Supervised tooth brushing in the early years
More than 2,000 children from 30 primary and special schools in south west London are benefiting from a supervised toothbrushing programme to promote lifelong, positive oral health habits from the age of three.
“Our supervised tooth brushing is one of our biggest success stories,” says Taiwo Oyegunle, oral health promotion manager at King’s College Hospital Community NHS Foundation Trust, which runs south London programmes to improve dental health across the life course.
The supervised toothbrushing programme for nursery and reception pupils launched in January 2025 in priority areas in each south west London borough, with selection based on a range of deprivation factors. The initiative comes ahead of a national announcement on funding for similar schemes throughout England.
By the age of three, more than one in 10 children in the UK already has dental decay, and this rate increases as they grow older.”
As Taiwo explained, the programme is addressing a national crisis in oral health, which is worsened by dental inequalities. “Despite notable strides in the past few decades, oral disease poses a significant health challenge nationally and regionally.
“By the age of three, more than one in 10 children in the UK already has dental decay, and this rate increases as they grow older. Poor dental health is still the primary reason for hospital admission among children aged between five and nine. And recent figures show that three-year-olds in the most deprived areas of the country had a dental decay rate nearly three times higher than for those in the least deprived areas.”
The results of the 2024 oral health survey, conducted among five-year-olds across England, found that in south west London 22.7% of children had experience of obvious dental decay, slightly above the national average of 22.4%. At borough level, average figures range from 16.6% in Merton to 25.3% in Croydon.
According to Taiwo, tooth decay in such young children has potential long-term consequences. “Its impact on a child’s quality of life can be significant, leading to painful symptoms, infections and difficulties with speech, eating and sleeping. Additionally, it can cause problems with communication and socialisation during crucial developmental years, potentially resulting in missed school days due to pain or the need for dental appointments.
“When children experience high levels of disease in their primary teeth, they face an increased risk of developing issues in their permanent teeth. Early treatment can help prevent this progression. However, more advanced dental problems may require long-term maintenance that could extend throughout the child’s life and into adulthood.”
Taiwo and her team found that starting the programme with nursery children helped establish tooth brushing at the right point in their development. “By the age of three, children are quite independent; they can take their toothbrush, use it properly, rinse it, and put it back in its place.”
As she explained: “Supervised toothbrushing does not mean that a teacher kneels down to brush all the children’s teeth. Its purpose is to create an environment where children can practice brushing with their peers.”
Almost 400 school staff members have been trained to implement the programme in south west London, with support to build their confidence in assisting children who may need extra help.
Says Taiwo: “We recommend schools make this practice a part of the daily routine. Children are also encouraged to brush their teeth in the morning and at night at home, under the supervision of parents, caregivers or guardians.”
Clare Hardy, assistant head of Green Wrythe Primary School in Sutton welcomed the programme, which she calls, “a valuable resource in educating both parents and children about the importance of dental hygiene, which is key, especially given the history of fillings and extractions in our local area.”
The children are already showing progress, becoming more independent in their brushing habits, and even looking forward to it.”
She added: “Encouraging dental visits and promoting teeth cleaning as a routine part of the children’s day is crucial. The children are already showing progress, becoming more independent in their brushing habits, and even looking forward to it.”
Improving oral health for people in care homes
An oral health pilot scheme in four care homes in Merton has involved training sessions, developed by Taiwo’s team. They included online workshops and in-person sessions tailored for each individual home, addressing common oral health conditions. Staff received advice including on supporting residents, completing a mouth care assessment and assisted brushing and denture care.
We understand that being a carer is a challenging job, but we want care homes in our boroughs to know that we are here to support them and help develop their skills in mouth care for their residents.”
As Taiwo explained, future plans involve ongoing support for care homes across south London boroughs. “Our aim is to ensure that every resident in a care home receives an oral health assessment, and that oral health becomes an integral part of the care provided. Additionally, we plan to create oral health champion networks to share information on training offered locally.
“We understand that being a carer is a challenging job, but we want care homes in our boroughs to know that we are here to support them and help develop their skills in mouth care for their residents.”
NHS England London, King’s College Hospital Community NHS Trust, NHS South West London and Merton Council partnered to deliver the care homes programme.
NHS South West London took over responsibility for dentistry in 2023 along with pharmacy and optometry. Mark Creelman, Executive for Merton and Wandsworth boroughs leads on dentistry across our boroughs and welcomed the programmes: “We know that inequalities are frequently at the heart of dental health issues – with young children and older people in care homes among groups where this is most apparent.
“Targeted programmes like these really do address these inequalities in practical ways, and we are developing plans to further boost dental care and access across south west London.”