Barriers and enablers in the implementation and sustainability of toothbrushing programs in early childhood settings and primary schools: a systematic review
Open accessAbstract
BACKGROUND: Untreated dental caries negatively impacts a child's quality of life including overall health and wellbeing, growth and development, social interaction ability, and school attendance. School-based toothbrushing programs have been recognised as an effective intervention to reduce the burden of dental caries. However, limited information is available to understand the real-world enablers and challenges in the implementation and sustainability of toothbrushing programs. This review aims to understand the barriers and enablers in the implementation and sustainability of toothbrushing programs in early childhood settings and primary schools. METHODS: Five electronic databases [i.e., CINAHL (EBSCO), Medline (EBSCO), EMBASE (Ovid), Web of Science, and PsycINFO] and backward citation chasing were performed. The last updated databases searches were conducted in May 2022. Studies reporting on barriers and enablers in the implementation and sustainability of toothbrushing programs in early childhood settings or primary schools were included in the review. The methodological quality of included studies was assessed by using Joanna Briggs Institute [JBI] and mixed methods appraisal tool [MMAT] critical appraisal tools and results were reported in accordance with PRISMA guidelines. RESULTS: A total of six studies met the eligibility criteria and were included in the review. Toothbrushing programs in early childhood settings and primary schools were mostly implemented under the supervision of staff and teachers. A positive attitude of the staff, the flexibility of toothbrushing sessions, involvement of community volunteers and parents were a few of the identified enablers. However, the timing of the communication of the program, inadequate transfer of information among staff, frequent staffing turnover, lack of parental support, and staff feeling overburdened while acting as pseudo parents were frequently reported as barriers. CONCLUSION: The results of this systematic review identify key enablers and barriers for toothbrushing programs in early childhood settings and primary schools which need to be considered for developing oral health promotion initiatives.
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Existing reviews focus on specific interventions, specific populations or service models, rather than systematically mapping implementation research across the oral health field.
“Existing reviews focus on specific interventions (eg, school-based toothbrushing), specific populations (eg, adults experiencing severe and multiple disadvantages) or service models (eg, integration of oral health into primary care), rather than systematically mapping implementation research across the oral health field.22 24 25”
From Mapping evidence on implementation research in oral health: a global scoping review protocol (2026) · cites this paper as [24]
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- Authors
- Chandio, N., Micheal, S., Tadakmadla, S. K., Sohn, W., Cartwright, S., White, R., Sanagavarapu, P., Parmar, J. S., & Arora, A.
- Affiliations
- Camden and Campbelltown Hospitals (AU)
- Western Sydney University (AU)
- The University of Sydney (AU)
- Corresponding author
- Arora, Amit
- ORCID
- Venue
- BMC Oral Health
- Published
- 2022-06-18
- Volume
- 22
- Issue
- 1
- Pages
- 242-242
- ISSN
- 1472-6831 (ISSN-L)
- PMC
- PMC9206278
- OpenAlex
- W4283070143
- Cited by
- 29
- References
- 70
- Citations by year
- 2026: 7 · 2025: 9 · 2024: 8 · 2023: 4 · 2022: 1
- FWCI
- 1.02
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Locations
- BMC Oral Health (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion)
- Funders
- Eli Lilly and Company
- Western Sydney University
- Topics
- Health Sciences › Dentistry › Periodontics › Dental Health and Care Utilization
- Health Sciences › Health Professions › Speech and Hearing › School Health and Nursing Education
- Health Sciences › Health Professions › General Health Professions › Health Policy Implementation Science
- Keywords
- school-based oral health intervention, early childhood settings, elementary school, dental caries prevention, implementation barriers and facilitators, program sustainability, employee attitudes, parental support, community volunteers, employee turnover, oral health promotion
- MeSH terms
- Child, Child, Preschool, Dental Caries, Humans, Oral Health, Quality of Life, Schools, Toothbrushing
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
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