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Tooth decay in young children is very common. It affects a quarter of children aged 5 years, increasing to nearly 40 in every 100 children living in deprived areas. These young children with tooth decay suffer from toothache, sleep loss, problems eating and absence from school and nursery. In England, the most common reason why children have a general anaesthetic (an operation while asleep in hospital) is for the removal of multiple decayed teeth. Treating tooth decay accounts for a large proportion of the £3.4 billion spent each year by the NHS on dentistry.

Tooth decay can be prevented. One of the best ways is to encourage “Parental Supervised Tootbrushing”. It is recommended that from the age when baby teeth first erupt (approximately 6 months old) up to the age of 6-7 years old, parents should supervise their child’s brushing. This involves establishing a good routine with parents brushing their infant’s teeth twice a day with fluoride toothpaste.

Our earlier research found that “Parental Supervised Toothbrushing” can be a difficult routine to start and even harder to keep going. Parents are aware it is important to brush, but struggle for many different reasons. Health visitors can play a key role in supporting parents to adopt good oral health practices, including Parental Supervised Toothbrushing. In England, health visitors carry out a home visit to all families when infants are aged 9-12 months and this includes a discussion about good oral health habits. Our interviews with health visitors have shown there is a wide variation in what they cover and discuss with families. Many do not feel confident discussing oral health. Health visitors receive minimal training and guidance on how to encourage good oral health habits. The HABIT study will test if we can improve how health visitors support parents to adopt good toothbrushing routines, namely Parental Supervised Toothbrushing.


(A) With health visitors and parents we will produce resources and training to support the habit of Parental Supervised Toothbrushing.

(B) We will then test if the way to support Parental Supervised Toothbrushing delivered by health visitors is acceptable and practical.

(C) We will study different ways of checking whether parents are performing Parental Supervised Toothbrushing.



In an area where children's oral health is problematic, we will recruit 30 parents of infants aged 9-12 months who are about to receive their home visit from a health visitor. Before this, our research team will visit their home to explore everyday routines and practices. Parents will then receive their 9-12 month home visit which will include the health visitor delivering support for Parental Supervised Toothbrushing.

At 2 weeks and 3 months after the health visitor’s home visit, our research team will visit the parents again to collect further records of their brushing routines and practices. We will ask parents how acceptable they found both the Parental Supervised Toothbrushing support and the collection of information about their infant’s toothbrushing. We will also ask health visitors how acceptable and practical the Parental Supervised Toothbrushing support was to deliver. Finally, we will compare the different ways of checking whether parents are performing Parental Supervised Toothbrushing.


We have worked closely with many different members of the local community at each stage of our research. They suggested incorporating the Parental Supervised Toothbrushing support into the health visitor home visits. They will help with the development of the resources to support Parental Supervised Toothbrushing and with writing a lay report at the end of the study.


This early phase study will ensure the support for Parental Supervised Toothbrushing is suitable for health visitors to deliver and acceptable to parents. We will find out which way is the best to check that Parental Supervised Toothbrushing is taking place. We will use the results to design a larger study to test whether the Parental Supervised Toothbrushing intervention can prevent decay (effectiveness) and save the NHS money.


The HABIT study is funded by the Medical Research Council (MR/P017185/1)




Dr Peter Day – Principal Investigator

Dr Ieva Eskyte – Research Manager

Ms Susan Gill – Health Visiting Lead

Ms Victoria Smith – Health Visiting Lead

Ms Jenny Owen – Dental Therapist

Ms Susan Hanslip – Dental Therapist

Mr Tim Zoltie – Head of Medical Illustration, University of Leeds

Prof Robert West – Professor of Biostatistics, University of Leeds

Prof Sue Pavitt – Professor in Translational and Applied Health Research/ Director of DenTCRU, University of Leeds

Prof Zoe Marshman – Professor/ Honorary Consultant in Dental Public Health -

Dr Rosemary McEachan – Programme Director for Born in Bradford

Ms Alison Barraclough - Clinical Studies Officer


Other members of the research team who are helping with delivery of the research project

Ms Katherine Holt – Dental Therapist

Ms Fiona Heffron – Dental Therapist

Ms Lucy Brown – Dentist

Mrs Helen Gledhill – Dentist

Ms Kerina Tull – Researcher

Dr Kara Gray-Burrows – Researcher

Mrs Faye Wray – Researcher

Miss Amrit Bhatti - Researcher


These research papers have informed the design and evaluation of the HABIT intervention

  • Marshman, Z., Ahern, S.M., McEachan, R.R.C., Rogers, H.J., Gray-Burrows, K.A., Day, P.F. Parents experiences of tooth brushing with children: a qualitative study. In: JDR Clinical and Translational Research, 2016. 1(2): p. 122-130. (doi: 10.1177/2380084416647727.)

  • Gray-Burrows, K.A., Day, P.F., Marshman, Z., Aliakbari, E., Prady, S.L., McEachan, R.R.C. Using intervention mapping to develop a home-based parental-supervised toothbrushing intervention for young children. In: Implementation Science, 2016. 11(1): p. 61. (doi: 10.1186/s13012-016-0416-4.)

  • Gray-Burrows, K.A., Owen J., Day, P.F. Learning from good practice: a review of current oral health promotion materials for parents of young children. In: British Dental Journal, 2017. 222(12): p. 937. (doi: 10.1038/sj.bdj.2017.543.)

  • Aliakbari, E., Gray-Burrows, K. A., Vinall-Collier, K., Marshman, Z., McEachan, R.R.C., Day, P.F. Systematic review of home-based toothbrushing practices by parents of young children to reduce dental caries. In final preparation for submission to International Journal of Paediatric Dentistry, 2017.



Wider research funding

 The research team have received funding for a number of projects in this research area:

BRIGHT – this is an NIHR HTA funded research grant to examine the impact of text messaging teenagers to undertake appropriate oral health behaviours (

SOAP – ( – we have worked with a small-medium size enterprise with expertise in training nursery staff. We have developed an oral health training programme in the style of a TV show for nursery staff and parents

HENRY – ( – we are working with HENRY to design and develop an additional oral health session to their existing 8 week group programme

Leeds City Council – we worked with Leeds to undertake a systematic review of current oral health materials, identify examples of good practice and provide guidance on development of new resources. (doi: 10.1038/sj.bdj.2017.543.)

Public Health England – we worked with York Health Economic Consortium to develop the Return on Investment of oral health improvement programmes for 0-5 year olds.  (

Health Education England – we are working with NHS England on their Starting Well: A Smile4Life programme. We will develop and evaluate training resources for the dental team to support them with behaviour change conversations specifically around preventive oral health conversations with parents of children aged 0-5 years old. 

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