Oral Health Toolkit

Every child in Wolverhampton deserves a healthy smile: how to maximise your role in children’s oral health prevention

Public Health, City of Wolverhampton Council

Introduction

Every child in Wolverhampton deserves a healthy smile

Tooth decay is the most common oral disease affecting children and young people in England, yet it is largely preventable.

Too many children in Wolverhampton have decayed, missing, or filled teeth, increasing the risk of disease in their permanent teeth.

Oral health problems, particularly dental decay, can have a significant impact on a child's overall well-being, including their physical health, self-esteem and educational outcomes.

Improving children's oral health involves a range of partners working together, from parents, carers and peers, to professionals such as Midwives, Health Visitors, our high street dentists, NHS colleagues, Public Health practitioners and staff in Early Years and Educational settings.

Elected Councillors also play a crucial role in shaping local policies and services to ensure that children in our community have access to effective oral health prevention measures.

The Oral Health Partnership is committed to supporting Councillors, stakeholders and local leaders to improve children's oral health in the city.

This toolkit provides an overview of key strategies and resources to improve children’s oral health. It includes guidance on understanding the issue, promoting evidence-based interventions, influencing policy, and mobilising community resources.

In this toolkit you will find:

Children's oral health

Oral health is directly linked to overall health and well-being.

Poor oral health can lead to:

  • Pain and discomfort: tooth decay is one of the leading causes of preventable pain in children.
  • Infections: untreated decay can result in serious infections and, in rare cases, life-threatening complications.
  • Speech and eating difficulties: missing or damaged teeth can impact a child’s ability to speak and eat properly.
  • Poor educational outcomes: children with poor oral health are more likely to miss school and have lower academic performance.
  • Psychosocial impact: bad teeth can affect a child’s confidence, self-esteem, and social interactions.

Click on the arrow on the right to learn more about local data.

The Scale of the Problem

Dental decay is the most common childhood disease, with significant inequalities evident in oral health outcomes:

  • Prevalence of tooth decay: in 2022-23, nearly a quarter (23.4%) of 5-year-olds in the city had tooth decay when they started school, and this increased to 43% for 11-year-olds in the same time period. More recent 2024 data shows a very small improvement for our 5-year-olds, with around 2 in 10 (22.1%) having tooth decay when they start school. For those children with decay, they often have multiple teeth affected.
  • Inequity in health outcomes: children living in the most deprived areas of Wolverhampton are more likely to have experience of dentinal decay than those living in the least deprived areas. Children with Special Educational Needs or Children in Care may also experience additional oral health barriers.
  • Impact on healthcare: poor oral health leads to higher healthcare costs, including hospital admissions for tooth extractions under general anaesthetic.

Children are often visiting the Emergency Department when decay could be prevented.

  • Almost 9 out of 10 hospital tooth extractions among children aged 0 to 5 years are due to preventable tooth decay.
  • Many of these children will have had antibiotics to help address previous dental infections.
  • Tooth decay can cause problems with eating, sleeping, communication and socialising, and results in at least 60,000 days being missed from school during the year for hospital extractions alone.
  • Severe or untreated dental decay in children can sometimes indicate neglect and may warrant further exploration by health or safeguarding professionals.

Key messages

  • Protect your pregnancy smile: pregnancy increases vulnerability to gum disease - NHS dental check-ups are free during pregnancy and for 12 months after giving birth.  
  • Help them brush twice a day to keep decay away: start brushing a baby's teeth twice a day as soon as their first tooth appears. Baby teeth have softer enamel than adult teeth.
  • To help avoid tooth decay say goodbye to the bottle: at around six months old when solid foods are beginning to be introduced, it’s also a good idea to introduce a cup. Open cups or free-flow cups (without a valve) help a baby to learn to sip and is better for their teeth, helping to prevent decay.
  • Avoid giving fruit juice, squash and fizzy drinks to your baby: avoid high sugar drinks, including baby and toddler drinks, as these can also be very sugary and cause tooth decay (water or milk are best).
  • Skip the sugar they're sweet enough: avoid adding sugar to meals, use sugar free medication and avoid dipping a dummy in sweet food or drinks. Once a child starts talking, or by the time they are 12 months old, try saying goodbye to their dummy altogether. Having a dummy long term can create arched teeth and affect a child’s speech development.
  • Protect their smile with regular visits to the dentist: under 18's are entitled to free NHS dental treatment, children with Special Educational Needs and Disabilities may also be entitled to access  special care dentistry 
  • Remember no need to rinse after brushing: don't rinse with water after brushing as it washes fluoride away.

