The subject of toothbrushing in schools has recently caught the attention of the press and politicians. Rather than being used as an example of positive public health measures, supervised brushing has been framed as the latest example of the ‘nanny state' in the UK.

figure 1

© hofred/iStock/Getty Images Plus

Supervised brushing may seem like an innocent and basic intervention. Still, instead of being viewed through the healthcare lens, it has become a surprising battlefield for the ongoing British culture war, with ideas seemingly polarised alongside political beliefs. Some feel that these measures are necessary to protect public health, while those against them claim that individuals should take ownership of their own issues and that it's not the state's place to hand-hold them through life. Similar accusations were levelled at the soft drink industry levy, or sugar tax when it was introduced in 2014, as well as the proposed ban on single-use vapes and sales of tobacco to young people.

Opponents of supervised brushing claim that this is the government overstepping the mark and interfering in people's lives, and that teachers have more than enough to do during the school day. While teachers may be rightly cautious about this, placing it as a cultural issue rather than a public health matter minimises the problems of caries in children.

NICE recommended supervised toothbrushing in schools in specific situations in 2014, and a toolkit to support such a programme was launched in 2016 by Public Health England. It is an evidence-based and cost-effective way to reduce caries in children. While many may feel that this is intrusive, tooth decay affects around a quarter of five-year-olds, and tooth extraction continues to be the most common reason for young people to undergo a general anaesthetic.

Our social contract means the government is responsible for looking after its citizens' basic health and wellbeing. In the UK, we have vaccination programmes, a prohibition of smoking in enclosed public spaces and a ban on junk food advertising on children's TV, for example. Supervised toothbrushing extends this civil protection to children at risk of experiencing tooth decay. Not only this, but it also reduces the ongoing burden of care for the NHS in years to come. While many will claim this is about controlling people's lives, it is really an extension of a reasonable approach to public health, with lasting benefits to the nation's finances as a plus.

Other similar healthcare interventions have proved to be incredibly successful. The sugar tax has reduced both sales of sugary soft drinks and rates of obesity among young people, with an estimated 45,000 tonnes of sugar being removed from soft drinks since 2018.1 The ban on smoking in public places has caused a drop in hospital admissions for heart attacks and led to increasing numbers looking to quit smoking altogether.2 Both of these public health interventions are now widely accepted following initial public reluctance. In ten years' time, will we be saying the same about toothbrushing in schools?