Nursery World - EYFS Best Practice - All about… oral health

With the revised EYFS including the promotion of ‘good oral health’ for children, Annette Rawstrone finds out why doing this is more important than ever

The most common reason for children aged under six years old to be admitted to hospital is to have teeth removed, the vast majority of which are due to preventable tooth decay. Each year in England around 60,000 school days are missed because children need to have tooth extractions, and in London boroughs alone, the NHS spends approximately £7 million for acute dental care for children, including emergency extractions.

A British Dental Association (BDA) spokesperson states, ‘Between 25 and 40 per cent of five year olds across the UK have had tooth decay for a range of reasons, including a sugary diet, poor dental hygiene and, in much of the country, a lack of fluoride. Left untreated, tooth decay can cause severe pain, problems eating and sleeping, sepsis, and disrupt learning and development.’

Tooth decay is associated with delays in speech and language development and school readiness. It can also impact the family, as parents or carers may need to take time off work to take their child for treatment.

It is shocking facts like these that has led to a requirement in the revised EYFS for early years settings to promote the ‘good oral health of children’. The new addition to the welfare requirements has been widely welcomed by those in both the early years and medical sectors.

Dr Nigel Carter, chief executive of the Oral Health Foundation, says, ‘Tooth decay is an entirely preventable disease but causes children great discomfort.’ He adds, ‘Oral health is an essential part of general health. It has often been neglected in curricula so its inclusion now is very welcome.

‘Good oral health habits need to be formed from an early age to keep children from developing tooth decay. On top of this, if we can encourage children to build healthy habits from an early age they will carry these with them throughout their lifetime and keep their chances of developing decay low.’

LINKS TO DEPRIVATION

An Office for Health Improvement spokesperson says, ‘The risk of tooth decay increases as a child’s diet starts to include foods and drinks other than breast milk or formula, depending on the free sugar content. Every child is at risk of tooth decay, but the risk increases if they are eating a poor diet, brushing their teeth less than twice a day with fluoride toothpaste and live in more deprived areas.’

In 2019 there were significant inequalities, with five-year-olds from the most deprived areas having more than twice the level of decay (34 per cent) as those from the least deprived areas (14 per cent).

Dr Linda Greenwall, founder of the charity Dental Wellness Trust, says, ‘Although tooth decay does not discriminate, there are huge inequalities in oral health, with tooth decay being strongly associated with deprivation and social exclusion.

‘While it’s evident that our self-funded oral health prevention and tooth brushing programmes do work, we urgently need further government funding to continue providing this vital service to all children. The cost saving to the Government is staggering and we urge decision-makers to fund these schemes and tackle this wholly preventable disease.’

BDA’s spokesperson adds, ‘Wales and Scotland have early years nationwide schemes in an effort to reduce oral health inequalities; there are some excellent schemes in England, but no nationwide equivalent, which is necessary. It requires considerable investment by Government, but the BDA estimates that Westminster is spending less on dentistry now than it did a decade ago; dentistry doesn’t seem to be a priority.’

It also flags up the issue of Covid-19 forcing dentists to implement enhanced infection prevention measures and social distancing, leading to capacity being reduced. There are reports of long waits for check-ups and dentists turning away new NHS patients, leading to young children and babies not receiving routine check-ups, an issue highlighted by a Healthwatch report in May. This all means that the promotion of oral health in early years settings is more important than ever.

GOOD HABITS

By helping to educate children and their families on good habits around tooth brushing and healthy eating choices, early years practitioners can help to prevent dental decay. How to do this depends on what works best for the setting and cohort of children, but it can be linked to conversations around self-care, healthy eating and physical development and providing parents with advice through informal chats or workshops (see case studies and resources).

The Office for Health Improvement spokesperson suggests the key areas to support child oral health include the following:

Encourage healthy food and drink consumption.
The use of fluoride toothpaste.
Identify and support families with children with urgent dental care needs to access care.
Signpost to routine dental care services.
Access to training to gain skills and confidence in oral health.

CASE STUDY: Leamore Primary School in Walsall, West Midlands

‘Raising awareness of the importance of good oral health, including dummy use and healthy eating, was important to us even before its introduction to the EYFS,’ says nursery teacher Claire Baker.

‘Here at Leamore, we have a big belief that it’s never too early to introduce our children to healthy habits. We take children from two years old and feel it is good to talk about these issues with families early on. Before the pandemic, a dental van would come to our school to check the children’s teeth and talk to the children. We have found in talking to our parents that most of our children are also now registered with a dentist.

‘Often parents don’t realise the issues associated with dummies, including poor teeth formation and speech and language delay, and haven’t thought about the impact of a poor diet. We hold parent workshops around these and other issues and talk with children about forming healthy habits, including how and when to clean their teeth.

‘It is important to me that the activities the children engage in help to extend their development in all areas of learning. As a class, we talked about what our teeth do and why we need to keep them healthy. We provided the children with opportunities during circle time and group activities to share their experiences of visiting the dentist and how they care for their teeth at home.

