Parental Supervised Toothbrushing for young children project

Problem:  Tooth decay is the most prevalent preventable condition in children and is a significant public health problem. Improving the dental health of children is a national priority. Yorkshire and the Humber have amongst the highest rates of tooth decay in England. A regional study showed that five-year-old children living in the most deprived areas were over four times more likely to have decay compared to children in the least deprived areas. This disparity extends to different ethnic groups with South Asian children having almost double the levels of disease compared with White British children of similar socio-economic status.

UK guidelines strongly advocate the importance of twice-daily Parental Supervised Brushing (PSB) with fluoride toothpaste for children up to seven years old.  However, there is clear gap in the translation of this guidance into practice. Reports suggest up to three quarters of five year olds are not supervised when brushing. The most recent UK national survey reported a figure of 50% of five-year-old children brush on their own with this value increasing to  85% of eight-year-olds.  A cross sectional study of 2822 children, identified the absence of PSB as one of three factors that doubled the likelihood of decay.  A further longitudinal cohort study of 629 three-year-old children, found twice-daily PSB led to a highly significant, 15%, reduction in decayed teeth. Local evidence has identified marked differences in attitudes to toothbrushing between South Asian parents of high and low socio-economic status which were not found in White British parents.  Barriers previously identified to PSB include: lack of parental confidence in their ability to brush their child’s teeth (self-efficacy) general attitudes about the usefulness of brushing and external factors (such as a reticent child).  There is a paucity of evidence on how to promote PSB skills and no interventions that have been developed based on models of behaviour change.

Research questions: What are the barriers and facilitators that influence PSB and oral health in young children? What are the most appropriate strategies to encourage and maintain PSB for young children and the most effective method of intervention delivery (e.g. who/when/where)?

Methods: Evidence Synthesis: A systematic review of previous attempts to promote PSB will be conducted. Exploration: Qualitative methods will then be used to explore the perspective of parents on toothbrushing and identify their preferences regarding the development of an intervention. An intervention to improve the uptake and maintenance of PSB will then be designed based on a theoretical model of behaviour change and relevant to the local community. The intervention will be field-tested and the acceptability evaluated.

Outcomes: A culturally acceptable intervention which can be integrated in current service provision.  Proof of concept testing of the intervention will lead to a proposal for full RCT for NIHR PHR, HTA or RfPB submission.

Progress to date:

Step 1 – Systematic review – underway with protocol already published on PROSPERO website (

Step 2 – Qualitative interviews – currently being undertaken in Bradford and Barnsley with ethics (14/NS/0093) and other research permissions (CSP 154002) already granted

Step 3 – Intervention development using behaviour change methodology to start in December 2014, with the project estimated to take 4 months.  Stakeholder meetings booked for January, February, March and April 2015.

Step 4 – Feasibility study planned 2015 subject to funding.