What's the evidence?
Effectiveness
The most recent evidence for supervised toothbrushing programmes is based on the national Childsmile programme in Scotland.
Within Childsmile, supervised toothbrushing programmes is a universal offer to all preschool establishments (e.g., children aged 3-5 years old). It includes daily toothbrushing with fluoride toothpaste, and distribution of toothpaste and toothbrush packs for home use. Childsmile has been evaluated thoroughly for the clinical and cost-effectiveness of the programme overall.
In summary, when delivered as a national programme, 89.1% (n=44,868) of eligible children took part in supervised toothbrushing programmes. Importantly, children from the most deprived quintile were more likely to participate (94.3%) and there was an inverse social gradient across quintiles down to 82.7% in the least deprived quintile.
The impact of supervised toothbrushing programmes on caries prevalence was seen within twelve months for the most deprived quintile (caries prevalence reduced from 52.4% to 45.7%). For those living in the second most deprived quintile significant benefits were seen with participation in supervised toothbrushing programmes at 12-24 months (caries prevalence reduced from 43.4% to 35.7%). Across all quintiles, a significant benefit was seen when participation was greater than 36 months.
There was a clear benefit of supervised toothbrushing programmes with a reduction in health inequalities, e.g., children with the greatest risk of dental caries receiving the greatest benefit. These benefits were also seen for children with special educational needs and/or disabilities, including autistic children’
Cost and cost-effectiveness
Within the evaluation of Childsmile, the costs of running supervised toothbrushing programmes were estimated to be between £15-17 per child per annum. These costs were predominantly staff costs (50-90%), with other costs including resources (toothpaste, toothbrushes, toothbrushing racks, etc), transport and travel costs, administration costs and staff training. Supervised toothbrushing programmes paid for itself within three years.
Return on Investment – A Return on Investment model was undertaken by University of York for Public Health England using data from Childsmile. This model estimated that for every one pound spent, the health service benefit at five years was £3.06 and at ten years was £3.66. The largest savings were seen for children living in the most deprived areas who often have multiple vulnerabilities. It should be noted that the model focused exclusively on oral health expenditure without consideration of the impact and benefits seen in education or other sectors.
Further reading
-
ChildSmile - Scotland's national Supervised Toothbrushing Programme
-
Designed to Smile - Wales' national Supervised Toothbrushing Programme
-
Public Health England (2016), A rapid review of evidence on the cost-effectiveness of interventions to improve the oral health of children aged 0-5 years
-
Anopa et al. (2015), PLoS ONE, Improving Child Oral Health: Cost Analysis of a National Nursery Toothbrushing Programme
-
Kidd et al. (2020), BMJ Open, Evaluation of a national complex oral health improvement programme: a population data linkage cohort study in Scotland