New school-based initiatives including oral health lessons and text message reminders can help to improve tooth brushing habits in teenagers, particularly those from low-income families.

• The BRIGHT trial, funded by the NIHR, included over 4,600 secondary school pupils from 42 schools over 2.5 years

• The intervention showed a positive effect on self-reported brushing habits six months later and some evidence of preventing tooth decay for those students from low-income families

• Tooth decay affects a third of young people aged 12-15 - this increases to a half in young people living in areas of poverty

Text message reminders can help to improve tooth brushing habits in teenagers, particularly those from low-income families, a new study has shown.

Researchers from the University of Sheffield, in collaboration with the Universities of Cardiff, Leeds, York and Dundee, investigated the effectiveness of a new programme designed to encourage better brushing habits and reduce tooth decay in secondary school pupils.

Tooth decay is a very common disease affecting a third of young people aged 12-15 years. This increases to nearly a half in youngsters living in areas of poverty. Young people with tooth decay often suffer from toothache, loss of sleep and problems eating; as well as it affecting their overall physical health and mental wellbeing. It can also lead to increased school absences.

The BRIGHT trial, funded by the National Institute for Health and Care Research (NIHR) and published in the journal of Health Technology Assessment, included a classroom lesson and twice-daily text messages about toothbrushing. The researchers involved 4,680 students from 42 schools across England, Scotland and Wales.

While the overall impact on preventing cavities was not significant, the intervention showed a positive effect on self-reported brushing habits six months later.

The report suggests the programme may be particularly beneficial for students from low-income families, as the analysis found some evidence of prevention of tooth decay within this group.

Professor Zoe Marshman, from the University of Sheffield’s School of Clinical Dentistry, who co-led the BRIGHT trial, said: 

“We checked almost 4,700 secondary pupils’ teeth at the start of the study and after two and a half years. Pupils who received the lesson and text messages reported brushing their teeth more often after six months, but did not have less tooth decay or plaque after two and half years. 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. 

“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 toothbrushing practices to become an established behaviour for adulthood. This is why it is vital to help young people to improve their understanding of the importance of toothbrushing and skills to prevent tooth decay.”

The text messages and lessons were well-received by students and teachers. Although challenges were identified with delivering text messages, the lesson plans have been downloaded almost 1,000 times.

Researchers will now use these results to find better ways to help secondary school pupils keep their teeth healthy. The study also highlighted the need to better understand the factors that influence oral health habits in teenagers, particularly sugar consumption 

James Colliver, Lead Learning Manager at ̨��swag Academy City, Sheffield took part in the BRIGHT trial. He 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.” 

Dental health is now statutory content of the health education curriculum for primary and secondary schools in England. The BRIGHT trial involved the development and evaluation of a new intervention which covers the dental health content for secondary schools.