NATIONAL

HEALTH BEHAVIOUR IN SCHOOL-AGED CHILDREN:
WHO COLLABORATIVE CROSS-NATIONAL STUDY (HBSC)
2014 SURVEY IN SCOTLAND NATIONAL REPORT
TOOTH BRUSHING
INTRODUCTION
Oral diseases represent a global public health concern owing to their high prevalence in all regions of the world 1 . Oral
disease can detrimentally impact on a person’s health and well-being. The most common types of oral disease, dental
caries and gum disease are largely preventable 2 .
The Scottish Government recommends tooth brushing at least twice a day 3 and this has been shown to reduce levels
of both tooth decay and gum disease. 4 Adolescents who brush their teeth at least twice daily by the age of 15, tend to
continue this throughout their teens 5 and have more favourable oral hygiene 6 .
Tooth brushing behaviour is associated with other health behaviours among adolescents. For example, young people who
consume high quantities of sugary-drinks are less likely to brush their teeth regularly, whereas those who eat a lot of fruit
and vegetables are more likely to brush their teeth regularly 7 . High family affluence, living with both parents, and regularly
eating together as a family (particularly at breakfast) are all also associated with regular tooth brushing 8 . Inequalities in
dental health have largely persisted in recent decades despite public health efforts focused on the social determinants of
health 9 . Poor and unequal access to dental care contributes to dental health inequalities, with those from more deprived
backgrounds disproportionately affected by dental disease 10 .
A large proportion of children across the UK continue to be affected by gum disease and tooth decay 11 . Traditionally,
Scottish adolescents have compared unfavourably with other school children within the UK when it comes to oral health 12 .
This may also be connected to high sugar intake among young people in Scotland combined with low levels of oral care,
including tooth brushing 13 .
Adolescence is an important period for interventions aimed at the establishment of healthy habits for promoting general
and oral health. Following a government consultation, the need for improvement in oral health was identified as a HEAT
target directed at early years 9 . In Scotland, population-based approaches designed specifically to improve children’s dental
health are delivered within the Childsmile programme 9 – a national programme designed to improve the oral health of
children, and to reduce inequalities in both dental health and access to dental health services.
HBSC FINDINGS
HBSC has collected data on tooth brushing frequency in Scotland since 1990, allowing for examination of trends across a
24-year period.
TOOTH BRUSHING AT LEAST TWICE A DAY
Most young people in Scotland brush their teeth at least twice a day (77%) (Figure 10.1). Girls are more likely than boys
to brush their teeth at least twice a day (84% compared with 71%, respectively). Among boys there is no change in the
prevalence of tooth brushing between the ages of 11 and 15, highlighting the importance of establishing boys’ good oral
health habits early in life. Amongst girls, an increase in tooth brushing is seen between the ages of 11 and 13, with no change
between 13- and 15-year old girls.
Since 1990, there has been a steady increase in the proportion of boys and girls that brush their teeth two or more times
a day. Among boys, the proportion has risen from 48% in 1990 to 71% in 2014. Among girls, the proportion has increased
from 70% in 1990 to 84% in 2014 (Figure 10.2). The observed gender difference in tooth brushing has existed since 1990,
however this has gradually reduced with time. Substantial improvement has been seen since 2010 for 15-year old boys,
among whom the proportion brushing their teeth at least twice daily has risen from 63% in 2010 to 71% in 2014.
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