A national survey of supervised toothbrushing programmes in England

Abstract
Introduction Supervised toothbrushing programmes (STPs) are a cost-effective public health intervention, reducing tooth decay and health inequalities in children. However, the uptake of STPs in England is unknown. This study aimed to establish the current provision of STPs across England and summarise the barriers and facilitators to their implementation.

Methods
An online survey was sent to dental public health consultants, local authority (LA) oral health leads, and public health practitioners across England. Quantitative data were analysed using descriptive statistics. Barriers and facilitators were analysed using the Consolidated Framework for Implementation Research.

Results
Information was received for 141 LAs across England. Approximately half implemented an STP (n = 68/141). Most STPs were commissioned by LAs (n = 44/68) and adopted a targeted approach (n = 54/68). Barriers to implementation were: 1) acquiring funding; 2) poor communication and engagement between LAs, oral health providers and settings; 3) oral health not a priority; 4) logistically challenging to implement; and 5) lack of capacity. Facilitators were: 1) an integrated and mandated public health approach; 2) collaboration and ongoing support between LAs, oral health providers, and settings; 3) clarity of guidance; 4) flexible approach to delivery; 5) adequate available resources; and 6) ownership and empowerment of setting staff.

Conclusion
The current provision of STPs is varied, and although there are challenges to their implementation, there are also areas of good practice where these challenges have been overcome.