Health & Wellbeing Service - Manchester

Brush Bus Project


There are currently over 5,000 children under 5 years of age brushing their teeth while at their education establishment. It has been gradually introduced in Manchester since January 2004 and the majority of schools, nurseries and childminders involved have continued the good work.

The aim of the project is to reduce the level of dental decay amongst 5 year olds by establishing daily supervised toothbrushing, using fluoride toothpaste, at all nurseries and pre-school childcare centres and encouraging daily toothbrusing at home.

The Parents are involved at the introduction stage of the project so the dental health team can provide information about the scheme and ensure informed choice. The project is run on negative consent and every parent is informed either by a member of the dental health team or a member of the teaching staff. A parent can refuse simply by signing the back of the leaflet and returning it to school.

All the equipment is provided for the school, this includes buses, so the brushes can be hygienically stored, different coloured toothbrushes, stickers and fluoride toothpaste at a concentration of 1450 ppm.

All staff are trained to deliver this programme and a trained member of staff supervises a small group at a time to brush their teeth for a couple of minutes everyday. A tiny smear of toothpaste is applied and the children do not rinse or spit out.

Why this project?
The prevalence of tooth decay in this area is high. We currently have 39% of 5 year olds experiencing tooth decay (National Dental Epidemiology Programme for England: Oral health survey of five-year old children 2012, Public Health England).

Also fluoride toothpaste is an effective method of reducing caries and its benefits can be maximised if brushing with toothpaste is started early in a child’s life, supervised and done at least twice a day with a higher concentration of fluoride toothpaste (1).   

Poor oral health can have an impact on general health as it can affect children’s ability to eat, speak and socialise. Other impacts include pain, infections, poor diet and impaired nutrition and growth. According to the Global Burden of Disease Study in 2010, five to nine year olds in the UK experienced the most disability caused by poor oral health.

Untreated tooth decay can lead to young children needing dental treatment under general anaesthesia (GA), which presents a small but real risk of life threatening complications for children. The financial impact of dental disease is also significant; tooth extractions under a GA are not only potentially avoidable but also costly. The cost of extracting multiple teeth in children in hospitals in England in 2011-12 was £673 per child with a total cost of nearly £23 million.


  • 1 A Randomised Control Trial of the Effectiveness of Providing Free Fluoride Toothpaste From the Age of Twelve Months in Reducing Caries in 5-6 Year Olds (2001). Davies, Worthington, Ellwood, Bentley, Blinkhorn, Taylor and Davies. Community Dental Health (2002) 19: 131-136     

Guidelines for tooth brushing with the Brush Bus


Tooth Brushing

  • Everyday each child will have a chance to brush their own teeth with the Brush Bus Scheme.
  • Only a smear of family fluoride toothpaste is needed for brushing - because there is only a very small amount of toothpaste used there is no need for water or rinsing.
  • Place the small amount of toothpaste on a paper-towel and use each brush to sweep the small amount onto it, this stops the toothpaste tube touching the brushes. 
  • Brushing can be done at any time of the day but must be supervised by teachers or lunchtime organisers


Looking after the tooth brushes

  • Store the tooth brushes in your Brush Bus with the bristles uppermost, this allows the brushes to air dry
  • Once the brushes are looking tired and the bristles have splayed please contact us for new ones
  • We will provide family fluoride toothpaste for the scheme


Looking after the Brush Bus

  • Use a permanent marker- spirit based and waterproof to write the names of the children on the Brush Bus, these may then be altered later using alcohol wipes, a vinyl eraser or a correction pen for overhead transparencies
  • The buses need to be stored up high out of the way of little hands
  • The Brush Bus can be cleaned with soap and water or Milton’s periodically

Children will receive a take home pack which contains a brush, toothpaste and brushing information to support brushing at home. For more information contact the Oral Health Team.