The problem
Tooth decay remains the most common reason for hospital admissions among young children in England, with 33,000 cases annually at a cost to the NHS of over £50 million a year. Astonishingly, a quarter of five-year-olds suffer from tooth decay, and this figure rises to 50% in deprived areas. The consequences are profound, affecting children’s ability to eat, speak, sleep, and attend school, thereby impacting their overall quality of life.
To address this, in March 2025 the UK government launched a nationwide programme of supervised toothbrushing for 3–5-year-olds, aiming to combat the alarming rates of tooth decay among young children. This prevention policy was underpinned by the research of the cross-ARC BRUSH (optimising toothBrushing pRogrammes in nUrseries and ScHools) programme, led by ARC South West’s predecessor, PenARC.
What we did
Evidence showed that supervised toothbrushing programmes for young children are effective in reducing tooth decay and easy for nurseries and schools to deliver and are especially beneficial for at-risk children, providing cost-effective solutions. However, a review of supervised toothbrushing programmes across 141 local authorities showed that uptake and maintenance of these programmes was fragmented.
As part of PenARC’s Children’s Health and Maternity National Priority Programme, researchers developed free online resources for ‘The Supervised Toothbrushing Toolkit’ for nurseries, schools, parents, local government and NHS organisations. The toolkit provided a central one-stop-shop containing evidence- based best practice and supporting materials developed through our implementation research. The aim of the toolkit is to give organisations setting up these programmes, and those delivering them, the relevant information and resources in an easy-to-use format.
The toolkit can be accessed here.
Impact
Since the BRUSH programme began, the number of supervised toothbrushing programmes in England has increased by 28%, and the number of children enrolled by 35%. The toolkit will make it easier for new toothbrushing programmes to be set up, meaning more children will be able to benefit. The Government’s £11m investment in this programme is expected to save £3 for every £1 spent, potentially saving the NHS more than £34m in the next 5 years.
The success of the BRUSH programme underscores the importance of evidence-based interventions in addressing public health challenges. By equipping children, families and professionals with the tools and knowledge to maintain good oral hygiene, we are not only preventing tooth decay but also fostering lifelong health and well-being.
Learn more about our BRUSH programme.
Updated June 2025.