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Pre-school Nursery Children’s Oral Health

Pre-school Nursery Children’s Oral Health

19 March 2021

Preschool Nursery Children’s teeth are vulnerable to decay as soon as they appear. Therefore it is imperative that good dental care and regular dental checks begin early.

The first 2 -4 years after eruption is when teeth are most susceptible to decay. This is the time before the enamel hardens.

The timings around which teeth appear vary greatly with at least one child in every 6000 born with teeth or begin to get teeth within the first 4 weeks of life. However the first of the primary teeth (baby teeth) usually appear at around 6 months and all baby teeth should be present by the time a child is 2-3 years.

As a preschool nursery child grows, sufficient space becomes available within the mouth for gaps to develop making space for the permanent (adult teeth)  to replace them. The primary teeth are gradually lost between the age of 6 and 12 Years in the same order they arrived. All the adult teeth are usually in place by the time a child reaches 14 years old, except for the wisdom teeth which appear between 17-21 years and complete the full set of 32 adult teeth.

As soon as a child’s diet starts to include more than just milk the risk of decay increases. The main cause of tooth decay is Sugar, ideally no more than 5% of energy consumed should come from free sugars, such as juices, syrups and baking this does not include those found naturally in whole fresh fruits and vegetables.

Parents should:

  • Avoid adding sugar to food and drinks
  • Reduce the amount and frequency of food and drinks that contain sugar, try to limit these to meal times only.
  • Swap sugary drinks for milk or water
  • Limit fruit juice and smoothies to a maximum of 150ml per day and restrict to mealtimes
  • Choose fruit canned in juice not syrup

After eating sugar, oral bacteria coverts this to acid which then attacks the enamel resulting in softening and decay. Saliva helps to neutralise the acid and repair the damage but this may take 30-40minutes. If the sugar consumption is too frequent there will not be enough time for effective repair. If the acid challenge is too great, damage continues, the enamel becomes more porous and finally a cavity will form.

By limiting the amount of sugar pre-school nursery children intake and the timings around these you help to manage the amount of time the teeth are under attack. For example if you offer a sugary desert after dinner with a glass of water you limit the attack time to just meal times, the water will also help to neutralise acids and allows sufficient enough time for repair before the next ‘attack’ meal time. However if you frequently offer sugary juice throughout the day the teeth will continuously be under attack, resulting in softened enamel and cavities.


Fluoride helps to reduce the solubility of the enamel and increases the resistance of the teeth and the protection following an acid attack. It is naturally present in drinking water and some foods and is also added to many toothpastes.

  • For children up to 3 years old, use only a smear of toothpaste with at least 1000ppmF
  • For children aged between 3 and 6 years use only a pea sized amount of toothpaste with at least 1350-1500ppmF

Toothpaste containing >1500 ppmF (parts per million fluoride) should not be used for young children.

Brushing teeth before bed is advised as this allows the fluoride to remain on the teeth overnight. Teeth should be brushed at one other time each day. The most effective way to brush teeth is with a dry brush to avoid diluting the fluoride. Excessive toothpaste should be spat out and not rinsed out as rinsing may wash away the fluoride and reduce protection. Brush gently with a simple scrubby motion for 2 minutes, making sure not to brush too hard.

Further advice and guidance can be found at