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Brushing RemInder 4 Good oral HealTh (BRIGHT) trial

Tooth decay affects nearly half of young people aged 12-15 years in deprived areas. Our study found a lesson and text reminders to promote regular tooth brushing with fluoride toothpaste improved toothbrushing behaviour but did not result in a reduction in caries.

Why did we do this research?

Tooth decay is very common, affecting nearly half of young people aged 12-15 years in deprived areas. Regular tooth brushing with fluoride toothpaste can prevent it. Regular text messages to mobile phones have been shown to increase frequency of brushing teeth. The aim of this study was to find out whether an intervention involving a school lesson about dental health followed by a series of text messages reduces tooth decay, increases how often (and how well) young people brush their teeth, and is cost effective.

What did we do?

We undertook a multicentre, assessor-blinded, two-arm cluster randomised trial to evaluate the clinical and cost-effectiveness of a promoting toothbrushing for preventing dental caries in UK secondary schools. Pupils aged 11–13 years with their own mobile telephone attending secondary schools with above average free school meals eligibility were randomised (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.

What did we find?

There was no 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. COVID-19 pandemic adversly affected follow-up.

Publications

• 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. Behaviour change intervention for toothbrushing (lesson and text messages) to prevent dental caries in secondary school pupils: The BRIGHT randomized control trial. Community Dent Oral Epidemiol. 2024 Jan 8. DOI: 10.1111/cdoe.12940
• Ainsworth, H., Marshman, Z., Whiteside, K. et al. Set up and assessment of progression criteria for internal pilots: the Brushing RemInder 4 Good oral HealTh (BRIGHT) trial example. Pilot Feasibility Stud 9, 17 (2023). https://doi.org/10.1186/s40814-023-01243-z
• Marshman, Z., Fairhurst, C., El Yousfi, S. et al. The oral health of secondary school pupils: baseline data from the Brushing RemInder 4 Good oral HealTh (BRIGHT) trial. Br Dent J(2023). https://doi.org/10.1038/s41415-023-6557-3
• Elyousfi S, Innes N, Leggett H, Ainsworth H, Chestnutt IG, Day P, Robertson M, Pavitt S, Kellar I, Dey D, Marshman Z. Acceptability of the Brushing RemInder 4 Good oral HealTh (BRIGHT) trial intervention: a qualitative study of perspectives of young people and school staff. BMC Oral Health. 2022 Feb 23;22(1):44. DOI: 10.1186/s12903-022-02073-w
• Marshman, Z., El-Yousfi, S., Kellar, I. et al. Development of a secondary school-based digital behaviour change intervention to improve tooth brushing. BMC Oral Health 21, 546 (2021). https://doi.org/10.1186/s12903-021-01907-3 
• Marshman Z, Ainsworth H, Chestnutt IG, Day P, Dey D, El Yousfi S, Fairhurst C, Gilchrist F, Hewitt C, Jones C, Kellar I, Pavitt S, Robertson M, Shah S, Stevens K, Torgerson D, Innes N. Brushing RemInder 4 Good oral HealTh (BRIGHT) trial: does an SMS behaviour change programme with a classroom-based session improve the oral health of young people living in deprived areas? A study protocol of a randomised controlled trial. Trials. 2019 Jul 23;20(1):452. DOI: 10.1186/s13063-019-3538-6
• Marshman Z and Innes N. Is there a BRIGHT future in texts? Dental Nursing. 06/12/2017

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