While these key messages are important for everyone, children with Special Educational Needs and Disabilities can have different challenges in maintaining good oral hygiene practices.

  • Try a range of different toothpastes and toothbrushes: for children with sensory differences try non-foaming and different flavoured toothpastes to find the one they are most comfortable with. There are also  different types of toothbrushes  to try with varying bristle and bristle-head designs, such as double-sided and triple-sided bristles, as well as aids and adaptations to make holding a toothbrush easier.
  • If a child is peg fed it is still important to brush their teeth.

Click on the right hand arrow to see key messages about breastfeeding and oral health.

Breastfeeding and oral health

Click on the right hand arrow to learn more.

Age and stage messages

Maintaining consistent oral hygiene from birth to age 5 helps prevent decay and supports healthy oral development, laying a foundation for lifelong oral health.

Pregnancy

·       NHS dental check-ups are  free  for pregnant women and for up to a year after a baby's birth. Women can ask their Midwife for more details.

·       In Wolverhampton, all pregnant and breastfeeding women, and children, can receive healthy start vitamins for free or by handing in their  healthy start vouchers .

Birth to 6 months

·       Wipe gums with a clean, damp cloth after feeding to remove bacteria and residue.

·        Breastfeeding  is encouraged, if possible, as it supports oral development and can  lower the risk of tooth decay .

·        Teething  is a natural process and usually starts around 6 months, although it may begin earlier or later. Signs of teething include red flushed cheeks, dribbling and irritability. Sugar free teething products, a teething ring or sugar free infant paracetamol medicine may help ease a child’s discomfort.

·       Moving from bottles to cups at around 6 months will also help to reduce risks of prolonged bottle-feeding and decay.

1-2 years

·       A baby's first teeth or "milk teeth" have softer enamel than adult teeth. This means they are more susceptible to getting tooth decay, with very little warning signs between decay that can be reversed and decay that requires intervention. It is therefore important to establish a daily brushing routine, brushing twice a day with a smear of fluoride toothpaste.

·       Try and avoid high sugar treats and limit any sugary snacks and drinks to mealtimes only.

·       Encourage withdrawal of a dummy once a child starts talking or by the time they are 12 months old, as having a dummy long term can create arched teeth and affect speech development. There's no single best way to lose the dummy - it can be done quickly by throwing it away, or more gradually by reducing when a child has their dummy, for example just at night-time.

·       To help children get used to going to the dentist make an appointment for a check-up by their first birthday or when they get their first teeth. Take them to family appointments so they can become familiar with going to the dentist.

3-5 years

·       Brush teeth twice a day for two minutes and encourage a balanced diet rich in fruits, vegetables, and low in sugary snacks and drinks.

·       Children at this age mimic adults, so adults can role model how to brush teeth.

·       Take children for regular dental check-ups to keep teeth healthy, the dentist will advise on frequency.

·       Spit out after brushing and don't rinse – if you rinse, the fluoride won't work as well.    

Children aged 7 and over should be able to brush their own teeth, but it's still a good idea to watch them to make sure they brush properly and for about 2 minutes. Find out more at  Children's teeth - NHS 

Making every contact count

Every child in Wolverhampton deserves a healthy smile. Achieving this involves a wide range of partners working together with children and their families.

Up to and during 2023/24 Public Health, in partnership with the Royal Wolverhampton NHS Trust – Special Dental Care Team, have achieved the following:

  • Over 100 early years professionals have been educated on key oral health improvement messages including, School Nurses, Health Visitors and Early Years Practitioners. The offer expanded to professionals working with vulnerable groups more recently. This enables all practitioners who come into contact with families to offer quality brief advice.
  • Over 49,000 tubes of toothpaste and toothbrushes have been distributed across the city by a range of partners, including Health Visitors at the 12-month developmental reviews, School Nurses to reception age children and at Early Years Settings to 3-4 year olds. A further 40,000 tubes of toothpaste and toothbrushes have been distributed to other vulnerable groups through places such as food banks and community shops.
  • 15 Early Years Settings have adopted supervised toothbrushing programmes (Brilliant Brushers), ensuring that participating children brush their teeth in the setting once per day. There are currently around 150 pre-school children engaged with the programme with more settings to join during 2024/25.
  • Partnership working with Healthwatch Wolverhampton has helped increase our understanding of the experiences of local people.

Click the arrow button on the right to find out ways you can help make every contact count.

