Supervised toothbrushing programmes and at home brushing behaviour: a rapid review of evidence

Abstract

Supervised toothbrushing programmes (STPs) are widely implemented to improve children’s oral health, yet it remains unclear which behaviour change techniques (BCTs) they use and whether these support children’s toothbrushing at home. This rapid review addresses this evidence gap to inform programme design and evaluation.

Aim(s)

To conduct a rapid review of behaviour change techniques (BCTs) used in supervised toothbrushing programmes (STP1qs) and assess whether they support children’s at-home toothbrushing.

Methods

A rapid review (Feb–Mar, updated Jul 2025) across PubMed, MEDLINE, Scopus and PsycINFO. Inclusion criteria focused on primary studies on children ≤12 years, STPs with any link to home brushing. Behaviour change techniques (BCTs), the active ingredients in changing behaviours, identified in included studies were code according Behaviour Change Taxonomy (BCTv1). BCTs were also mapped to COM-B mode of behaviour change and the Theoretical Domains Framework. There was no formal quality appraisal.

Results

From 187 records, 153 were screened, 16 full texts assessed, and 4 studies included (randomised controlled trials, mixed-methods, single-case). A range of BCTs was identified: instruction/demonstration, behavioural practice, prompts/cues, social support, environmental restructuring; incentives/rewards appeared in some trials. Only one study explicitly used the COM-B. Evidence for effects on home brushing was limited and largely parent-reported (e.g., greater enthusiasm, longer brushing, transfer of songs/charts), with no robust quantitative measures of home routines.

Conclusion(s)

Based on this rapid review, a number of STPs reliably embedded BCTs strengthening children’s capability and opportunity to brush with the possibility of a “spill over” effect to home brushing behaviour. However, evidence that STB is associated with sustained at-home brushing remains weak and poorly theorised. Future evaluations should pre-specify mechanisms, measure home brushing with validated tools, and test which BCT combinations most effectively bridge school-to-home behaviour.