1. Ealing Smiles Daily
Supervised Tooth brushing programme for Early Years Settings and Primary Schools (3-5 years old)

2. Aims of Ealing Smiles Daily
To develop good oral health behaviours during the early years of life which can establish prevention for life
To promote Supervised Toothbrushing and develop good oral health practices from a young age in early years settings across Ealing

3. Highest proportion of 5 year olds with tooth decay in London

5. Risks of poor oral health on children
School absence
Severe decay in baby teeth can have serious consequences for a child’s speech and jaw development
Untreated dental disease compromises the child’s ability to eat well, sleep well, and function well at home and at school.
Loss of time at school, impact on education learning and development
Parental Stress
More complicated and expensive treatment
Sleepless nights and anxiety
A&E and hospital visits
Pain
The longer tooth decay is left untreated, the more a child will experience
Pain and discomfort
A higher risk of new decay in neighbouring teeth and future adult teeth

6. Before getting started
Staff at the EY setting must be trained in carrying out Supervised brushing
Each participating child must have signed consent by their parent/ carer for them to brush at nursery/school .Consent letters to include information and FAQs
These letters must be kept on file on location
No consent = No participation

7. Equipment required for Supervised Toothbrushing
Toothbrushes and corresponding racks with lids to be provided by Ealing Public Health /Whittington Health CDS Oral Health Promotion
1450 ppm Fluoride toothpaste-to be provided by Ealing Public Health /Whittington Health CDS Oral Health Promotion
Additional equipment
Paper towels /paper plates
Hand wash soap
Cleaning detergent
Gloves for staff (to wear whilst cleaning during the session)

8. Resources

9. Getting Started Only trained Staff should be “supervising”
Ensure supervision of children at all times during the brushing activity
Supervisor should cover any cuts or abrasions or breaks in their skin with waterproof dressing
Supervisor must wash their hands before and after session

10. Toothbrushes Toothbrushes MUST NOT be shared!
Toothbrushes are NOT to be handled by the children unless during a session
Toothbrushes are changed every 2-3 months or per term unless splayed, a log must be kept in the replacement log form

11. Toothpaste
For children aged 3 years and above use a pea-sized amount of fluoride tooth paste provided
For children 0-3 years use a smear of fluoride toothpaste

12. Toothpaste To be dispensed by a supervisor
Where toothpaste is shared a supervisor dispenses it onto a clean surface such as a paper towel or plate
Ensure there is sufficient spacing between quantities of dispensed toothpaste to allow collection without cross contamination
Toothpaste must be dispensed at
the time the child is ready to brush
Children should SPIT toothpaste
out, NOT Rinse or swallow

13. Toothbrushing

14. Toothbrushing Ensure all Tooth surfaces are being brushed.
Time the brushing for 2 minutes either using a 2 minute timer, a 2minute brushing app or 2 minute brushing song/video
Prompt during session
All children must be encouraged to brush however if a child is uncooperative, they should not be forced.

15. After brushing
Thoroughly rinse each toothbrush individually under cold running water right after the brushing activity ends i.e. toothpaste must not be allowed to dry on the toothbrush
Shake to remove excess water, avoid contact with the sink
Toothbrush racks should be cleaned weekly with household detergent and warm water to remove any contamination (ensure the racks are dry before replacing any toothbrushes
Tooth brushes should be stored
appropriately

16. Storage and Replacement
Toothbrushes should be placed in correct place holders to avoid cross contamination
Contact WH if the storage racks become cracked / damaged for a replacement
Keep out of reach of children
Store in a dry clean cupboard or room
Storage racks should not be placed next to the child whilst they are brushing their teeth – may become contaminated

17. Replacement of toothbrushes
Each participating child must have a replacement brush ,in case of loss or compromise on hygiene
All brushes should be replaced on a termly (2-3 monthly) basis regardless of their condition
Once the bristles are bent/splayed, the brush must be replaced - keep an eye out for chewing, focus on those children to improve their brushing technique
If a toothbrush gets accidentally dirty it will need to be replaced
Keep a log for audit purpose

18. Cross Infection Control
Supervisors MUST wash hands before and after session
Supervisors MUST cover all cuts/abrasions
If a toothbrush gets accidentally dirty it will need to be replaced
DO NOT allow children to handle tooth brushes (when not in use) and racks
Store appropriately
All staff must read through the guidelines in the Protocol document

19. Toothbrushing in a DRY Area
The Supervisor should dispense toothpaste onto a clean surface such as a plate or paper towel right before the activity is to take place
Ensure there is sufficient spacing between quantities of dispensed tooth paste
Brush for two minutes ensuring all tooth surfaces are brushed
Children must not rinse the toothpaste and should be discouraged from swallowing
Ideally children should not eat or drink for 30 minutes in order to get the maximum benefit from the fluoride

20. Any Questions