?  How do you share the essential healthy food messages and ensure that parents don’t fill lunch boxes with unhealthy choices?

You could also talk to parents about the importance of only providing milk and water for their children to drink, and the impact sugar free drinks can have on children’s teeth.  Do parents bring in children’s drink bottles or could you provide them to ensure that children are being given the opportunity to use free flow or open cups with only milk and water?

Another great idea is to share a ‘Congratulations on your first tooth!’ card for the littlest ones in your care.  It could include details about establishing a good dental care routine and gentle reminders about taking their child to routine dentist appointments.  Perhaps you could list the local dentists to help parents?

We would love to hear what you already do to support your families to make these healthy choices and what you might do next.

Signposts

• Oral health – Help for early years providers – GOV.UK (education.gov.uk)
• National Dental Epidemiology Programme (NDEP) for England: oral health survey of 5 year old children 2022 – GOV.UK (www.gov.uk)
• Example menus for early years settings in England – GOV.UK (www.gov.uk)
• Drinks and cups for babies and young children – NHS (www.nhs.uk)

More for members

These free CEY smart courses for members can be found in Fit and healthy theme

• Dental hygiene and oral health in the early years
• Food and drink in the early years foundation stage