You're already managing school attendance, therapy sessions, contact arrangements, placement stability, and navigating numerous meetings and reviews. Now, someone is asking about a child's dental health.

It's important to understand that oral health directly impacts the outcomes you are working towards. A child suffering from a toothache may struggle to concentrate in school, eat properly, or get a good night's sleep. Dental pain can affect their mood and behaviour, while visible decay can diminish their confidence and make them reluctant to smile.

If you're unsure how oral health relates to your statutory responsibilities, what questions to ask foster carers during visits, or when to escalate dental concerns to health colleagues, this guide is for you.

Why Oral Health Matters

Looked-after children face significant oral health inequalities. Research indicates that 36% of children in care aged 5 to 11 have experienced tooth decay in their primary teeth.⁷

This situation is not surprising, as many children enter care having missed years of dental visits and daily brushing routines. Their oral health needs often reflect visible signs of previous neglect.

In our experience, when oral health issues are addressed early in a placement, children tend to settle in better. 

Establishing a consistent brushing routine provides much-needed predictability. Alleviating dental pain removes a source of hidden distress, and feeling cared for in these practical ways helps build trust.

Oral health is not separate from the work you already do; it is an essential part of meeting a child's holistic needs.

Where Oral Health Fits in Your Practice

The statutory context

Health assessments for looked-after children should include an evaluation of their oral health.³ The initial health assessment, which should occur within 28 days of a child entering care, along with subsequent reviews, provides opportunities to identify dental needs and ensure that children are able to access dental services and are supported to attend dental appointments.²

NICE guidance NG205 includes specific recommendations on oral health for looked-after children, emphasising the importance of training foster carers to promote good oral health.³

Designated health professionals

Designated nurses and doctors for looked-after children have a strategic role in ensuring health needs are met. They can advise on complex cases, support access to dental services, and help coordinate care.⁴

If you are uncertain about how to address a child's oral health needs, consulting with your designated nurse is a good starting point.

What You Can Do

During visits

You don’t need to be a dental expert to identify potential problems. During visits, pay attention to the following signs:

• A child complaining of a toothache or avoiding certain foods
• Visible decay, such as dark spots or holes on the teeth
• Persistent bad breath
• Swelling in the face or jaw
• A child covering their mouth while smiling or speaking

Children often do not report dental pain, especially if they have learned to tolerate discomfort. Look for indirect signs, such as changes in eating habits or sleep disturbances.

Questions to ask foster carers

Simple questions help you understand whether oral health is being addressed:

"Does [child] have an NHS dentist they can access, or an identified dental practice they attend?"

"When was their last dental check-up?"

"How is the brushing routine going?"

"Have you noticed any problems with their teeth or mouth?"

"Is there anything making dental care difficult?"

These questions signal that oral health matters and open the door for carers to raise concerns.

Supporting foster carers

Foster carers may need assistance with oral health, particularly if a child resists brushing or experiences significant dental anxiety. Common challenges include:

• Children who have never had a brushing routine
• Resistance linked to sensory sensitivities or past trauma
• Difficulty accessing NHS dental appointments
• Anxiety about dental visits

Connecting carers with practical resources can be beneficial.⁵ If a carer is struggling, acknowledge their challenges. Building oral health routines with a traumatised child takes time, and progress is more important than perfection.

Working with health colleagues

Oral health improves when professionals work together. Consider:

• Raising oral health in discussions with the designated nurse or doctor
• Ensuring dental information is included in health assessments
• Flagging dental access problems to health colleagues who may have local solutions
• Including oral health in placement planning meetings

Care planning

Oral health needs should be documented in the child's care plan when relevant. This includes:

• Current dental registration status
• Any identified dental problems or treatment needs
• Support the child may need with daily oral care
• Dental anxiety and approaches that help

Good documentation ensures oral health isn't overlooked during reviews or placement changes.

Recognising Dental Neglect

Dental neglect can occur as part of a broader pattern of neglect or in isolation. Key signs of dental neglect include:

• Untreated decay, which appears as brown or black spots on teeth
• Frequent complaints of toothache without any dental visits
• Broken teeth that remain unrepaired
• Swelling or infection in the mouth
• A child in clear pain who has not seen a dentist

If a child arrives in care with severe dental neglect, this should be documented in the overall assessment.6 Promptly addressing their dental needs is a health priority and demonstrates proper care for the child.

When to Escalate

Involve the designated nurse when:

• A child has significant dental needs, and you are unsure how to address them
• There are barriers to accessing dental care in the local area
• A foster carer needs additional support with a child's oral health
• Dental problems are affecting a child's well-being or placement stability

Seek urgent dental care when:

• Facial swelling, especially if it spreads towards the eye or neck
• Severe pain that affects eating or sleeping
• Fever accompanying dental symptoms
• Significant bleeding from the mouth

Emergency dental care can be accessed even if the child is not currently registered with a dentist.

What This Makes Possible

When oral health is addressed as part of holistic care, children experience benefits that extend beyond oral health. 

A child without a toothache sleeps better, eats properly, and can concentrate at school. They feel confident enough to smile rather than cover their mouth. They learn that someone notices when they are in pain and takes action.

For some children, having their dental needs met for the first time serves as tangible proof that their current placement is different. It shows that they matter and that someone is paying attention to the details of their care.

You are already engaged in complex and demanding work. Addressing oral health doesn't have to be an overwhelming addition to your workload. Instead, it can be integrated into the conversations you're already having and the signs you are already observing, while collaborating with colleagues who can provide support.

Quick Reference

What to check during visits

• Is the child registered with a dentist?
• Is a brushing routine established?
• Are there any dental pains or problems?
• Is the carer managing okay?

Signs needing attention

• Complaints of toothache
• Visible decay or damage
• Facial swelling
• Persistent bad breath
• Changes in eating or sleeping

When to involve health colleagues

• The child has significant dental needs
• Difficulties accessing dental care
• The carer needs support with oral health
• Dental problems affecting well-being

When to seek urgent care

• Facial swelling spreading
• Severe pain affecting function
• Fever with dental symptoms
• Significant bleeding

Call NHS 111 for urgent dental problems outside hours.