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Tackling tooth decay in children

A new toolkit to increase supervised toothbrushing for younger children aims to address health inequality caused by tooth decay.

Researchers from the University of Leeds, University of Sheffield and Bradford Improvement Academy have developed free online resources for NHS organisations, local government, schools, nurseries and parents as part of the BRUSH project to support existing and new toothbrushing programmes.

The toolkit is a central one-stop-shop sharing best practice and containing new materials

Dr Kara Gray-Burrows, School of Dentistry

A quarter of five-year-olds in England have tooth decay, a figure which rises to up to half in deprived areas of the country.

The burden of tooth decay is significant, causing pain, as well as affecting what children eat, their speech, sleep, quality of life and attendance at nursery or school.

Treatment of decay is the most common reason young children are admitted to hospital (33,000 each year), costing the NHS over £50 million annually. 

The study was co-led by Dr Kara Gray-Burrows, Lecturer in Behavioural Science & Complex Intervention Methodology at Leeds’ School of Dentistry.

She said: “We know that there’s good practice and excellent resources out there, so our project was about bringing together all that’s already good and seeing what gaps there were.

“The toolkit is a central one-stop-shop sharing best practice and containing new materials we have developed to give organisations setting up these programmes, nurseries, schools, parents and children the relevant information and resources easily.”

Preventing decay

Study co-lead Zoe Marshman, Professor in Dental Public Health at the University of Sheffield, said: “One of the key ways to prevent tooth decay is toothbrushing with a fluoride toothpaste. Toothbrushing programmes in nurseries and early years at school are really important to complement toothbrushing at home.
“We already know supervised toothbrushing programmes for young children are effective in reducing tooth decay and easy for nurseries/schools to run. However, the uptake and maintenance of these programmes has been fragmented.
“The new toolkit will make it easier for new toothbrushing programmes to be set up, meaning more children will be able to benefit from the programmes so less children suffer from tooth decay and its consequences.”

The BRUSH project was funded and supported by the NIHR Applied Research Collaboration South West Peninsula (PenARC). The researchers worked with NIHR Applied Research Collaboration Yorkshire and Humber to understand how best to implement and evaluate supervised toothbrushing programmes.

Health inequalities

Professor Claire Stevens CBE, spokesperson for the British Society of Paediatric Dentistry, said: “BSPD welcomes the BRUSH initiative. We know that a targeted supervised toothbrushing approach is one of the priority solutions to tackling the oral health inequalities in our society.

“The fact that BRUSH will provide a new free access-to-all toolkit to help facilitate supervised toothbrushing will go a long way to making this simple but highly effective intervention get traction. It will improve young children’s oral health in the short-term, whilst setting them on the path to a lifetime of good oral care practice for life.

“Whilst BSPD believes that every child should have a ‘dental home’ – an ongoing and preventively focused relationship with an NHS dentist – with children’s dental services in crisis, we urgently need to take a creative approach to address the persistent and immoral inequalities we see in children’s oral health. BRUSH provides a wonderful toolkit that will help everyone showing children how to clean their teeth.”

Hayden Ridsdale, Strategy and Transformation Programme Manager, NHS West Yorkshire Integrated Care Board, said: “As a commissioner of dental services in West Yorkshire I think the BRUSH toolkit is a fantastic resource to enable the implementation of supervised toothbrushing schemes. In West Yorkshire, we've embedded it into our contracts with our five local authority partners to ensure good practice guides service delivery.”

For more information about the BRUSH study or to download the free resources please visit:

Further information

For media enquiries email University of Leeds press officer Lauren Ballinger via

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