BRUSH (optimising toothBrushing pRogrammes in nUrseries and ScHools)

Introduction

A quarter of five-year-old children in England have tooth decay. This figure can rise up to 50% in deprived areas of the country. The burden of decay is significant. Decay causes pain and suffering, as well as affecting what children eat, their speech, quality of life, self-esteem and social confidence. In addition, decay has a wider societal impact on school readiness and attendance. In England, treatment of decay is the most common reason why young children (over 33,000 per annum) are admitted to hospital, costing the NHS over £30 million every year.

Tooth decay is preventable. One key behaviour for preventing tooth decay is toothbrushing with a fluoride toothpaste. For a large number of reasons, toothbrushing behaviours at home are variable. To supplement behaviours at home, the government has recommended nursery and school-based (Foundation and Year 1) toothbrushing programmes. These supervised toothbrushing programmes are effective in reducing tooth decay, especially in children at greatest risk and are cost-effective. However, uptake and maintenance of these programmes are fragmented with funding coming from a variety of sources and there is considerable variation in how they are implemented.

This project will work with a range of stakeholders, to learn how best to implement these programmes and how to increase their uptake and success in the longer term. Research methods include a stocktake of current practice, qualitative methods, implementation science, improvement science and co-design approaches. The project will lead to the production of an implementation toolkit to optimise the implementation of supervised toothbrushing programmes across England.

Aims

1. To explore current variation in toothbrushing programmes and their roles within local oral health improvement strategies
2. To explore the barriers and facilitators to the implementation of toothbrushing programmes at commissioner, trainer, organisation, practitioner, parent, and child levels
3. To co-design, with stakeholders an implementation toolkit including appropriate guidance for stakeholders involved at all levels of implementation of a toothbrushing programme (i.e., commissioners, practitioners etc)
4. To pilot test the section of the implementation toolkit aimed at school/practitioners

Outcomes

1. A comprehensive stocktake of toothbrushing programmes at the beginning and the end of the project capturing key information such as number of programmes running in England, number of children involved, who has been targeted (e.g., age, level of deprivation), duration, funding and delivery method.
2. Identification of barriers to implementation and the key determinants of implementation success.
3. Co-designed implementation toolkit, including resources aimed at different stakeholders and ways to optimise implementation. Examples of the types of resources likely to be included are:
   • An explanation of the importance of getting implementation right and ways nurseries/schools can learn what might help or hinder the implementation of toothbrushing in their setting
   • A step-by-step approach of how to plan for implementation
   • Guidance on adapting their intervention to emerging issues
   • Details on how to measure the success of adaptations over time
   • Advice on bulk purchasing toothpaste/brushes
   • Supporting materials including a slide set for providing training to a nursery/school, a template for a toothbrushing club newsletter, a frequently asked questions sheet for nurseries/schools and information videos aimed at parents and children.
4. Increased uptake and maintenance of toothbrushing programmes operating best practice

Contact details

For more information about this project please contact:

• ARC Child Health and Maternity Team – ARC-ChildHealthMaternity@exeter.ac.uk
• Zoe Marshman, Co-Principal Investigator, University of Sheffield – z.marshman@sheffield.ac.uk
• Kara Gray-Burrows, Co-Principal Investigator, University of Leeds – K.Gray-Burrows@leeds.ac.uk