Researchers investigating how best to implement supervised toothbrushing programmes across England are developing a toolkit which could help to address health inequalities caused by dental decay.

The BRUSH project has seen a team of researchers working with ARC Yorkshire and Humber to understand how best to implement supervised toothbrushing programmes in nurseries and schools across England to help tackle dental decay in young children.

Now the research team are developing an online toolkit to make it easy to deliver programmes across different settings. The team are working closely with government departments including the Department for Education and Department of Health and Social Care to promote and shape national policy. The Core20PLUS5 strategy for children is a national NHS England approach to reduce health inequalities. One of the key areas identified to target with interventions is oral health. 

A quarter of five-year-old children in England have tooth decay, a figure which can rise to 50% in deprived areas. The impact of decay is far-reaching, affecting self-esteem, speech, eating, sleeping, and quality of life. But it can also affect a child’s school attendance, impacting negatively on life outcomes. In England, treatment of decay is the most common reason why tens of thousands of young children are admitted to hospital, costing the NHS over £50 million, every year. But tooth decay is preventable through toothbrushing with a fluoride toothpaste and reducing sugar consumption.

The BRUSH project, part of the cross-ARC Child Health and Maternity Programme, is co-led by Dr Kara Gray-Burrows and Professor Peter Day at the University of Leeds and Professor Zoe Marshman at the University of Sheffield. Talking about the exciting developments for the project Dr Kara Gray-Burrows said: “We interviewed people at different levels, from commissioners and oral health providers to nurseries/schools, parents, and children. They all told us that they wanted to be able to find the relevant information and resources easily. So, the toolkit will be a central one-stop-shop sharing best practice and containing new materials we have developed through our work.

We’ve worked with the Department for Education to link our activities to the educational curriculum, so it becomes about health, wellbeing, and education as well as oral health. The activities can help to teach topics like numeracy, literacy and fine motor skills and can be produced at minimal expense. The children loved these activities when we piloted them at a local nursery.” 

When asked about the factors that lead to poor dental health Kara said: “We know that there’s a link between dental decay and deprivation and understand how demanding family life is. Sometimes, there can be misconceptions about the importance of baby teeth which are precursors for adult teeth. Evidence links dental decay in childhood to adult life, so our supervised toothbrushing programme is about setting up good habits for life. Young children enjoy sharing those messages with their family and friends. We want to support that partnership between home and nursery and school. There’s good evidence from national tooth brushing programmes like Childsmile in Scotland to show that supervised toothbrushing reduces health inequalities and is cost effective. We hope our toolkit will support large scale expansion of toothbrushing programmes in England so more children can benefit here too.”

The team have published a paper in the British Dental Journal. Titled, ‘A national survey of Supervised Toothbrushing Programmes in England, it is a survey of the current provision of supervised toothbrushing programmes across England. 

Kara said: “We know that there's good practise and excellent resources out there, so our project is about bringing together all that's already good and seeing what the gaps are. People have been very willing to share their work which is a wonderful credit to them.”

What next?

The project team are hoping to continue to develop and improve the toolkit to see how it addresses the gaps they’ve identified and produce new resources for settings like special schools and childminding services. They are also developing maps to illustrate supervised toothbrushing programmes across England.