Background: Tooth decay in children remains a significant public health concern, impacting well-being, school attendance, and long-term oral health. The integration of oral health education in schools in England became part of the Relationships, Sex and Health Education curriculum in 2020, and the Early Years Foundation Stage in 2021. Schools are now recognised as key settings for oral health education, aligning with the World Health Organization’s Health Promoting Schools global standards. This study explored how schools deliver oral health education.Methods: An online survey containing open and closed questions was designed based on a structured review of literature and was pre-tested prior to national roll-out. Recruitment adopted a two-phase strategy involving targeted invitation letters sent to 248 schools in the North West of England, followed by wider national recruitment via social media dissemination of a research poster.The survey included a demographics data section, and questions related to current practices in the content and delivery of oral health education within the school curriculum, along with resources used and challenges encountered. Quantitative data were analysed descriptively, and qualitative responses underwent directed content analysis. Data collection occurred between September 2024 to January 2025. Ethical approval was granted by Edge Hill University (ETH2324-0166).Results: Overall, 55 school staff took part in this study, representing early years, primary, and secondary schools across nine regions. Delivery of oral health education varied widely, with 22% of participants reporting teaching the topic less often than once a year. Daily supervised toothbrushing was generally embedded in early years settings.While 93% of participants felt confident in their oral health knowledge, many reported classroom-related time pressures and challenges in prioritising oral health education within the curriculum. Participants expressed a need for engagement with parents to reinforce healthy habits outside of the school environment. The external support from dental professionals was valued for engaging pupils and providing practical tools such as toothbrushes and toothpaste. Three main opportunities for improving oral health education in schools interpreted through the global standards for Health Promoting Schools framework were identified:1. School curriculum: embedding oral health education across subjects with clear objectives and links to the curriculum. Where supervised toothbrushing is implemented, this is to take place outside of lesson time.2. Policies and governance: a whole-school model which invests in health promotion by provision of practical teaching resources and standardised lesson plans underpinned by evidence-based preventive guidance.3. Community partnerships: inclusive engagement with parents. Co-delivery of oral health education with dental professionals to promote multi-professional oral health reinforcement.Conclusion: Teachers recognise the importance of their role in delivering oral health education, but need structured resources, external support, and strategies that minimise classroom time pressures. Breakfast clubs offer a promising venue for supervised toothbrushing without disrupting lessons. Sustainable funding and multidisciplinary collaboration with health professionals are key to delivering evidence-based oral health education in schools.
