Joint blog by Cllr David Fothergill, Chairman of the LGA Community Wellbeing Board and Sam Watt, Zoe Marshman, Kara Gray-Burrows and Peter Day on behalf of the BRUSH team.
Last Friday (7 March), the government have committed £11 million of funding to councils for 2024/25 to fulfil their pledge to introduce supervised toothbrushing in early years settings for all three to five-year-olds living in the most deprived areas of England. The funding will allow councils to use their own data and networks to identify early years settings for new or expanded supervised toothbrushing programmes and specific groups of children they wish to prioritise, for example children with special education needs.
Since the election, work has been ongoing within the Department of Health and Social Care, the Department for Education, the Local Government Association with other key stakeholders, including the BRUSH research team to support delivery of the pledge.
Cllr Fothergill, Chairman of the LGA’s Community Wellbeing Board said:
“We are pleased to see new funding for supervised toothbrushing, which is an evidence-based and cost-effective intervention proven to improve children’s oral health. This investment will help address health inequalities by supporting children in the most deprived areas to develop positive brushing habits, preventing tooth decay and reducing the need for hospital treatment. This funding builds on the excellent work already being done by many councils up and down the country to improve children’s oral health. The flexibility in how the funding can be used is particularly appreciated, allowing councils to tailor programmes to best meet local needs. Councils are committed to playing their part in improving children’s oral health and reducing inequalities.”
Tooth decay is preventable
Recent national dental epidemiology programme data shows almost one quarter of five-year-old children in England currently have tooth decay with persistently wide inequalities. Tooth decay causes pain and suffering, as well as affecting what children eat, their speech, quality of life, self-esteem, social confidence with wider impacts on school readiness and attendance. In England, treatment of tooth decay is the most common reason why children aged 5-9 are admitted to hospital, with treatment of tooth decay costing the NHS over £50 million every year.
Councils are responsible for commissioning child oral health improvement programmes. One of the key programmes recommended to reduce tooth decay is supervised toothbrushing in early years settings.
Supervised toothbrushing explained
One key behaviour for preventing tooth decay is toothbrushing with a fluoride toothpaste. Supervised toothbrushing programmes are usually delivered in early-years settings such as nurseries and schools, with children brushing their teeth daily with a fluoride toothpaste while supervised by trained staff. These programmes aim to supplement toothbrushing at home.
Supervised toothbrushing programmes are effective in reducing the prevalence and inequalities in tooth decay and are cost effective. For every £1 spent on supervised toothbrushing programmes, there is an estimated return on investment of £3 over a 5-year period. The BRUSH project led by researchers from the University of Sheffield and Leeds investigated the implementation of supervised toothbrushing programmes across England. The project is funded by the National Institute for Health and Care Research Applied Research Collaboration.
The NIHR-funded BRUSH project has:
A history of supervised toothbrushing: not a new policy!
Concerns about the state of children's oral health, and the need for preventative measures, are not new. As far back as the late 19th century, dental surgeon Richard Denison Pedley was pioneering efforts to improve dental hygiene among schoolchildren.
In his 1893 report Teeth of Pauper Children, Pedley and his colleague Sidney Spokes examined the teeth of over 3,000 children in London schools. Their findings were stark—only 707 children had healthy teeth, while 78 per cent had teeth that required fillings or extraction.
The report highlighted the impact of poor dental health on children's wellbeing and strongly recommended appointing school dental surgeons to provide regular check-ups and preventive care. Pedley
also advocated for the introduction of supervised 'toothbrush drills' in schools, recognising that daily brushing was as essential as any other health-related exercise.
Pedley's recommendations laid the groundwork for school dentistry in Britain and remain strikingly relevant today. Over a century later, dental decay remains the leading cause of hospital admissions among young children. Echoing Pedley's call for preventive measures, it is positive to now see this vision being realised with the government’s latest investment in children's oral health.
Current provision of supervised toothbrushing programmes
The BRUSH team has conducted consecutive surveys of supervised toothbrushing programmes currently available to children in England. In the 2023-2024 academic year 60% of councils implemented a supervised toothbrushing programme with 143,200 children participating across England. This represents an increase in the number of children participating of over one third compared to 2022. However, despite this progress, there are still areas with high levels of tooth decay and over 500, 000 children who could benefit from new or expanded programmes. A third survey is planned for March/April 2025.
Implementation of supervised toothbrushing programmes
The interviews conducted as part of BRUSH have found that supervised toothbrushing has strong support due to the compelling evidence-base, positive impact on children’s health and relative ease of implementation. System-wide engagement from key stakeholders was also found to be crucial for successful implementation.
Facilitators included:
- high level policy imperatives
- available and sustained source(s) of funding
- necessary oral health expertise
- strong partnerships and connections between all those involved including council commissioners, organisations running the programmes, early years settings and families.
The BRUSH team have developed an online supervised toothbrushing implementation toolkit which is a central hub for resources and provides guidance to a range of stakeholders – available here. Since its launch in January 2024, the toolkit has received over 13,000 visitors. http://www.supervisedtoothbrushing.com/
Government’s pledge – funding and a new partnership
The additional funding comes with support in the form of a new partnership with Colgate-Palmolive who will donate over 23 million toothbrushes and toothpastes over the next five years and run a public facing campaign.
This announcement is an exciting opportunity for co-ordinated action to reduce the prevalence and severity of tooth decay and its consequences for children’s daily lives. Continued collaboration and investment will be key to ensuring every child has the opportunity to benefit from good oral health and thrives throughout childhood and beyond.
Useful links
For more information on supervised toothbrushing programmes visit: