Behaviour change intervention for toothbrushing (lesson and text messages) to prevent dental caries in secondary school pupils: The BRIGHT randomized control trial

Nicola Innes; Caroline Fairhurst; Katie Whiteside; Hannah Ainsworth; Debbie Sykes; Sarab El Yousfi; Emma Turner; Ivor G. Chestnutt; Anju Keetharuth; Simon Dixon; Peter F. Day; Nassar Seifo; Fiona Gilchrist; Katie Hicks; Ian Kellar; Waraf Al-Yaseen; Mariana Araujo; Donna Dey; Catherine Hewitt; Sue Pavitt; Mark Robertson; David Torgerson; Zoe Marshman

doi:10.1111/cdoe.12940

Behaviour change intervention for toothbrushing (lesson and text messages) to prevent dental caries in secondary school pupils: The BRIGHT randomized control trial

Nicola Innes (Lead / Corresponding author), Caroline Fairhurst, Katie Whiteside, Hannah Ainsworth, Debbie Sykes, Sarab El Yousfi, Emma Turner, Ivor G. Chestnutt, Anju Keetharuth, Simon Dixon, Peter F. Day, Nassar Seifo, Fiona Gilchrist, Katie Hicks, Ian Kellar, Waraf Al-Yaseen, Mariana Araujo, Donna Dey, Catherine Hewitt, Sue PavittMark Robertson, David Torgerson, Zoe Marshman

Research output: Contribution to journal › Article › peer-review

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Abstract

Objectives: This multicentre, assessor-blinded, two-arm cluster randomized trial evaluated the clinical and cost-effectiveness of a behaviour change intervention promoting toothbrushing for preventing dental caries in UK secondary schools.

Methods: Pupils aged 11-13 years with their own mobile telephone attending secondary schools with above average free school meals eligibility were randomized (at year-group level) to receive a lesson and twice-daily text messages or to usual care. Year-groups (n = 84) from 42 schools including 4680 pupils (intervention, n = 2262; control, n = 2418) were randomized.

Results: In 2383 participants with valid data at baseline and 2.5 years, the primary outcome of presence of at least one treated or untreated carious lesion (D4-6 MFT [Decayed, Missing and Filled Teeth] in permanent teeth using International Caries Detection and Assessment System) was 44.6% in the intervention group and 43.0% in control (odds ratio [OR] 1.04, 95% CI 0.85-1.26, p = .72). There were no statistically significant differences in secondary outcomes of presence of at least one treated or untreated carious lesion (D1-6 MFT), number of D4-6 MFT and D1-6 MFT, plaque and bleeding scores or health-related- (Child Health Utility 9D) or oral health-related- quality of life (CARIES-QC). However, twice-daily toothbrushing, reported by 77.6% of pupils at baseline, increased at 6 months (intervention, 86.9%; control, 83.0%; OR 1.30, 95% CI 1.03-1.63, p = .03), but returned to no difference at 2.5 years (intervention, 81.0%; control, 79.9%; OR 1.05, 95% CI 0.84-1.30, p = .69). Estimated incremental costs and quality-adjusted life-years (QALYs) of the intervention, relative to control, were £1.02 (95% CI -1.29 to 3.23) and -0.003 (95% CI -0.009 to 0.002), respectively, with a 7% chance of being cost-effective (£20 000/QALY gained threshold).

Conclusion: There was no evidence of statistically significant difference for caries prevalence at 2.5-years. The intervention's positive 6-month toothbrushing behaviour change did not translate into caries reduction. (ISRCTN 12139369). COVID-19 pandemic adversly affected follow-up.