Children whose parents support toothbrushing are less likely to have dental decay, and behaviours that are learnt in childhood are more likely to continue into adulthood.

  • Use your every day conversation with families and their children to share the key messages and resources in this toolkit.
  • Encourage parents to include toothbrushing in their daily routine such as the first nappy change of the morning and with a child's bath before bed.
  • Support local and  national  public health campaigns that educate families about the importance of good oral hygiene practices.

What Councillors can do

01 / 05

Councillors are well-positioned to influence local policies, services, and the environments that promote children’s oral health.

Your role encompasses:

1.   Leadership and Advocacy: acting as champions for oral health, raising awareness and advocating for effective interventions within the community and at decision-making levels.

2.   Policy Shaping: influencing the development of local strategies, ensuring that oral health is prioritised in public health and community services.

3.   Partnership Development: fostering partnerships between public health departments, schools, dental professionals, and community organisations to create a unified approach to oral health.

4.   Resource Allocation: influencing local budgets to help ensure that adequate resources are dedicated to oral health prevention programmes.

5.   Raising Awareness and Mobilising the Community: supporting local and national public health campaigns that educate families about the importance of good oral hygiene practices, including brushing, flossing, and regular dental check-ups.

Evidence based interventions: Healthy Schools Programmes

What it is: Schools provide a critical opportunity to promote oral health through education, healthy food environments, and access to fluoride tooth brushing programmes.

How Councillors can help: Advocate for integrating oral health education into the school curriculum as part of broader health and wellbeing programmes.

Further action: Encourage schools in your ward to sign up to champion the ‘Brilliant Brushers’ initiative - click on the video to find out more.

Evidence based interventions: Sugar-Smart Campaigns

What it is: Reducing sugar intake is a key factor in preventing dental decay. Community-led campaigns can raise awareness of the risks associated with high-sugar diets.

How Councillors can help: Partner with public health teams to launch local sugar reduction campaigns. Engage with retailers and schools to limit the availability of sugary snacks and drinks and promote healthier options.

Further action: Use social media, newsletters, or council websites to promote campaigns, like ' food swaps ' to help reduce children’s sugar intake.

Promote the uptake of ‘ healthy start vitamins ’ for pregnant and  breastfeeding  women, and children.

Support planning decisions that promote alternatives to the proliferation of fast food take aways.

Evidence based interventions: Water Fluoridation

What it is: Fluoridating community water supplies is a cost-effective way to prevent tooth decay across the population, particularly in areas with high levels of tooth decay.

How Councillors can help: Educate community members and stakeholders about the benefits and safety of fluoride.

Further action: Use social media, newsletters, or council websites to promote accurate information about water fluoridation and dispel common myths.

Resource bank - free to use leaflets etc.

National smile month free resources:  Free Downloads | Oral Health Foundation 

Videos to make toothbrushing fun for families:  British Society of Paediatric Dentistry (BSPD) > Kidsvids 

Healthy Child Wolves: a free app packed with tips, advice, and signposting to support families, from pregnancy to getting a child ready for school and everything in between.  The app is available to download for free from  Google Play  or the  App Store .

For more information about how you can support children and their families to have a healthy smile email: PublicHealth@wolverhampton.gov.uk

How dentistry is organised

Primary Care

There are about 11,000 independent dental provider practices in England, these are private businesses. About three-quarters of these hold contracts to provide NHS services. All dental practices must be registered with the  Care Quality Commission .

Dental professionals – comprising of dentists and other staff like dental nurses, therapists, technicians and orthodontists – have the choice to work within the NHS, as private practitioners, or a combination of both.

Patients can therefore opt for NHS dental care or seek treatment from private dental providers. Unlike GP services, patients are not registered with an NHS dentist and dental practices do not have to hold a list of patients. This means that dental practices can choose whether to offer patients NHS dental services based on their capacity to deliver care. When a patient receives NHS dental care from a dental practice, the provider has to complete the course of treatment. Providers may choose to treat regular patients via regular recalls, but there is no obligation for them to maintain the relationship. If your teeth, gums and mouth are healthy, you may only need a check-up every 12 or 24 months and more regularly for children.

Dental practices are allowed to refuse future NHS appointments if a patient is repeatedly late for treatment or fails to attend appointments, both of which incur a financial penalty to the dentist. They are not allowed however, to charge patients for missed appointments or ask for a deposit for NHS treatment.

