Toothbrushing Programmes Advocated for Older Students
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- Published: Thursday, 24 October 2024 10:32
- Written by Peter Ingle
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The search for a preventive dental silver bullet continues. Water fluoridation seems very unlikely to be made available to more of the population any time soon. The enthusiasm for having dental nurses applying fluoride varnish to children out in the community has died down, and further roll out of sugar taxes or restrictions on cariogenic food and drink, seems unlikely. Which leaves tooth brushing programmes. A recent major trial has failed to add to the evidence base for them.
A key part of Labour’s pre-election promise to the public that they would ‘rebuild dentistry’ was to introduce a supervised tooth-brushing scheme for 3- to 5-year-olds, targeting the areas of highest need. A trial published first in January 2024 has suddenly received a lot of press coverage, possibly reflecting the growing interest in brushing programmes.
The BRIGHT study, was a randomized controlled trial intended to evaluate the clinical and cost-effectiveness of a behaviour change intervention promoting tooth brushing for preventing dental caries in UK secondary schools. It used lessons and text messages with the aim of preventing dental caries in the pupils.
Students aged 11–13 years with a mobile telephone attending schools with above average free school meals eligibility were randomized with one group receiving a lesson and twice-daily text messages, and the other to continue their usual routine. The 4680 subjects came from 42 schools.
After 2.5 years, the primary outcome of presence of increased DMFT of 1 or more using the ICDAS system (ICDAS 4-6) was 44.6% in the intervention group and 43.0% in the controls. There were no statistically significant differences in secondary outcomes of presence of at least one DMFT, plaque and bleeding scores, or those for oral health-related- quality of life.
Twice-daily tooth brushing, reported by 77.6% of pupils at baseline, increased at 6 months to 86.9% in the test group and 83.0% in controls, but returned to no difference at 2.5 years. Estimated incremental costs and quality-adjusted life-years were assessed as having a 7% chance of being cost-effective.
The researchers concluded that there was no evidence of statistically significant difference for caries prevalence at 2.5-years. Nor did the intervention’s positive 6-month tooth brushing behaviour change, translate into caries reduction. The COVID-19 pandemic had affected follow-up with 2383 pupils completing the trial.
Professor Zoe Marshman, of the University of Sheffield’s School of Clinical Dentistry, who co-led the Bright trial said: “Tooth decay and all its negative consequences such as toothache, loss of sleep and problems eating are very common in children of secondary school age.
“While school-based initiatives for children between the ages of 4-11 have been delivered for decades, there is very little for secondary schools.
“However, this is a critical stage for tooth brushing practices to become an established behaviour for adulthood.
Recognising that overall the pupils did not have less tooth decay or plaque after two and half years, she added: “Pupils eligible for free school meals, however, may have benefited more than others suggesting a potential for the programme to reduce inequalities in oral health.”
It would seem that it will take more than a published trial to dent the current enthusiasm for tooth bushing schemes. James Colliver, lead learning manager at Outwood Academy City in Sheffield, which took part in the Bright trial, said: “We have a lot of students losing their teeth so I felt it was definitely worthwhile. One of the girls, aged 12, who was in the class told me she’d already had eight teeth out, so that made it feel like this was really important.”
The Bright trial is funded by the National Institute for Health and Care Research (NIHR)
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