‘They explored their feelings and emotions as they considered how visiting the dentist can sometimes make them feel. Talking about their experiences is great for their listening, understanding and speaking skills. We also explore and learn new vocabulary around looking after our teeth, such as “enamel”, “plaque” and “hygiene”.

‘Teaching the children health and self-care is a big part of our day-to-day practice. We help and support the children to gain an understanding that oral health is an important part of their daily hygiene routine. We also teach them about healthy and unhealthy foods and about making good food choices.

‘One parent commented that their child chose to have fruit over a packet of sweets. Mum was really impressed in the healthy choices that her little one is now independently making.’

CASE STUDY: Happy Days Penair Nursery in Truro, Cornwall

‘There is a shortage of NHS dentists in Cornwall and there are long waiting lists of more than two years. Over 60 per cent of our children currently don’t have access to a dentist, so one of the things we ask all parents when their child joins the nursery is whether they are registered, and if not we signpost them to the waiting list,’ says nursery manager Nicky Smith. ‘We tell parents how important it is to get their child’s name put down, because many don’t think about it when they’re babies.

‘We’ve known of children who have needed teeth removing because of decay. Recent statistics show that the number of children in Cornwall needing extractions has gone up to more than a quarter. It’s a massive concern. Sadly, there is sometimes the impression that having milk teeth removed doesn’t matter. We try to explain to parents about how the formation of a child’s mouth can be affected, which can impact on their speech and language development.

‘Here at Happy Days we support and promote dental hygiene as part of our Oral Health Programme within our “Where Children Shine” curriculum. We regularly talk to children and parents about the importance of good oral health. I was talking to a mum just last night about her two-year-old son who doesn’t like brushing his teeth. We discussed how to make it fun, such as cleaning teeth together and getting him to also clean his favourite toy’s teeth. We have resources in the nursery that we use to demonstrate good tooth brushing, such as puppets and teeth models with toothbrushes, and we’ll support him with these.

‘We focus on what food and drinks are good – and bad – for teeth and sometimes have displays showing how much hidden sugar is in certain products, such as yoghurts and smoothies. People are often not aware of the impact that juice in a bottle has on their child’s teeth, as well as other contributing factors such as how raisins can stick to teeth and lead to decay.

‘Dental nurses often need to give talks on dental care as part of their training so it’s worth making connections with local dental practices. We had a dental nurse visit before the pandemic and the children enjoyed seeing her in her uniform and it reinforced the oral health messages that we give them.’

CASE STUDY: Little Adventurers Nursery in Upminster, East London

‘We decided to stop supervised tooth brushing at the start of the pandemic but will be re-introducing it this month [November]. While the children already brushed their teeth at nursery as part of our holistic approach, we decided to have an even greater focus on oral health after attending a meeting with Havering local authority a few years ago about the dangers of poor oral hygiene. I was horrified by the statistics, such as the high number of under-fives needing extractions,’ says nursery manager Ginny Andreas.

‘We appointed an oral champion to lead our practice and undertook oral-health training. The training showed us that we should supervise children more closely during tooth brushing because some younger children simply sucked off the toothpaste without brushing their teeth. We also recognised that we should not encourage children to swill out excess toothpaste because fluoride needs to remain on the teeth. Children clean their teeth after lunch and we make it fun by playing a toothbrushing song from YouTube or we do a two-minute dance.

‘We have a large model mouth and toothbrush that we use with the children to demonstrate how to correctly clean teeth. Children are fascinated by our role-play dentist set – our dolls and soft toys regularly get their teeth checked! We’ve not been able to arrange a nursery visit to the dentist, but I had my photo taken in the dentist’s chair when I went for a check-up and showed it to the children. Many of the pre-schoolers have been excited to do the same and then tell their friends about their visit.

‘We wanted to ensure our nutritional provision supported strong teeth so we consulted our nutritionist who assured us that the homemade rice pudding, yoghurt and milk drinks provided the daily recommended intake of calcium for under-fives. We spoke to parents about the need for limiting sugars to protect children’s teeth and how water or milk should be offered, not squash. Children sometimes help to unpack the food delivery and identify which foods are good for their teeth. One time a pre-schooler showed his understanding when I offered him a drink. He pointed at the milk jug saying, “I’d like calcium, please!”’

MORE INFORMATION

RESOURCES

Children’s Oral Health Programme: https://bit.ly/3vYabcR
Oral Health Foundation’s Dental Buddy programme: www.dentalbuddy.org and Brush Time: https://bit.ly/3jJ9T4Q
‘Improving oral health: A toolkit to support commissioning of supervised tooth brushing programmes in early years settings and schools’: https://bit.ly/3pOBdm0
Dental Wellness Trust organises supervised tooth brushing programmes: https://www.dentalwellnesstrust.org/uk-programmes
Childsmile Core Programme in Scotland: https://bit.ly/3jNO5oE
Designed to Smile programme in Wales: https://bit.ly/3pMoYX4
Oral Health inequalities in England: https://bit.ly/31hR8iN
‘Health matters: child dental health’: https://bit.ly/3pPqCHK