Toothbrushing programme in schools could tackle crisis of tooth decay

A national supervised toothbrushing programme should be rolled out in our schools to tackle the crisis of tooth decay affecting millions of children.

These are the recommendations of the latest Child of the North report, produced by academics at the University of Leeds alongside former Children’s Commissioner Anne Longfield’s Centre for Young Lives thinktank.  

Banning the sale of energy drinks to under-16s, expanding fluoridation and sugar taxes, and increasing access to dental care should also be part of a new evidence-based national strategy to improve the oral health of children in England, it says. 

There is much to do if we are to put a smile on every child’s face. This report lays out strong evidence for what works.

The report entitled “An evidence-based plan for improving children’s oral health with and through educational settings” is published today (13 September). It is the eighth in a series looking at how the new Government can put the life chances of young people at the heart of its policies.  

It reveals the substantial and wide-ranging extent of tooth decay affecting millions of children and young people throughout the UK, and its impact on their quality of life. Untreated disease can cause toothache, sleepless nights, and altered eating habits, and may also impact negatively on the development of speech and language.  

Poor oral health can lower confidence and affected children may be less likely to reach their developmental potential. There is also evidence to suggest that even when accounting for the different levels of tooth decay, the burden of tooth decay on the lives of children living in deprived areas is more severe. 

Peter Day, Professor and Consultant in Paediatric Dentistry at the University of Leeds, said: “I welcomed the opportunity to write this report with colleagues across the North of England and shine a light on children’s oral health.  

“As a paediatric dentist, I see the impact of tooth decay on children every day in my clinic. There is much to do if we are to put a smile on every child’s face. 

“This report lays out strong evidence for what works. We need to reorient and coordinate national and local public services towards prevention and ‘turn the taps off.’ All children deserve the best start in life, and this includes having a healthy set of teeth.” 

Oral health crisis

New analysis included in the report reveals that when school readiness was explored by researchers in Bradford, as part of the Born in Bradford project, children who were not considered school ready were more likely to have tooth decay compared to those who were school ready.  

The report sets out the alarming scale of the children’s oral health crisis, particularly in the North of England:  

Overall, fewer than four out of 10 children in England have good oral health.    

One in 10 three-year-olds in England already have tooth decay, rising to three in 10 by the age of five.  

One in five Year 6 school children in North East England and Yorkshire have experience of tooth decay in their permanent teeth.   

Research involving Year 7 and Year 8 children from deprived areas in the North of England, Scotland and Wales has found that over one-third had tooth decay in their permanent teeth. Four in 10 reported that their oral health had an impact on their daily lives.  

Families living in deprived areas are more than twice as likely to have tooth decay, and there are much higher levels of tooth decay in children in the North compared with elsewhere in England.  

Tooth decay is also the most common reason for hospital admission in five to nine-year-olds.  

In 2023, only half of children had visited an NHS dentist within the recommended maximum period of 12 months. For under-fives it was less than a third.  

Last year, 27,000 children in England were on NHS waiting lists for dental care by specialists, with 12,226 children on waiting lists for dental procedures under general anaesthetic with average waiting times of up to 80 weeks.  

Quality of life

Anne Longfield, Executive Chair of the Centre for Young Lives, said: “It is staggering that so many children, particularly in the North of England and those living in low-income families, are now growing up with tooth decay and suffering from toothache and discomfort.  

“This can affect their quality of life, sleep patterns, eating habits, and impact on school readiness and attendance, speech and language development, and overall confidence. In some areas it has sadly become the norm.  

“Many children are not only missing out on NHS dental healthcare but are more likely to suffer tooth decay from a younger age.   

“The Government’s proposals for a national programme of supervised teeth-brushing in schools is a positive step forward, as is its overall focus on boosting children’s wellbeing.   

“We urge Ministers to be radical, go much further, and ignore any accusations of a ‘nanny state’. We need to take radical evidence-based action and to develop a national plan to tackle a rotten teeth crisis affecting millions of our children.”

Recommendations  

The report recommends the new Government develops and implements a national strategy to improve children’s oral health and reduce social inequalities, particularly those experienced by children and young people in the North of England. This would be overseen by a national board including representatives from government departments, local government, dental organisations and specialist societies, universities, citizen representatives, and charities. This strategy would include:    

• Reducing sugar consumption through policy action such as expanding the Soft Drinks Industry Levy to include other sugar-sweetened beverages such as sugary milk drinks.   
• Applying restrictions on food marketing, advertising and promotions.  
• Banning the sale of caffeinated energy drinks to under 16-year-olds.   
• Optimising exposure to fluoride through a combination of community water fluoridation and increasing the number of targeted programmes such as supervised toothbrushing.  

The report sets out proposals to maximise the impact of early years and education-based interventions, co-designed by health visitors, nurseries, and schools.  

It also calls for dental services to be re-orientated towards prevention of dental diseases among children and young people. This would mean:  

Working with the dental profession, dental system reform, and innovative commissioning - led by integrated care boards (ICBs) - to provide opportunities to prioritise improving dental services for children, particularly for those with additional needs.   

Better mechanisms for allocation and distribution of funding based on need, and consideration of providing dental services with and through schools and nurseries.   

A renewed emphasis on clinical prevention, including better use of fluoride treatments, dental sealants and behaviour change interventions to support families’ and children’s oral health behaviour.   

Professor Mark Mon-Williams of Leeds’ School of Psychology and editor of the Child of The North series, said: “Toothache is caused primarily by decay and the rotten teeth of the next generation provide a stark reminder of the perilous state of the nation’s health.  

“The pain of toothache is excruciating and the most brilliant teacher in the world will struggle to educate a child experiencing dental disease.  

“The time has come for the UK to start taking its future seriously - and helping ensure that all children throughout the UK have a smile on their face seems a pretty good place to start.”