Title	Supervised School-Based Toothbrushing with Fluoridated Toothpaste Reduces Caries Increment in School-Aged Children
Clinical Question	In school-aged children, does a supervised school-based toothbrushing program with fluoridated toothpaste reduce caries incidence or caries increment compared with no supervised brushing program?
Clinical Bottom Line	Supervised school-based toothbrushing with fluoridated toothpaste reduces caries increment in school-aged children compared with no supervised brushing program. This is supported by two randomized controlled trials (RCTs) and one controlled longitudinal study showing lower caries increment or improved caries outcomes among children receiving supervised brushing.
Best Evidence
PubMed ID Author / Year Patient Group Study type (level of evidence) 12218280 Curnow, 2002 534 high caries risk children, mean age 5 Randomized Controlled Trial Key results Children in the supervised toothbrushing group had a lower 2-year caries increment in first permanent molars than the control group. Using clinical examination plus fiber-optic transillumination (FOTI), the intervention group had 32% fewer affected surfaces at the D1 threshold, and 56% fewer affected surfaces at the D3 threshold, reflecting dentin level caries. The reported 95% confidence intervals were 4%-60% for D1FS and 13%-101% for D3FS. 15741722 Jackson, 2005 517 children aged 5-6 Randomized Controlled Trial Key results Daily teacher-supervised school toothbrushing with 1,450 ppm fluoride toothpaste was associated with lower DMFS scores compared with no supervised brushing. The main surface-specific benefit was seen on proximal surfaces, with 0.78 additional affected proximal surfaces per child in the intervention group versus 1.03 in controls, a 21.4% lower adjusted increase (p < 0.01). Differences on occlusal and smooth surfaces were not statistically significant. In the permanent dentition alone, adjusted DMFS increased by 0.16 surfaces per child in the intervention group and 0.15 in the control group, with no statistically significant difference. 16451437 Al-Jundi, 2006 856 first- and sixth-grade children Controlled Longitudinal Study Key results After 4 years, children receiving supervised daily toothbrushing with fluoridated toothpaste had better caries outcomes than children receiving oral hygiene instruction alone. Mean deft was 4.6 vs. 5.25 teeth per child in the first-grade group, and mean DMFT was 1.7 vs. 2.0 teeth per child in the sixth-grade group. The difference between groups was significant (p = 0.001). The control group was 6.4 and 3.1 times more likely to have caries in the first and sixth-grade groups, respectively. However, confidence intervals were not reported, and the study did not clearly explain how normal exfoliation and eruption were handled in the younger cohort over 4 years. Additionally, potential confounders such as diet, home brushing, fluoride exposure, and dental treatment were not adjusted for.
Evidence Search	PubMed: "school-based toothbrushing" "school-based supervised toothbrushing" "effects of school-based supervised" toothbrushing
Comments on The Evidence	The evidence consisted of two randomized controlled trials and one controlled longitudinal study. Curnow et al. provided the strongest evidence because the study used randomized allocation, blinded outcome assessment, calibrated examinations, and reported treatment effects with confidence intervals. The study also accounted for differences in first permanent molar maturity, an important consideration because earlier erupted teeth had more time at risk for caries. However, the intervention included both supervised school brushing and supplies for home use, making it difficult to isolate the effect of school brushing alone. Jackson et al. also used a randomized, single-blind design and adjusted its analysis for baseline differences in caries experience. However, the analysis did not appear to statistically account for the children’s transition from primary to mixed dentition over the 21-month study. This makes it more difficult to determine how much of the observed change was due to the intervention rather than normal tooth eruption and exfoliation. These findings suggest that the effect was not consistent across all tooth surfaces or dentitions. Al-Jundi et al. had several strengths, including a large sample, 4-year follow-up, annual clinical examinations, low and similar attrition between groups, a calibrated examiner, and baseline similarity in caries experience. However, the randomization procedure, allocation concealment, and examiner blinding were not described, and confidence intervals were not reported. The study’s discussion and interpretation were also limited. In particular, the investigators did not clearly explain how exfoliation of primary teeth and eruption of permanent teeth were handled in the younger cohort over 4 years. Potential confounders such as diet, home brushing, fluoride exposure, and dental treatment were not incorporated into the reported analysis. Overall, the studies generally favor supervised school-based toothbrushing with fluoridated toothpaste, but confidence in the magnitude and consistency of the effect is limited by mixed-dentition changes, differences in study protocols, incomplete reporting, and inconsistent results across tooth surfaces and dentitions.
Applicability	The evidence is applicable to school-aged children, especially those in high-caries-risk or underserved communities where preventive oral health habits may be inconsistent. However, the populations studied were from Scotland, London, and Jordan, so differences in fluoride exposure, diet, access to dental care, school resources, and baseline caries risk may affect how directly the results apply to children in South Texas. Implementation would require school cooperation, trained supervision, fluoride toothpaste, toothbrushes, storage procedures, and a consistent daily routine. Despite these limitations, supervised school-based toothbrushing is a low-risk preventive intervention that may be especially useful when added to school-based oral health education for children at elevated caries risk.
Specialty	(Public Health)
Keywords	school-based supervised toothbrushing; school toothbrushing
ID#	3767
Date of submission	07/23/2026
E-mail	eddymaldonado1@icloud.com
Author	Eduardo Maldonado
Co-author(s)
Co-author(s) e-mail
Faculty mentor	Peter M. Loomer, DDS, PhD, MBA
Faculty mentor e-mail	loomer@uthscsa.edu
Basic Science Rationale (Mechanisms that may account for and/or explain the clinical question, i.e. is the answer to the clinical question consistent with basic biological, physical and/or behavioral science principles, laws and research?) None available
Comments and Evidence-Based Updates on the CAT (FOR PRACTICING DENTISTS', FACULTY, RESIDENTS and/or STUDENTS COMMENTS ON PUBLISHED CATs) None available