Teacher supervised toothbrushing reduces dental decay in socially deprived school children

Dental decay is one of the most common preventable health problems in children living in socially deprived areas of the UK.

Children living in low-socioeconomic neighbourhoods tend to start brushing their teeth at a later age and use fluoride containing toothpaste less often and, therefore, experience higher levels of dental decay overall. As a result, rates of tooth decay in five-year-olds have not improved in the last 10 years.

A study conducted by scientists from the Oral Health Research Centre, London, and published in Caries Research (1), reported that daily teacher supervised toothbrushing, during school term time only, reduced the occurrence of tooth decay by 11% in 5-year-old children living in a socially deprived region of London, over a period of 21 months.

A total of 370 first year primary school children (aged 5 years) in a London borough completed the study. Half of the children brushed their teeth once a day at school (after lunch but before afternoon lessons) with commercially available fluoride toothpaste under the supervision of their teacher. No supplementary dietary or dental health advice was given to the children or their parents.

A significant overall reduction in tooth decay was reported in all children. Looking solely at those with previous dental decay, the reduction in dental decay becomes even more apparent. A 30% reduction in further dental decay was noted in this group. Greater protection was seen in primary (milk) teeth than in permanent (second) teeth.

This study illustrates the fact that a programme of daily supervised toothbrushing, using fluoridated toothpaste, can be effectively integrated into socially deprived communities to achieve a significant reduction in dental decay in primary school aged children, without any changes to diet. It is well recognised that the introduction and use of fluoridated toothpaste has been the most important factor in the general decline in dental decay in children. Regular toothbrushing with fluoridated toothpaste has a greater impact on dental health than the restriction of sugary foods and beverages (2).

The prevalence of dental decay varies according to social class. Furthermore, children belonging to certain ethnic minority groups may be at greater risk of dental decay due to difference in dental hygiene practices.

The children taking part in this study attended schools with a catchment encompassing neighbourhoods of social deprivation and with a high percentage of ethnic minorities. Children living in the London borough of Kensington and Chelsea include some of the most deprived in London and have amongst the highest rates of dental decay in the UK. An average 5-year-old living in the borough has 2.83 decayed, missing or filled teeth (DMFT) compared to the national average of 1.53 teeth. Only 54% of 5-year-olds in the borough have no tooth decay compared with a nationwide average of 64% (3).

The toothpaste used in this study contained 1,450 parts per million (ppm) fluoride. The level of fluoride in water supply for the Borough of Kensington and Chelsea is low (less than 0.3ppm).

This study illustrates the potential for lowering tooth decay rates amongst British children further still by addressing the most intractable sectors of the child population with a simple inexpensive intervention. Encouraging such children to brush teeth at home would likely result in greater improvements in dental health.

(1) Jackson RJ, Newman HN, Smart GJ, Stokes E, Hogan JI, Brown C, Seres J (2005) The effects of a supervised toothbrushing programme on the caries increment of primary school children, initially aged 5-6 years. Caries Research 39. 108-15.
(2) Gibson S, Williams S (1999) Dental caries in pre-school children: associations with social class, toothbrushing habit and consumption of sugars and sugar-containing foods. Further analysis of data from the National Diet and Nutrition Survey of children aged 1.5-4.5 years. Caries Research 33. 101-13.
(3) Pitts NB, Evans DJ, Nugent ZI (1999) The dental caries experience of 5-year-old children in the . Surveys co-ordinated by the British Association for the Study of Community Dentistry. Community Dental Health 16. 50-56.