Tooth decay remains the leading cause of hospital admissions for 5-to-9-year-olds in England, and a new government-funded programme is now paying 147 local authorities to set up supervised toothbrushing for the most deprived three-to-five-year-olds. This evaluation examines how that national rollout is actually working. The researchers will track which local authorities are using the money, how many nurseries and schools are taking part, and how many children are brushing their teeth under supervision. They will also interview commissioners, nursery staff, and families to uncover what helps or hinders the programme on the ground. If the evaluation identifies clear barriers and facilitators, it will give the government and local authorities practical guidance on how to expand the scheme effectively. The goal is to reduce the stark gap in tooth decay between children from deprived and affluent backgrounds. Because the evaluation runs for only 18 months, it is designed to hand over findings to a longer-term study, ensuring the lessons learned feed directly into sustained policy improvement rather than sitting on a shelf.
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Background Dental caries is a major public health issue in the UK and remains the leading cause for hospital admissions among 5-to-9-year-olds in England. While there has been ongoing decline in the prevalence of dental caries until 2017 in England, the progress has slowed in the past decade. Furthermore there are socioeconomic disparities, with children from more deprived backgrounds reporting that they are less likely to brush their teeth twice daily, and experiencing higher levels of dental caries. Supervised toothbrushing with fluoridated toothpaste in the Childsmile programme in Scotland has demonstrated effectiveness for reducing tooth decay and social inequalities. In 2025, the UK government announced it was providing 147 local authorities with funding to implement a national targeted supervised toothbrushing (STB) programme for children aged 3-5-years living in the 20% most deprived Lower Super Output Areas (LSOA) in England according to the Indices of Multiple Deprivation (IMD), with an aim to stabilise existing supervised toothbrushing programmes and expand provision where needed. Aims The aim is to conduct an early phase evaluation of the national roll out of the STB programme. The evaluation will focus on how the government programme is being implemented and received, aiming to gain insight into how the funding is being used to target particular groups, how it adds to any existing and ongoing local STB schemes, and to highlight barriers and facilitators to implementation. Methods The evaluation is underpinned by the RE-AIM and PRISM implementation frameworks. Evaluation indicators: We will analyse routine evaluation data collected by Department of Health and Social Care on a termly basis from all local authorities in receipt of funding to understand reach and adoption. The evaluation indicators will explore the number of settings approached to deliver STB and of those, the number actively delivering STB and the number of children attending settings actively delivering STB. We will collect these data for all educational settings for 3-5-year-olds and for educational settings for 3-5-year-olds in LSOAs within IMD 1&2 deciles (20% most deprived areas nationally) Research Survey: For all local authorities in receipt of STB funding, we will distribute survey invitations. The survey will explore aspects of implementation and maintenance, including funding utilisation, delivery timelines, targeting approaches, programme details, views on commercial partnerships, staff training, uptake and challenges and facilitators to implementation. Qualitative study: We will collect data across multiple levels of programme delivery to understand contextual factors that interact with the programme. We will select a sample of 12-15 local authorities and conduct online semi-structured interviews with commissioners and STB providers. Of the 12-15 local authorities, we will select 3 local authorities and recruit educational setting staff, families and children to participate in the qualitative data collection. Timeline The evaluation will take 18 months, between July 2025 and December 2026. Overlapping activities include project set up and protocol submission (0 to 3 months); ethical approval, data collection and report writing (3-16 months); and dissemination activities, including handover to the project team commissioned to conduct a longer-term evaluation (14-18 months).
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