Supervised toothbrushing: What oral healthcare teams in practice need to know

As described above, there are many stakeholders involved in STP who are key to the programmes being effective at reducing dental caries and to sustaining the STPs long term. Below, key stakeholders involved in STP share their perspectives.

Jill Allbutt, Oral Health Improvement Service Lead, Shropshire Community Health NHS Trust

I led the development of a supervised toothbrushing programme in Stoke-on-Trent in 2016 and I am now the Lead for an Oral Health Improvement Service in a Community NHS Trust which is commissioned by Integrated Care Boards. The service delivers a range of evidence-based community interventions, including STP, across four LAs. I work closely with the local Consultant in Dental Public Health who provides leadership to support the programmes and their ongoing development.

At a strategic level I oversee the expansion and delivery of the supervised toothbrushing programme. This includes engaging with LAs, headteachers, early years leads and wider education and health partners to support settings and promote the benefits of daily supervised toothbrushing.

Locally, I lead on the training and development of oral health improvement practitioners to deliver the programmes, and am responsible for planning the delivery, activity and quality monitoring, and rollout out of our local STP for 3-5-year-olds in day nurseries, mainstream schools, and 3 years upwards in SEND schools. The programme specifically targets early years settings serving the 20% most deprived areas. We follow the national guidance for supervised toothbrushing to ensure it is delivered safely, effectively and consistently and in accordance with current Infection Prevention and Control standards.

I believe supervised toothbrushing is one of the simplest, most effective ways we can support children’s oral health, especially in communities where tooth decay is still far too common.

I have seen first-hand how a small daily habit – taking only 5-10 minutes in a nursery or school, can make a big difference, not just in oral health outcomes but in building school readiness and confidence in young children. For me, it is about more than just brushing teeth. It’s about giving the young children the best possible start in life and helping to remove preventable barriers to learning and thriving.

In our area the supervised toothbrushing has been well received. We have over 160 targeted settings currently participating and it continues to grow. We focused on making the programme as simple and practical as possible – providing clear guidance, ready to use resources, training that fits around busy school routines and promotional material to raise awareness of the programme. The success we have seen so far, I feel comes down to strong partnerships. Day nursery managers, early years leads and headteachers are often enthusiastic once they understand how little time it takes, how well it fits into existing routines and how much it benefits the children. Consent rates in settings are almost 100%.

The programme is intended to be in addition to any home toothbrushing and many parents report their child being more willing to clean their teeth at home and allow their parents to help them, which reduces some of the stresses experienced when getting children ready for nursery/school or at bedtime.

We are continuing to grow participation steadily and feedback from schools has been key to refining our approach. It has become a valued part of the wider work to reduce inequalities in oral health in areas where a high percentage of children starting nursery already experienced tooth decay.

Victoria Major, Children’s Health Improvement Coordinator, Herefordshire Public Health, Herefordshire Council

My role in Herefordshire supervised toothbrushing has largely been project management. I am the person who works with the early years settings delivering the STP. I have lots of oral health promotion experience in my previous roles in early years and family support; rather than a dental background, with oral health advice coming from the local Consultant in Dental Public Health.

It has been an honour and delight to build this programme from scratch in 2021 with 0 settings involved to now in 2025 a total of 45 early years providers involved and enjoying the programme. Initially my role at the council allowed my full focus to be on children’s oral health which meant I could learn more about the settings involved, build relationships and trust and then create an ‘offer’ that was localised and fit the needs of our area. Our offer incorporates fun and creative ideas to maintain engagement with the settings and parents which is so important to keeping up momentum.

Herefordshire is a highly rural and agricultural area. Compared to urban areas, while the number of children living in deprived areas may be lower, the poverty some families experience is still really significant. So families may be seen to live in large farm houses but their income is very low. Families also have to travel miles to get to an early years setting highlighting the importance of these settings to promote oral health. Knowing the needs of the area and the families living there has been vital to the success of the programme.

‘ Improving children’s oral health is a priority for government departments of both health and education because of the impact dental caries can have on young children’s health, development, educational attendance and quality of life.’

I have watched our STP grow from strength to strength and witnessed huge progression among the children. Something I always reiterate to settings is that supervised toothbrushing isn’t a replacement for home brushing it’s to encourage a positive experience of toothbrushing, it’s about getting children to watch their peers, have fun with oral health, learn different techniques in a relaxed and positive capacity, this is to take the chore out of brushing!

Laura MacRae, Teacher and Early Years Foundation Stage Leader and Abbie Smith, Teacher and SEND co-ordinator, St Nicholas Church of England Primary Academy, Boston, Lincolnshire

A lot of our children come to school with really poor teeth. It’s heart-breaking to see the amount of children we’ve had in pain and agony, how can you learn if you’re in pain? You can’t! I remember one child who had to have all of his baby teeth removed, and the effect on his speech was so upsetting because he just couldn’t talk. So, we feel it’s a real big need for our children to get that extra brushing, or actually the only brush that they will have every day. Dental health is part of our curriculum. It is part of our science curriculum and part of relationships education, relationships and sex education and health education (RSHE). We have the educational side built in and the actual physical daily toothbrushing for two minutes and then we send the toothbrush and toothpaste pack home with them to make sure they have what they need to brush their teeth at home too. The Lincolnshire Smiles team come in at the start of each year to introduce the programme and then once every term to check we are doing it correctly.

Parent of a 3-year-old girl attending a nursery in Sheffield

We had problems with toothbrushing to begin with and my daughter was taking food from her brother when I wasn’t looking and she got hooked on sweets at a very young age. I was very gentle with her at first when she didn’t want to brush, just giving her the toothbrush and letting her do it herself but obviously she wasn’t doing a good job and she ended up having teeth out. It scared me! When she woke up from the anaesthetic, I’ve never seen her so angry, and blood was dripping from her mouth. Then she couldn’t speak for a few days and her mouth was sore. It has taught me a lesson though that even when my child doesn’t want something, it doesn’t mean it’s good for them. I will pin my child down and make sure they brush their teeth now. They have really encouraged toothbrushing at the nursery and I think it’s really helped at home too. It would be nice to come in and watch them brush their teeth in there, we could pick up some tips as well on how to help brush their teeth!

Jennie Ross, Associate Dentist, Richmond Dental Care, Sheffield

Working in NHS General Dental Practice I have had young patients come in really proud to tell me that they are brushing their teeth at nursery or pre-school and what they have learnt about doing it properly. They tell me about brushing for two minutes and making sure not to rinse afterwards. I have even had one parent tell me how their child now makes sure all the other family members are brushing twice a day too. Initially, I was not sure how the programme worked but I have now seen some videos online and learnt how schools and nurseries are able to integrate it into their day.

‘ Oral healthcare professionals should be proactive in discussing these programmes with children and their parents and carers, explaining the benefits of being involved’

It is great to hear that the messages we are giving families are being supported in other settings, and so regularly compared to the two to four times a year we would normally see children in practice. This is also being reinforced through dental nurses from our practice visiting local community centres, GPs or family hubs to discuss oral health and offer access to appointments at our practice, as part of a contract that has been commissioned locally.