What have we done?

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This project is working 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. We are using a variety of methods underpinned by implementation and improvement science to undertake this work, including:

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• A series of national stocktake surveys; The first survey, published in the British Dental Journal, was undertaken in Spring 2022 to explore the current provision of supervised toothbrushing programmes in nurseries and schools across England. The second survey was undertaken in Winter 2024 and also published in British Dental Journal, examined the changes since the first survey, and summarised key barriers and facilitators to the implementation of these programmes and was published in the British Dental Journal. We are planning to undertake a third survey in April 2025.

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• Geographical mapping of toothbrushing programmes across England with variables such as deprivation level, levels of tooth decay in children, number of hospital admissions for tooth extraction under general anaesthetic, dental access, rurality and early-years education data. We will examine the current geographic spread of supervised toothbrushing and how it changes over time using the stocktake survey data.

• Qualitative interviews with key stakeholders involved in running supervised toothbrushing programmes – Policymakers, Oral Health providers, Nursery/school staff, parents and children. We have interviewed 159 participants across England to explore in-depth the barriers and facilitators to implementing supervised toothbrushing programmes. This work has been published in Community Dentistry and Oral Epidemiology.

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• Co-design of an implementation toolkit for supervised toothbrushing programmes with stakeholders at all levels of implementation. We are holding sessions with stakeholders to discuss our findings and reflect on what resources are already available, their quality and what the gaps are that need addressing to aid implementation. The outcome of these co-design sessions was the development of a toolkit that includes resources to both improve implementation and sustain the intervention over time. The toolkit has been published online and the resources included are freely available (www.supervisedtoothbrushing.com).

• Pilot testing the toolkit in a small number of sites who are seeking to develop or expand their toothbrushing programme.

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• Case studies involving interviews with high level stakeholders engaged in the commissioning and delivery of supervised toothbrushing programmes. Research with these stakeholders, typically from local authorities, Integrated Care Systems and provider organisations will capture their experiences of implementing supervised toothbrushing programmes and offer insight into the factors which affect their delivery. The findings will help inform the roll out of the national supervised toothbrushing programme and shape further enhancements of this toolkit.