Advice on how to find an NHS dentist:  Find a dentist - NHS 

Some people are entitled to free NHS dental treatment:  Who is entitled to free NHS dental treatment in England? - NHS 

Find out more about how dentistry is organised:  NHS Dentistry In England Explained | The King's Fund 

Information about dental treatment for people with special needs:  NHS 

Community dental services and secondary care dentistry

Community dental services are commissioned separately and provide care to people (children and adults) who are unable to access a dental practice due to a disability or medical condition. For example, this could include people with severe learning disabilities, autistic spectrum disorders, physical disabilities and wheelchair-users, severe mental health problems, dental phobia, people engaging in substance misuse, people from socially excluded groups (e.g. asylum seekers, rough sleepers), elderly and frail adults residing in care homes, looked after children and children with high treatment needs who are difficult to manage. Community dental services are provided in a range of settings including in hospitals and specialist health centres.

Most secondary care dentistry is provided by NHS hospitals, including the 10 NHS specialist dental hospitals in England. It includes services such as complex oral surgery, oral and maxillofacial pathology, dental and maxillofacial radiology.

Secondary and tertiary care dental providers have an important role in providing dentistry training and may also provide emergency primary care dentistry.

How NHS dentistry is organised (Black Country)

The  Black Country Integrated Care Board  (ICB) is responsible for commissioning dentistry services with accountability sitting with the Director for Primary Care. Commissioning officers sit within the  Office of the West Midlands  a body that brings together the six ICBs in the West Midlands to undertake a set of agreed commissioning functions at a West Midlands footprint on behalf of their respective ICBs.

Community dental services (CDS) in Wolverhampton are delivered by the  Royal Wolverhampton  NHS Trust (RWT).

The Health and Social Care Act (2012) confers responsibilities on local authorities for health improvement, including oral health improvement, in relation to the people in their areas. Local authorities are statutorily required to provide or commission oral health promotion programmes to improve the health of the local population, to the extent that they consider appropriate in their areas. They are also required to provide or commission oral health surveys to facilitate the assessment and monitoring of oral health needs and the planning and evaluation of oral health promotion programmes dental services, and water fluoridation schemes.

If you are unable to  find a dentist  the NHS advises you to contact your  ICB 

Useful links for residents

Dental

Find an NHS dentist:  Find a dentist - NHS 

Information about dental charges and eligibility:  How much will I pay for NHS dental treatment? - NHS 

Information about free NHS dental entitlement:  Who is entitled to free NHS dental treatment in England? - NHS 

Information about dental treatment for people with special needs -  NHS 

Information about quality of care:  Find a dentist - Care Quality Commission 

Queries/ complaints about Primary Care (e.g. GPs, dentists, opticians or pharmacy services): ICB ‘Time 2 Talk’  Customer services - Time 2 Talk :: Black Country ICB 

Royal Wolverhampton NHS Trust - Patient Advice and Liaison services (PALs)  Overview - New Cross Hospital - NHS 

Other queries, concerns and sign-posting Healthwatch Wolverhampton:  Home | Healthwatch Wolverhampton 

Information about the NHS app, including how to download the app:  NHS App and your NHS account - NHS 

Information about the RWT patient portal and how to register for the portal:  myRWT patient portal | The Royal Wolverhampton NHS Trust 

Parenting support and information about Wolverhampton's Family Hubs:  Family Hubs | City Of Wolverhampton Council 

Advice for parents of children with autism:  British Society of Paediatric Dentistry guide 

Oral health and dental care for children with a learning disability, autism or both:  a parent's guide 

Health promotion

Tips for keeping older children's teeth healthy:  Children's teeth - NHS 

Tips for healthy teeth and gums for all the family:  How to keep your teeth clean - NHS 

Help for parents and carers with teeth brushing:  Brushing better together 

Advice on how to limit sugary snacks and drinks, (water and milk are the best drinks for children):  Healthy food swaps 

In person and virtual breastfeeding support groups:  Breastfeeding Support & Information | Wolverhampton Information Network  

Making tooth-brushing fun - download  Dental Buddy  and  Brush DJ 

 Resource bank:  health promotional materials for campaigns

Healthy Child Wolves: a free app packed with tips, advice, and signposting to support families, from pregnancy to getting a child ready for school and everything in between.  The app is available to download for free from  Google Play  or the  App Store .

Click on the right hand arrow to learn more.

Children aged 7 and over should be able to brush their own teeth, but it's still a good idea to watch them to make sure they brush properly and for about 2 minutes. Find out more at  Children's teeth - NHS