Supervised toothbrushing programmes in England: a national survey of current provision and factors influencing their implementation

Introduction: Supervised toothbrushing programmes (STPs) in nurseries and schools are effective at reducing inequalities in caries when targeted to areas of dental disease. Recent changes to government education and health policy have increased interest in STPs in England. This study aimed to establish the current level of provision of STPs in England, describe changes over time, understand associations with predictor variables, and summarise key barriers and facilitators to their implementation.

Methods: A national survey was conducted at upper tier local authority level about the extent of a STP across England between December 2023 and April 2024. Quantitative data were analysed using descriptive statistics, with regression analyses examining associations with key predictor variables. Barriers and facilitators to implementation were analysed and summarised based on the Consolidated Framework for Implementation Research.

Results: Data were received from 152 local authorities. Around 60% implemented a STP. Nearly one-third of programmes were commissioned by local authorities (28.9%) and most adopted a targeted approach (77.8%). Statistical analyses demonstrated significant and positive associations between dental caries prevalence and the number of children in STPs. Barriers to implementation included: 1) funding; 2) capacity; 3) pressures at settings; 4) logistics; and 5) lack of engagement. Facilitators included: 1) partnerships and connections; 2) available resources; 3) oral health expertise; 4) external policy and incentives; 5) shared knowledge; and 6) engagement.

Conclusions: Provision of STPs in England has increased since 2022. Any future expansion of STPs should consider the barriers and facilitators identified to enable smooth implementation.