Supervised toothbrushing programmes in England: a national survey and multi-site case study

Aims: Supervised toothbrushing programmes (STPs) reduce oral health inequalities and are a cost-effective way of preventing dental caries in children. This study aimed to detail current STP provision across England, compare it with 2022 and 2024 data, and explore barriers and facilitators to implementation.

Methods: A national survey of local authorities (LAs) was combined with a longitudinal multi-site case study. Survey data were analysed descriptively, while semi-structured interviews with 14 stakeholders engaged in the commissioning and delivery of STPs across four sites were thematically analysed using implementation science frameworks.

Results: Responses were received from 152 of 153 LAs, with 81% reporting a STP in 2025 (up from 48% in 2022 and 59% in 2024). The number of participating children more than doubled from 106,273 in 2022 to 238,636 in 2025. Case study findings highlighted two persistent barriers: uncertain funding and challenges engaging early years settings; and two key facilitators: relationship building and knowledge sharing.

Conclusions: STP provision is expanding but remains variable. To achieve government targets of reaching 600,000 children, attention must move beyond one-off funding to ensure recurrent investment, workforce stability, and logistical support. Building local partnerships and facilitating knowledge exchange will be critical to sustaining equitable implementation.