Original language	English
Number of pages	10
Journal	Community Dentistry and Oral Epidemiology
Early online date	8 Jan 2024
DOIs	https://doi.org/10.1111/cdoe.12940
Publication status	E-pub ahead of print - 8 Jan 2024

Keywords

child
cost–benefit analysis
dental caries
dental health
fluorides
oral health
quality of life
schools
text messaging
toothpaste

ASJC Scopus subject areas

Public Health, Environmental and Occupational Health
General Dentistry

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

Access to Document

10.1111/cdoe.12940Licence: CC BY

Final Published VersionFinal published version, 798 KBLicence: CC BY

BRIGHT Trial: Brushing Reminder 4 Good oral HealTh: the Clinical and Cost-effectiveness of a Short Messaging Service Behaviour Change Programme to Improve the Oral Health of Young People Living in Deprived Areas (joint with Universities of Sheffield,Cardiff, York and Leeds)
Dey, D. (Investigator), Innes, N. (Investigator) & Robertson, M. (Investigator)
4/01/17 → 3/08/22
Project: Research

Cite this

Innes, N., Fairhurst, C., Whiteside, K., Ainsworth, H., Sykes, D., El Yousfi, S., Turner, E., Chestnutt, I. G., Keetharuth, A., Dixon, S., Day, P. F., Seifo, N., Gilchrist, F., Hicks, K., Kellar, I., Al-Yaseen, W., Araujo, M., Dey, D., Hewitt, C., ... Marshman, Z. (2024). Behaviour change intervention for toothbrushing (lesson and text messages) to prevent dental caries in secondary school pupils: The BRIGHT randomized control trial. Community Dentistry and Oral Epidemiology . Advance online publication. https://doi.org/10.1111/cdoe.12940

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title = "Behaviour change intervention for toothbrushing (lesson and text messages) to prevent dental caries in secondary school pupils: The BRIGHT randomized control trial",

abstract = "Objectives: This multicentre, assessor-blinded, two-arm cluster randomized trial evaluated the clinical and cost-effectiveness of a behaviour change intervention promoting toothbrushing for preventing dental caries in UK secondary schools.Methods: Pupils aged 11-13 years with their own mobile telephone attending secondary schools with above average free school meals eligibility were randomized (at year-group level) to receive a lesson and twice-daily text messages or to usual care. Year-groups (n = 84) from 42 schools including 4680 pupils (intervention, n = 2262; control, n = 2418) were randomized.Results: In 2383 participants with valid data at baseline and 2.5 years, the primary outcome of presence of at least one treated or untreated carious lesion (D4-6 MFT [Decayed, Missing and Filled Teeth] in permanent teeth using International Caries Detection and Assessment System) was 44.6% in the intervention group and 43.0% in control (odds ratio [OR] 1.04, 95% CI 0.85-1.26, p = .72). There were no statistically significant differences in secondary outcomes of presence of at least one treated or untreated carious lesion (D1-6 MFT), number of D4-6 MFT and D1-6 MFT, plaque and bleeding scores or health-related- (Child Health Utility 9D) or oral health-related- quality of life (CARIES-QC). However, twice-daily toothbrushing, reported by 77.6% of pupils at baseline, increased at 6 months (intervention, 86.9%; control, 83.0%; OR 1.30, 95% CI 1.03-1.63, p = .03), but returned to no difference at 2.5 years (intervention, 81.0%; control, 79.9%; OR 1.05, 95% CI 0.84-1.30, p = .69). Estimated incremental costs and quality-adjusted life-years (QALYs) of the intervention, relative to control, were £1.02 (95% CI -1.29 to 3.23) and -0.003 (95% CI -0.009 to 0.002), respectively, with a 7% chance of being cost-effective (£20 000/QALY gained threshold).Conclusion: There was no evidence of statistically significant difference for caries prevalence at 2.5-years. The intervention's positive 6-month toothbrushing behaviour change did not translate into caries reduction. (ISRCTN 12139369). COVID-19 pandemic adversly affected follow-up.",

keywords = "child, cost–benefit analysis, dental caries, dental health, fluorides, oral health, quality of life, schools, text messaging, toothpaste",

