More work needed on children’s supervised toothbrushing programmes

Barriers to running supervised toothbrushing programmes for young children must be overcome if the UK government is to successfully tackle childhood tooth decay, researchers say.

PenARC researchers at the University of Exeter supported a team from the Universities of Leeds and Sheffield, to conduct a nationwide survey of supervised toothbrushing programmes currently available to children in England. This research, funded by the National Institute for Health and Care Research (NIHR), highlights both progress and persistent challenges in expanding these initiatives.

The research found that the number of programmes has increased since their last survey in April 2022 – but also identified several barriers preventing schools, nurseries, and other organisations from setting them up, including funding, time pressures and competing priorities.

The increase in numbers of programmes can be attributed to increased priority given by the NHS and local authorities to improving children’s oral health; recovery from the COVID-19 pandemic, and awareness of the Labour Party’s pledge to introduce targeted supervised toothbrushing for three to five-year-olds.

However, they say there are still many three- to five-year-olds living in the most deprived areas of England who would benefit from these programmes, but do not yet have access to them – and call for the government to provide dedicated funding to ensure its campaign pledge is fulfilled.

This paper is the latest publication from the BRUSH project, which focuses on implementing supervised toothbrushing programmes for children aged three to five across England. Previously, the team created a free online toolkit containing all the necessary resources for setting up these programmes in various settings.

BRUSH is funded by the NIHR Applied Research Collaboration Child Health and Maternity National Priority programme, co-led by NIHR ARC South West Peninsula (PenARC) and NIHR ARC Yorkshire & Humber (YH ARC). It is one of four priority research projects exploring how evidence-based interventions can enhance children’s and maternity services in England.

Dr. Shannu Bhatia, President of the British Society of Paediatric Dentistry (BSPD), stated: “The report recognises some of the implementation challenges and the need for dedicated funding. The new government needs to deliver on their manifesto pledge – because we know from experience that targeted supervised toothbrushing schemes work. They are easy to implement and take no longer than 10 minutes out of the school day. Teachers are not required to brush each child’s teeth, since it becomes a peer-led activity that the children quickly engage with and enjoy, as well as being effective in delivering on improving children’s oral health – and cost effective in the long-term.”

The latest BRUSH paper, published in the British Dental Journal, found that as of April 2024, the number of supervised toothbrushing programmes had increased by 28 percent since the previous survey in April 2022, while the number of children enrolled rose by 35 percent. Currently, there are 2,978 clubs with 143,200 participants aged 0-19 years.

The study indicates that nearly 60 percent of surveyed local authorities have implemented these programmes, supported by collaborations with stakeholders, free resources like the BRUSH toolkit, assistance from oral health professionals, increased awareness of poor oral health risks, and shared knowledge among schools.

Despite these successes, respondents pointed out obstacles such as insufficient funding for programme delivery and essential supplies like toothbrushes, staffing challenges in settings with high turnover or competing Ofsted priorities, logistical issues like supply delays, and concerns from some schools that the initiative would be too time-consuming or interfere with parental responsibilities.

Tooth decay affects about a quarter of five-year-olds in England, rising to 50 percent in areas of deprivation. The impact is severe, causing pain, affecting diet, speech, quality of life, self-esteem, and social confidence. Additionally, decay influences school readiness and attendance. In England, dental decay is the leading cause of hospital admissions for over 33,000 young children annually, costing the NHS more than £40 million.

Brushing with fluoride toothpaste is a key preventive measure. Supervised toothbrushing programmes in nurseries and schools do not replace at-home brushing but reinforce good oral hygiene habits. These programmes are especially beneficial for at-risk children and provide cost-effective solutions. However, implementation varies widely, with funding coming from multiple sources, leading to inconsistencies.

To address this, the BRUSH evidence-based toolkit, available for free, aids the implementation of supervised toothbrushing initiatives in England. It provides comprehensive guidance, including navigating commissioning and procurement, establishing, running, and evaluating programmes, training, promotion, and tailored information for early years settings and parents.

Academics and stakeholders collaboratively designed the toolkit through an extensive research programme, beginning with a 2022 review of supervised toothbrushing programmes across 141 local authorities in England.

The paper presents findings from a survey conducted between December 2023 and April 2024, involving 152 local authorities, 59 percent of which had implemented a toothbrushing programme.

Councillor David Fothergill, Chairman of the Local Government Association’s Community Wellbeing Board, commented: “These findings emphasise both the progress made and the significant challenges we still face in addressing childhood tooth decay through supervised toothbrushing programmes. Local government is committed to overcoming these barriers, but we need dedicated funding and support from central government to ensure every child – especially those in the most deprived areas – has access to these vital programmes. Improving children’s oral health is not just a health issue, it’s about giving them the best start in life.”