BRUSH (optimising toothBrushing pRogrammes in nUrseries and ScHools)

Introduction

A quarter of five-year-old children in England have tooth decay. This figure can rise up to 50% in deprived areas of the country. The burden of decay is significant. Decay causes pain and suffering, as well as affecting what children eat, their speech, quality of life, self-esteem and social confidence. In addition, decay has a wider societal impact on school readiness and attendance. In England, treatment of decay is the most common reason why young children (over 33,000 per annum) are admitted to hospital, costing the NHS over £50 million every year.

Tooth decay is preventable. One key behaviour for preventing tooth decay is toothbrushing with a fluoride toothpaste. Toothbrushing programmes in nurseries and early years at school (Foundation and Year 1) are very important to complement toothbrushing at home and are recommended by the government.  These supervised toothbrushing programmes are effective in reducing tooth decay, especially in children at greatest risk and are cost-effective. However, uptake and maintenance of these programmes are fragmented with funding coming from a variety of sources and there is considerable variation in how they are implemented.

This project is working with a range of stakeholders, to learn how best to implement these programmes and how to increase their uptake and success in the longer term. Research methods include a stocktake of current practice, qualitative methods, implementation science, improvement science and co-design approaches. The project has produced an implementation toolkit, supervised toothbrushing to optimise the implementation of supervised toothbrushing programmes across England, (read the guide here).

Aims

1. To explore current variation in toothbrushing programmes and their roles within local oral health improvement strategies.
2. To explore the barriers and facilitators to the implementation of toothbrushing programmes at policy/commissioner, oral health provider, nursery/school, parent, and child levels.
3. To co-design, with stakeholders an implementation toolkit including appropriate guidance for stakeholders involved at all levels of implementation of a toothbrushing programme (i.e., policymaker/commissioner, oral health provider, nursery/school staff, parents, and children).
4. To pilot test the section of the implementation toolkit with the targeted population.

Outcomes

1. A series of comprehensive stocktakes and geographical maps of toothbrushing programmes throughout the project capturing key information such as number of programmes running in England, number of children involved, who has been targeted (e.g., age, level of deprivation), duration, funding and delivery method.  The results of the two national stocktakes are published in the British Dental Journal.  Stocktake 1 academic year 2021/22, (view the publication here), stocktake 2 academic year 2023/24 (view the publication here).
2. Identification of barriers to implementation and the key determinants of implementation success (view publication here).
3. Co-designed implementation toolkit, including resources aimed at different stakeholders and ways to optimise implementation (www.supervisedtoothbrushing.com).
4. Increased uptake and maintenance of toothbrushing programmes operating best practice.

Contact details

For more information about this project please contact the ARC Child Health and Maternity Team – ARC-ChildHealthMaternity@exeter.ac.uk