author = "Nicola Innes and Caroline Fairhurst and Katie Whiteside and Hannah Ainsworth and Debbie Sykes and {El Yousfi}, Sarab and Emma Turner and Chestnutt, {Ivor G.} and Anju Keetharuth and Simon Dixon and Day, {Peter F.} and Nassar Seifo and Fiona Gilchrist and Katie Hicks and Ian Kellar and Waraf Al-Yaseen and Mariana Araujo and Donna Dey and Catherine Hewitt and Sue Pavitt and Mark Robertson and David Torgerson and Zoe Marshman",

note = "Copyright: {\textcopyright} 2024 The Authors. Community Dentistry and Oral Epidemiology published by John Wiley & Sons Ltd.",

year = "2024",

month = jan,

day = "8",

doi = "10.1111/cdoe.12940",

language = "English",

journal = "Community Dentistry and Oral Epidemiology ",

issn = "0301-5661",

publisher = "Wiley",

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Innes, N, Fairhurst, C, Whiteside, K, Ainsworth, H, Sykes, D, El Yousfi, S, Turner, E, Chestnutt, IG, Keetharuth, A, Dixon, S, Day, PF, Seifo, N, Gilchrist, F, Hicks, K, Kellar, I, Al-Yaseen, W, Araujo, M, Dey, D, Hewitt, C, Pavitt, S, Robertson, M, Torgerson, D & Marshman, Z 2024, 'Behaviour change intervention for toothbrushing (lesson and text messages) to prevent dental caries in secondary school pupils: The BRIGHT randomized control trial', Community Dentistry and Oral Epidemiology . https://doi.org/10.1111/cdoe.12940

Behaviour change intervention for toothbrushing (lesson and text messages) to prevent dental caries in secondary school pupils: The BRIGHT randomized control trial. / Innes, Nicola (Lead / Corresponding author); Fairhurst, Caroline; Whiteside, Katie et al.
In: Community Dentistry and Oral Epidemiology , 08.01.2024.

Research output: Contribution to journal › Article › peer-review

TY - JOUR

T1 - Behaviour change intervention for toothbrushing (lesson and text messages) to prevent dental caries in secondary school pupils

T2 - The BRIGHT randomized control trial

AU - Innes, Nicola

AU - Fairhurst, Caroline

AU - Whiteside, Katie

AU - Ainsworth, Hannah

AU - Sykes, Debbie

AU - El Yousfi, Sarab

AU - Turner, Emma

AU - Chestnutt, Ivor G.

AU - Keetharuth, Anju

AU - Dixon, Simon

AU - Day, Peter F.

AU - Seifo, Nassar

AU - Gilchrist, Fiona

AU - Hicks, Katie

AU - Kellar, Ian

AU - Al-Yaseen, Waraf

AU - Araujo, Mariana

AU - Dey, Donna

AU - Hewitt, Catherine

AU - Pavitt, Sue

AU - Robertson, Mark

AU - Torgerson, David

AU - Marshman, Zoe

PY - 2024/1/8

Y1 - 2024/1/8

N2 - Objectives: This multicentre, assessor-blinded, two-arm cluster randomized trial evaluated the clinical and cost-effectiveness of a behaviour change intervention promoting toothbrushing for preventing dental caries in UK secondary schools.Methods: Pupils aged 11-13 years with their own mobile telephone attending secondary schools with above average free school meals eligibility were randomized (at year-group level) to receive a lesson and twice-daily text messages or to usual care. Year-groups (n = 84) from 42 schools including 4680 pupils (intervention, n = 2262; control, n = 2418) were randomized.Results: In 2383 participants with valid data at baseline and 2.5 years, the primary outcome of presence of at least one treated or untreated carious lesion (D4-6 MFT [Decayed, Missing and Filled Teeth] in permanent teeth using International Caries Detection and Assessment System) was 44.6% in the intervention group and 43.0% in control (odds ratio [OR] 1.04, 95% CI 0.85-1.26, p = .72). There were no statistically significant differences in secondary outcomes of presence of at least one treated or untreated carious lesion (D1-6 MFT), number of D4-6 MFT and D1-6 MFT, plaque and bleeding scores or health-related- (Child Health Utility 9D) or oral health-related- quality of life (CARIES-QC). However, twice-daily toothbrushing, reported by 77.6% of pupils at baseline, increased at 6 months (intervention, 86.9%; control, 83.0%; OR 1.30, 95% CI 1.03-1.63, p = .03), but returned to no difference at 2.5 years (intervention, 81.0%; control, 79.9%; OR 1.05, 95% CI 0.84-1.30, p = .69). Estimated incremental costs and quality-adjusted life-years (QALYs) of the intervention, relative to control, were £1.02 (95% CI -1.29 to 3.23) and -0.003 (95% CI -0.009 to 0.002), respectively, with a 7% chance of being cost-effective (£20 000/QALY gained threshold).Conclusion: There was no evidence of statistically significant difference for caries prevalence at 2.5-years. The intervention's positive 6-month toothbrushing behaviour change did not translate into caries reduction. (ISRCTN 12139369). COVID-19 pandemic adversly affected follow-up.

