Kamini Shah, Consultant in Dental Public Health for NHS England – North East and Yorkshire, reflects on how supervised toothbrushing programmes are improving oral health for children in Teesside and across the North East and North Cumbria area, helping to reduce inequalities and establish good oral health habits that can last a lifetime.

Tackling tooth decay through early intervention

Kamini Shah

The supervised toothbrushing initiative began in 2008 in Teesside in response to a significant oral health challenge. At the time, five-year-old children in Middlesbrough had the highest rates of tooth decay in the North East and levels above the national average.

Recognising the need for early intervention, supervised toothbrushing was introduced across early years settings and schools to help children develop good oral health habits from a young age. The programme has since expanded across the North East and North Cumbria, with support from the North East and North Cumbria Integrated Care Board (ICB), helping more children establish effective daily brushing routines and reduce the risk of tooth decay, particularly in communities where oral health outcomes have historically been poorer.

Improving oral health through schools and nurseries

While supervised toothbrushing is not a dental treatment service, it plays an important role in preventing oral health problems before they develop.

The programme is offered free of charge to targeted schools in areas with the highest levels of deprivation through a nationally funded programme introduced in 2025. In addition, ICB funding has enabled some local authority areas to extend the offer to all eligible schools, with eight local authorities currently operating universal supervised toothbrushing programmes.

By reaching children in settings they attend every day, we can support families who may face barriers to accessing oral health advice and services. The programme also helps embed positive routines and encourages children and parents to prioritise oral health at home.

Reducing tooth decay and improving oral health

The evidence shows that supervised toothbrushing can make a real difference.

Evaluation of decay rates among five-year-old children in the Teesside area found that schools participating in the programme achieved greater reductions in tooth decay than non-participating schools. This demonstrates the positive impact that regular supervised brushing can have when delivered consistently over time.

We also receive extremely positive feedback from children, parents and education settings. One of the most common messages from parents is that brushing at school encourages children to brush more regularly at home. For many families, the programme reinforces healthy routines and gives children the confidence and motivation to look after their own teeth.

Building confidence one brush at a time

One story that perfectly illustrates the impact of the programme comes from a nursery in Darlington.

A young boy joined the supervised toothbrushing scheme in May with very little confidence around toothbrushing, both at nursery and at home. Initially, he would simply observe other children brushing their teeth from a distance.

Over time, he became more comfortable and gradually moved closer during each session. He then progressed to holding a toothbrush while sitting on an adult’s lap and enjoyed watching videos about toothbrushing, although he still was not confident enough to put the toothbrush into his mouth.

With patience, encouragement and consistent support, his confidence steadily grew. Eventually, he independently went to the cupboard, patted it and excitedly said, “Teeth, teeth!” He selected his toothbrush, added his own toothpaste and brushed independently for the full two minutes while looking at himself in the mirror.

This is the perfect example of how a nurturing and supportive approach can help children build confidence, develop important self-care skills and create healthy habits that can last throughout their lives.

Overcoming barriers to participation

One of the biggest challenges has been recruiting schools to take part in the programme.

Many schools are balancing significant time and workforce pressures and can understandably be reluctant to introduce something new. We have addressed this by working closely with schools to understand their concerns and identify practical solutions that fit within existing routines.

Another important factor has been the use of peer champions. Hearing directly from schools where the programme is already working well has helped build confidence and encouraged others to get involved. Sharing positive experiences and demonstrating the benefits in practice has been invaluable.

We have also commissioned a research team from the University of Sheffield to explore how we can improve uptake among schools that have previously declined. The research will result in a menu of evidence-based tactics that can be tested and adapted locally to increase participation.

The report is expected in the autumn, and our oral health promotion teams are already preparing to implement the recommendations. We hope that these new approaches will help more schools participate and enable even more children to benefit.

This work aligns closely with the ambitions of the NHS 10-Year Health Plan. By preventing poor oral health before treatment is needed, supporting children in community settings and helping tackle health inequalities, supervised toothbrushing contributes to the shift from treatment to prevention.

Lessons learned

My advice to colleagues delivering similar programmes is that recruiting schools requires persistence and there will be challenges along the way. However, the clinical outcomes and the positive impact on children’s lives make the effort worthwhile.

Manage your expectations, keep going and make the most of peer champions to share success stories. When schools hear directly from others that have seen the benefits first-hand, it can encourage them to take that step themselves.

Most importantly, remember that every child supported through the programme is another child being given the opportunity to develop healthy habits, improve their oral health and enjoy a healthier future.