Sir, it is disappointing to see the UK rank bottom in a global survey of oral health education in schools. Sadly, our experience indicates there is an inconsistent approach in schools to delivering oral health education and children are rarely taught about how to look after their own teeth. This is a serious missed opportunity to influence a child at an influential stage of their life. Teachers have told us they lack the knowledge and confidence to talk about the key oral health messages, and oral health does not feature prominently in key stages one and two of the national curriculum. As this survey reveals, we are falling behind in the global league table with many developing countries outperforming the UK.

This is something we have been aware of in Plymouth, UK, where schools have requested more support in delivering oral health education. In response, we have developed a school oral health programme called 'Open Wide and Step Inside'. The programme has been developed using a community engagement approach involving children and schools, the local authority and a range of partners to develop resources for integrating oral health more formally into school life.1 Due to its co-design, the programme has high acceptability and integration into the curriculum, recognising some of the challenges to working in schools in a sustainable manner.

Alongside local initiatives, more government action is needed in England to ensure oral health and, in particular, prevention is a key component of the school curriculum and activity, and is delivered in a systematic way to mirror the excellent work in Wales and Scotland. It is our ambition that every child understands the importance of looking after their own teeth alongside other established health and wellbeing topics, and teachers are adequately supported to deliver these important oral care messages in a way that does not overburden their workloads.