AB - Objectives: This multicentre, assessor-blinded, two-arm cluster randomized trial evaluated the clinical and cost-effectiveness of a behaviour change intervention promoting toothbrushing for preventing dental caries in UK secondary schools.Methods: Pupils aged 11-13 years with their own mobile telephone attending secondary schools with above average free school meals eligibility were randomized (at year-group level) to receive a lesson and twice-daily text messages or to usual care. Year-groups (n = 84) from 42 schools including 4680 pupils (intervention, n = 2262; control, n = 2418) were randomized.Results: In 2383 participants with valid data at baseline and 2.5 years, the primary outcome of presence of at least one treated or untreated carious lesion (D4-6 MFT [Decayed, Missing and Filled Teeth] in permanent teeth using International Caries Detection and Assessment System) was 44.6% in the intervention group and 43.0% in control (odds ratio [OR] 1.04, 95% CI 0.85-1.26, p = .72). There were no statistically significant differences in secondary outcomes of presence of at least one treated or untreated carious lesion (D1-6 MFT), number of D4-6 MFT and D1-6 MFT, plaque and bleeding scores or health-related- (Child Health Utility 9D) or oral health-related- quality of life (CARIES-QC). However, twice-daily toothbrushing, reported by 77.6% of pupils at baseline, increased at 6 months (intervention, 86.9%; control, 83.0%; OR 1.30, 95% CI 1.03-1.63, p = .03), but returned to no difference at 2.5 years (intervention, 81.0%; control, 79.9%; OR 1.05, 95% CI 0.84-1.30, p = .69). Estimated incremental costs and quality-adjusted life-years (QALYs) of the intervention, relative to control, were £1.02 (95% CI -1.29 to 3.23) and -0.003 (95% CI -0.009 to 0.002), respectively, with a 7% chance of being cost-effective (£20 000/QALY gained threshold).Conclusion: There was no evidence of statistically significant difference for caries prevalence at 2.5-years. The intervention's positive 6-month toothbrushing behaviour change did not translate into caries reduction. (ISRCTN 12139369). COVID-19 pandemic adversly affected follow-up.

KW - child

KW - cost–benefit analysis

KW - dental caries

KW - dental health

KW - fluorides

KW - oral health

KW - quality of life

KW - schools

KW - text messaging

KW - toothpaste

U2 - 10.1111/cdoe.12940

DO - 10.1111/cdoe.12940

M3 - Article

C2 - 38189629

SN - 0301-5661

JO - Community Dentistry and Oral Epidemiology

JF - Community Dentistry and Oral Epidemiology

ER -

Behaviour change intervention for toothbrushing (lesson and text messages) to prevent dental caries in secondary school pupils: The BRIGHT randomized control trial

Abstract

Keywords

ASJC Scopus subject areas

UN SDGs

Access to Document

Fingerprint

Projects

BRIGHT Trial: Brushing Reminder 4 Good oral HealTh: the Clinical and Cost-effectiveness of a Short Messaging Service Behaviour Change Programme to Improve the Oral Health of Young People Living in Deprived Areas (joint with Universities of Sheffield,Cardiff, York and Leeds)

Cite this