Barriers to running supervised toothbrushing programmes for young children must be overcome if the UK government is to successfully tackle childhood tooth decay, researchers have said.

The team, from the University of Leeds and the University of Sheffield, has completed a survey of supervised toothbrushing programmes currently available to children in England.

The researchers found that the number of programmes has increased since their last survey in April 2022 – but also identified several barriers preventing schools, nurseries, and other organisations from setting them up. These include funding, time pressures, and competing priorities.

The paper published in February 2025 features the results of a survey of 152 local authorities carried out between December 2023 and April 2024. Of those, 59 per cent had implemented a toothbrushing programme.

However, the researchers said there are still many three to five-year-olds living in the most deprived areas of England who would benefit from these programmes, but do not yet have access to them. They have called for the government to provide dedicated funding to ensure its campaign pledge is fulfilled.

Peter Day, senior author and consultant in paediatric dentistry at the University of Leeds’ School of Dentistry, said, “Evidence shows that many young children are experiencing poor oral health, and we know that there are other issues associated with this, including children’s readiness for the earliest years of their education.

“Our study shows there is clear progress in rolling out supervised toothbrushing programmes among this group of children - but more needs to be done. Our toolkit can help those responsible for setting up new programmes in schools and nurseries implement supervised toothbrushing by providing examples of good practice in this vital area of health.”

Barriers to access

The BRUSH paper, which was published in the British Dental Journal, has found that in April 2024 the number of supervised toothbrushing programmes increased by 28 per cent since the last survey in April 2022. Also, the number of children enrolled increased by 35 per cent. There are now 2,978 clubs, and 143,200 individuals aged 0 to 19 years taking part in them.

The study revealed that almost 60 per cent of surveyed local authorities have rolled out programmes, with collaborations with stakeholders; free resources such as the BRUSH toolkit; support from oral health professionals; awareness of the risks of poor oral health, and shared knowledge among schools all cited as examples of facilitators for setting them up.

However, respondents also highlighted barriers including a lack of funding to deliver programmes and buy resources such as toothbrushes; pressures at settings, such as high staff turnover or focus on Ofsted requirements; logistics, such as delays in delivery of supplies, and a lack of engagement, with some schools believing the process would be too time consuming or set a precedent for taking away parental responsibility.

Shannu Bhatia, president of the British Society of Paediatric Dentistry (BSPD), said, “BSPD welcomes the fact that there are more children enrolled in a supervised toothbrushing scheme. However, there is more work to be done.

“The report recognises some of the implementation challenges and the need for dedicated funding. The government needs to deliver on their manifesto pledge – because we know from experience that targeted supervised toothbrushing schemes work. They are easy to implement and take no longer than 10 minutes out of the school day.

“Teachers are not required to brush each child’s teeth, since it becomes a peer-led activity that the children quickly engage with and enjoy, as well as being effective in delivering on improving children’s oral health - and cost effective in the long-term.”

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