Over 50% of eligible settings now brushing daily as All Together Smiling reaches key milestone

The All Together Smiling supervised toothbrushing programme has achieved a significant milestone, with more than 50% of eligible childminder, early years, and primary settings across Cheshire and Merseyside now taking part. This level of participation marks an important tipping point, with evidence showing that programmes of this scale can begin to deliver measurable reductions in tooth decay among children and young people.

Across the region, over 300 settings are now delivering daily supervised toothbrushing, supporting more than 15,200 children to build strong, lifelong oral health habits. The programme has also distributed over 382,000 oral health packs - each containing a toothbrush, fluoride toothpaste, and a key‑messages leaflet, to children most at risk of tooth decay as well as to partners including General Dental Practices, Community Dental Services, Special Educational Needs and Disabilities (SEND) settings, and more - helping to reinforce positive habits at home and ensure every child has access to the essentials they need to care for their teeth.

The latest oral health survey (2024) highlights the scale of the challenge locally with 31.2% of 5‑year‑olds in Cheshire and Merseyside living with tooth decay, compared with 22.4% on average across England. Children in the most deprived communities are three and a half times more likely to require teeth extracted under general anaesthetic due to decay than those in the most affluent areas. Tooth decay also remains the leading cause of hospital admissions for children aged 5 to 9. Poor oral health affects far more than teeth, influencing a child’s ability to eat comfortably, sleep well, develop speech, feel confident, and much more.

This milestone demonstrates the growing momentum behind prevention efforts and the importance of giving children the right support, resources, and environments to develop positive oral health habits. Alongside other local initiatives, All Together Smiling is helping to reduce longstanding oral health inequalities across the region.

Settings taking part in the programme, and completing training delivered by the programmes provider Healthbox CIC, have shared their experiences. One Cheshire West and Chester nursery said, “I didn’t realise how important it is to spit, not rinse, or how much toothpaste children actually need.” A Liverpool SEND setting added, “For our children who struggle with brushing, the tools and guidance are incredibly helpful.” Another nursery in Warrington commented, “Understanding how to store toothbrushes safely and follow the correct brushing procedure has been really valuable.”

Settings also described how they plan to embed the learning. A Liverpool nursery shared, “We’ll follow the steps to set this up properly, so children benefit, and staff feel confident. This will make a huge difference to our families.” A Sefton nursery added, “We’re in a deprived area so this programme will support our children immensely.”

The programme continues to encourage more eligible settings, those in the 20% most deprived communities, to join the effort to reduce tooth decay and improve children’s health and wellbeing.

For more information about the All Together Smiling programme, or to check if your setting is eligible to take part, contact: alltogethersmiling@alderhey.nhs.uk.