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Supervised toothbrushing programs: evaluating impact, barriers, and facilitators – a mixed-method umbrella review

Evidence-Based Dentistry (2025)Cite this article

Subjects

Abstract

Objective

To assess the effectiveness of supervised toothbrushing programs in improving oral health outcomes among children and adolescents aged 3 to 18 years and to explore stakeholders’ perceptions in implementing and sustaining tooth brushing programs.

Methods

This mixed-method umbrella review followed JBI methodology and PRISMA guidelines. A systematic search was conducted across databases including MEDLINE, Cochrane, Scopus, Web of Science, CINAHL, Epistemonikos, ProQuest, and Google Scholar. A total of 159 articles were identified, and after screening, three systematic reviews met the inclusion criteria. The quantitative and qualitative findings were synthesized using a convergent segregated approach. The Theoretical Domains Framework (TDF) was applied to map barriers and facilitators influencing program adoption and sustainability.

Results

The quantitative synthesis included one systematic review with four included trials, two of which found statistically significant reductions in dental caries with supervised toothbrushing. The qualitative synthesis (two mixed-method systematic reviews) revealed key facilitators and barriers. The most prominent enablers and barriers identified across these reviews were knowledge about oral health/tooth brushing, social influences, and environmental context and resources. Specifically, the knowledge domain received 32 enabler responses and 25 barrier responses, underscoring the importance of understanding oral health practices to improve toothbrushing behavior. Social support garnered 35 enabler responses and 26 barrier responses, highlighting the role of a supportive environment in enhancing adherence to toothbrushing routines.

Conclusion

This review highlights the effectiveness of supervised toothbrushing programs in reducing dental caries. The qualitative synthesis, guided by the Theoretical Domains Framework (TDF), identifies key barriers and facilitators, including knowledge gaps, environmental constraints, social influences, and behavioural regulation factors.

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Data availability

All data supporting the conclusions of this study are available from the corresponding author from reasonable request.

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Funding

The author(s) didn’t receive grants from any funding agency in the public, commercial or not for profit sectors.

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Authors and Affiliations

  1. Department of Public Health Dentistry, Amrita School of Dentistry, Amrita Vishwa Vidyapeetham, Kochi, Kerala, India

    Chandrashekar Janakiram, Anju James & Sujay Vivek Vattiprolu

  2. JBI Amrita Centre for Evidence Synthesis and Implementation, Amrita School of Dentistry, Amrita Vishwa Vidyapeetham, Kochi, Kerala, India

    Chandrashekar Janakiram, Anju James & Sujay Vivek Vattiprolu

  3. Indian Council of Medical Research, New Delhi, India

    Nitika Monga

  4. Executive director, HRIDAY and Vice President (Research and Health Promotion), Public Health Foundation of India (PHFI), New Delhi, India

    Monika Arora

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  1. Chandrashekar Janakiram
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Contributions

C.J conceived the study. V.S.V conducted the literature search. C.J and A.J conducted the review, data extraction, coding, interpreted the data and wrote the first draft of the manuscript. N.M and M.A conducted quality assessment and revised the work critically for important intellectual content. All authors have contributed to the design, revisions, and approved the final manuscript.

Corresponding author

Correspondence to Chandrashekar Janakiram.

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The authors declare no competing interests.

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The review complies with international ethical standards in reviewing research studies.

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Janakiram, C., James, A., Vattiprolu, S.V. et al. Supervised toothbrushing programs: evaluating impact, barriers, and facilitators – a mixed-method umbrella review. Evid Based Dent (2025). https://doi.org/10.1038/s41432-025-01178-9

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