Promoting parental supervised toothbrushing practices


Caries remains a significant public health problem and affects a large proportion of children.  Caries is preventable and there is evidence to show that supervised toothbrushing with fluoridated toothpaste results in lower levels of caries. UK guidance also recommends supervised brushing twice daily with a fluoridated toothpaste following the eruption of the first primary tooth. However, studies suggest that a large proportion of children under the age of 5 brush their teeth without parental assistance.

The aim of this review was to examine interventions promoting parental supervised toothbrushing practices to reduce dental caries in young children (under the age of 8 years).


Searches were conducted in the Medline, Embase, PubMed, Web of Science, PsycINFO, Scopus and the Cochrane Library. Studies published in English and investigating parental involvement in toothbrushing in children under the 8 years of age and the impact on caries were considered. Three reviewers screened the studies for inclusion and data extraction.  Interventions were classified using the Theoretical Domains Framework (TDF) which outlines 12 key domains explaining health behaviour. Three reviewers assessed risk of bias using the quality assessment tool (QATSDD), developed by Sirriyeh, Lawton, Gardner, Armitage (Sirriyeh et al, 2012).


  • 42 studies were included.
  • A range of study designs were used; 15 RCTs, 4 community-based/RCTs, 5 mixed methods, 4 quasi-experimental, 3 prospective with an additional 3 prospective cohort studies, 1 retrospective cohort, 1 case-control ,1 case-cohort study, 3 pre-post-test design, and 1 had a serial cross-sectional design.
  • Follow-up periods ranged from immediate post-intervention to 5 years.
  • 10 of the 12 defined constructs in the TDF were addressed in the interventions
    • 41 out of 42 studies addressed knowledge
    • 35 studies addressed skills
    • 22 studies addressed environmental context and resources
    • 20 studies addressed social influences
  • Only 18 studies clearly stated they were based on psychological theory and that this was used to inform intervention delivery and measures.
  • A majority of the interventions (27/42) were delivered in health care settings and delivered by health or primary care staff including graduate and undergraduate dental students in 28/42 studies.
  • 26/42 of the interventions were delivered one-to-one basis.
  • 16 out of 42 studies reported significant improvements in parental supervised toothbrushing.
  • 5 showed significant improvements in intervention and control groups.
  • 29 studies reported on impact on caries with 19 showing significant reduction in caries experience.
  • 10 studies explored changes in barriers associated with parental supervised toothbrushing with 9 of them reporting significant improvements in some variables.


The authors concluded: –

There are few interventions targeting home-based oral health behaviours underpinned by theory and methodological rigour in their development and evaluation. This demonstrates a clear need for future interventions to be guided by complex intervention methodology.


The reviewers have searched a wide range of databases identifying a good number of studies. However, restricting inclusion to English language studies may have excluded some relevant papers as noted by the authors. The authors have provided an extensive table summarising the key features of the included papers which provides very helpful details of the interventions and the TDF areas addressed. It is recognised that behaviour change interventions based on psychological theory are more likely to be successful, so it is perhaps disappointing that only 18 of the included studies clearly stated this, although the authors did not that in publications after 2015 there has been an increase in theory-based interventions.

The authors also point out the only 5 of the interventions were specifically focussed on home-based toothbrushing as the majority were directed more generally at oral health. The review’s discussion highlights that the majority of interventions used similar formats although some used motivational interviewing and demonstrations or technique practice.  This review using the TDF as it does provides a very helpful summary of the work conducted in this area and will hopefully lead to lead to the development of better theory based interventions to improve future uptake of parental supervised toothbrushing.


Primary Paper

Aliakbari E, Gray-Burrows KA, Vinall-Collier KA, et al. Home-based toothbrushing interventions for parents of young children to reduce dental caries: A systematic review [published online ahead of print, 2020 Apr 25]. Int J Paediatr Dent. 2020;10.1111/ipd.12658. doi:10.1111/ipd.12658

Review protocol on PROSPERO

Other references

Sirriyeh R, Lawton R, Gardner P, Armitage G. Reviewing studies with diverse designs: the development and evaluation of a new tool. J Eval Clin Pract. 2012;18(4):746-752. doi:10.1111/j.1365-2753.2011.01662.x

Dental Elf – 25th Oct 2017

Supervised toothbrushing for children and adolescents



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