This is a plain English summary of an original research article. The views expressed are those of the author(s) and reviewer(s) at the time of publication.
Supervised toothbrushing programmes in nurseries and schools improve children’s oral health. A survey of local authorities in England found that fewer than half had supervised toothbrushing programmes.
Their responses highlighted approaches that could promote toothbrushing programmes in schools and nurseries. Measures included:
- clarifying existing policy (for example, on including oral health in the curriculum)
- clear guidance on how to run a programme
- a flexible approach to delivery and implementation
- protected funding.
The findings have informed a new toolkit for all those involved in setting up and maintaining supervised toothbrushing programmes in England.
Information on how to look after children’s dental health can be found on the NHS website.
How many supervised toothbrushing programmes are there in England?
A quarter of children in England have tooth decay; in deprived areas, this rises to half. Tooth decay can cause pain, affect quality of life, and reduce school attendance.
Supervised toothbrushing programmes aim to improve oral health. Young children (3 to 6 years old) brush their teeth with fluoride toothpaste while supervised by nursery or school staff.
In Scotland and Wales, national oral health campaigns rolled out supervised toothbrushing in nurseries, schools and with childminders. These campaigns have improved children’s oral health. The programmes cost £15 to £17 per child per year in Scotland, and paid for themselves within 3 years through improved oral health and reduced need for dental treatment.
England has had no such campaign. Local authorities are responsible for oral health improvement, and their responses have varied. Different organisations (for instance local authorities, charities and NHS organisations including integrated care boards which plan and fund NHS services) have funded and delivered local supervised toothbrushing programmes in England.
The Government has proposed to introduce supervised toothbrushing programmes for 3 to 5 year olds, targeting the areas of highest need. This study explored whether supervised toothbrushing programmes are widespread in England, what challenges they face, and what factors contribute to their success.
What’s new?
Researchers sent an online survey to dental public health consultants, local authority oral health leads and public health practitioners in England in January 2022. Responses were received from people at 141 of the 333 local authorities.
Half (48%) the respondents had implemented a supervised toothbrushing programme. Most (65%) were commissioned by local authorities, and most (79%) targeted deprived areas (where tooth decay is known to be common). Some local authorities ran programmes which included special education schools and involved pupils up to 19 years.
Programmes were more likely to succeed where:
- oral health was included in the early years and school statutory curriculum
- local authorities, oral health teams and early years providers (including nurseries and schools) collaborated and communicated effectively
- clear and straightforward guidance was available
- the approach to delivery was flexible to suit each nursery or school (including staff training and parent engagement sessions)
- financial, human and physical resources (such as toothbrush racks, toothbrushes and fluoride toothpaste) were consistently available
- each nursery or school, and each local authority, had an oral health lead.
Logistical challenges were revealed. Schools could find it initially time-consuming to set up toothbrushing programmes. Some schools lacked capacity, due to staff shortages, competing priorities or lack of physical space.
Why is this important?
These findings will help local authorities, nurseries and schools set up and maintain toothbrushing programmes.
Almost all respondents cited difficulties caused by the pandemic. Reasons included staff and child absences, and a lack of confidence in how to help children with their oral health, while keeping down the chance of transmitting COVID-19.
Local authorities faced varying challenges. For instance, the number of schools and nurseries involved in each local authority varied (from 11 to 201), as did the number of children (254 to 8,689).
What’s next?
Since the survey in 2022, integrated care boards have assumed responsibility for dentistry, and this change, along with NHS policies, has increased interest in supervised toothbrushing programmes. A follow-up survey found that the number of programmes increased between 2022 and 2024. This increase is shown in maps of local authorities and integrated care board areas.
This paper was published as part of a larger project called BRUSH (optimising toothbrushing programmes in nurseries and schools). The findings of this study informed the development of a toolkit to increase the uptake and maintenance of these programmes. The toolkit, launched in January 2024, provides information for commissioners, providers (NHS or charities), schools and nurseries, and parents. It has already been accessed by 10,000 people across the UK and internationally.
The researchers have discussed their findings with the Department for Education, the Department for Health and Social Care, NHS England and the Local Government Association. Supervised toothbrushing programmes have been set up by some of the pilot schemes involved in an NHS England Early Years Intervention initiative scheme.
You may be interested to read
This is a summary of: Gray-Burrows K, and others. A national survey of supervised toothbrushing programmes in England. British Dental Journal 2023.
A Government website offering support for nurseries and schools. Help for early years providers: Oral health
An article about supervised toothbrushing programmes. Supervised toothbrushing in schools and nurseries is a good idea – it’s proven to reduce tooth decay
An evidence-based plan for improving children’s oral health with and through educational settings by Child of the North and Anne Longfield's Centre for Young Lives; an article about the plan by the NIHR Applied Research Collaboration Yorkshire and Humber.
Funding: This study was funded by the NIHR Applied Research Collaborations South West Peninsula and Yorkshire and Humber.
Conflicts of Interest: No relevant conflicts were declared. Full disclosures are available on the original paper.
Disclaimer: Summaries on NIHR Evidence are not a substitute for professional medical advice. They provide information about research which is funded or supported by the NIHR. Please note that the views expressed are those of the author(s) and reviewer(s) at the time of publication. They do not necessarily reflect the views of the NHS, the NIHR or the Department of Health and Social Care.
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