Surrey community dental team takes on toothbrushing “blind spot” in special care dentistry with £8.6k pilot
Carly Greener-Simon, Surrey Community Dental Services
Surrey Community Dental Services, part of HCRG Care Group, has launched a new
assisted-tooth brushing pilot to improve daily plaque control for patients who depend
on others to clean their teeth, following an £8,608 award from HCRG’s Difference
Fund.
The project is targeting one of the most persistent, yet under-addressed, practical
failures in special care dentistry: how to achieve consistent, effective daily
toothbrushing when patients rely on parents, family members or paid carers.
More than 1,400 specialist three headed toothbrushes are being introduced across
seven Surrey community dental sites (16 surgeries) for children and adults with
learning disabilities, physical impairments, neurological conditions, frailty and post-
surgical needs. Hundreds of patients are expected to benefit directly during the pilot
Phase.
The project is being led by Carly Greener-Simon, Surrey Community Dental
Services.
The everyday reality behind preventable disease
For many special care patients, oral hygiene is entirely dependent on third-party
support. Even where carers are committed and well-intentioned, assisted
toothbrushing is frequently undermined by:
● restricted mouth opening and limited tolerance
● physical access and positioning difficulties
● variable technique between different carers
● time pressure in home and care-home settings
Carers and families frequently report a lack of availability of specialist
assisted-brushing tools on the high street, making it difficult to establish and
maintain effective oral hygiene routines even when they understand what is required.
As a result, because these brushes are not easily sourced, daily oral care is
often substituted with a standard toothbrush that is less suitable for the
patient’s needs.
This lack of availability creates an additional obstacle, meaning patients’ oral
health needs may go unmet despite the best intentions of both staff and
families.
By offering a hands-on demonstration and allowing the patient to take the
recommended brush home, understanding, confidence and compliance would
be significantly improved, reducing reliance on verbal explanations alone and
enabling immediate implementation of correct techniques.
Without this support, the outcome is a predictable clinical pattern of persistent
plaque accumulation, untreated caries, advancing periodontal disease and
repeated treatment under increasingly challenging conditions.
“Most of our patients/carers and parents already know they should be brushing twice
daily with fluoride toothpaste,” said Carly Greener-Simon, Clinical Lead for Surrey
Community Dental Services. “The problem is not the message. The problem is how
you deliver effective brushing when someone else has to do it for you, twice a day, in
real life. That’s where prevention breaks down.”
A simpler approach for complex situations
The pilot introduces a three-surface brushing method, where buccal, lingual and
occlusal surfaces are cleaned simultaneously using short back-and-forth
movements. The aim is to reduce dependence on fine motor skill and perfect
technique, and instead offer a more forgiving, repeatable method for assisted
brushing.
Delivery is fully embedded into existing clinical workflows. As part of routine
appointments, dental teams will:
● identify patients who require third-party assistance with brushing
● supply an age-appropriate three headed toothbrush
● provide chairside, intra-oral demonstrations to parents, family members and paid carers
● integrate the approach into the patient’s individual oral-hygiene plan, without
adding clinical time
“We’re not asking carers to become dental professionals,” said Carly Greener-
Simon. “We’re giving them a tool that does more of the work for them, and showing
them how to use it properly in the mouth they are actually dealing with.”
Measuring impact where it matters
The pilot will be evaluated using both clinical and experience-based measures, including:
● comparison of oral hygiene status at baseline and review appointments
● patient and carer feedback using the Friends and Family Test
● clinician assessment of tolerance, compliance and practical usability
● uptake and interest from care homes and supported-living services
The service will also track whether improved daily plaque control translates into
reduced treatment demand and fewer preventable appointments, a key benefit for
both patients and commissioners.
Health equity and system benefit
People with learning disabilities and complex needs consistently experience higher
levels of preventable dental disease and poorer access to effective daily oral care.
This project directly supports HCRG’s wider commitment to health equity and
targeted prevention in vulnerable populations.
If successful, the model could be replicated across other HCRG community dental
services, supporting a shift from reactive treatment to stabilised daily prevention in
assisted-brushing populations.
“This is about closing a very specific gap in the prevention system,” added Carly
Greener-Simon. “If we can stabilise daily plaque control in patients who rely on
others to brush their teeth, the downstream impact on disease burden, quality of life
and treatment demand is substantial.”
About the Difference Fund
HCRG Care Group’s Difference Fund is an internal innovation programme that backs
frontline ideas delivering clear patient-experience and outcome benefits to develop new models and ideas for delivering commissioned services. The £8,608 award to Surrey Community Dental Services
covers specialist assisted-brushing equipment for paediatric and adult patients,
alongside structured evaluation of its real-world use.
About HCRG Care Group
HCRG Care Group is one of the UK’s largest independent providers of community
health and care services, delivering NHS and local-authority-commissioned services
including community dental, 0–19 services, adult community health and urgent care
across England. The organisation has a strong focus on prevention, health equity
and practical service innovation.