title: The BBaRTS Healthy Teeth Behaviour Change Programme for preventing dental caries in primary school children: study protocol for a cluster randomised controlled trial.
abstract: BACKGROUND
  Oral health behaviours such as establishing twice-daily toothbrushing and sugar control intake need parental self-efficacy (PSE) to prevent the development of childhood dental caries. A previous study has shown that behaviour change techniques (BCTs) delivered via a storybook can improve parental self-efficacy to undertake twice-daily toothbrushing.
  
  
  OBJECTIVE
  to determine whether an intervention (BBaRTS, Bedtime Brush and Read Together to Sleep), designed to increase PSE; delivered through storybooks with embedded BCTs, parenting skills and oral health messages, can improve child oral health compared to (1) an exactly similar intervention containing no behaviour change techniques, and (2) the BBaRTS intervention supplemented with home supply of fluoride toothpaste and supervised toothbrushing on schooldays.
  
  
  METHODS
  A 2-year, three-arm, multicentre, cluster randomised controlled trial.
  
  
  METHODS
  children (estimated 2000-2600) aged 5-7 years and their families from 60 UK primary schools.
  
  
  METHODS
  Test group 1: a series of eight children's storybooks developed by a psychologist, public health dentist, science educator, children's author and illustrators, with guidance from the Department for Education (England). The books feature animal characters and contain embedded dental health messages, parenting skills and BCTs to promote good oral health routines focused on controlling sugar intake and toothbrushing, as well as reading at bedtime. Books are given out over 2 years. Test group 2: as Test group 1 plus home supplies of fluoride toothpaste (1000 ppmF), and daily supervised toothbrushing in school on schooldays. Active Control group: series of eight books with exactly the same stories, characters and illustrations, but without BCTs, dental health messages or parenting skills. Annual child dental examinations and parental questionnaires will be undertaken. A sub-set of participants will be invited to join an embedded study of the child's diet and salivary microbiota composition.
  
  
  METHODS
  dental caries experience in permanent teeth at age 7-8 years.
  
  
  CONCLUSIONS
  A multi-disciplinary team was established to develop the BBaRTS Children's Healthy Teeth Programme. The books were developed in partnership with the Department for Education (England), informed by a series of focus groups with children, teachers and parents.
  
  
  BACKGROUND
  ISRCTN21461006 (date of registration 23 September 2015).
authors.affiliation: Institute of Dentistry, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, Whitechapel, London, E1 2BA, United Kingdom. c.m.pine@qmul.ac.uk.|R&D Department, Salford Royal NHS Foundation Trust, Mayo Building, 3rd Floor, Stott Lane, Salford, M6 8HD, United Kingdom. c.m.pine@qmul.ac.uk.
authors.forename: Cynthia
authors.initials: C
authors.lastname: Pine
authors.affiliation: Health Psychology and Behavioural Medicine Research Group, School of Psychological Sciences and Health, University of Strathclyde, 40 George Street, Glasgow, G1 1QE, United Kingdom. pauline.adair@strath.ac.uk.
authors.forename: Pauline
authors.initials: P
authors.lastname: Adair
authors.affiliation: R&D Department, Salford Royal NHS Foundation Trust, Mayo Building, 3rd Floor, Stott Lane, Salford, M6 8HD, United Kingdom. louise.robinson@srft.nhs.uk.
authors.forename: Louise
authors.initials: L
authors.lastname: Robinson
authors.affiliation: Department of Biostatistics, University of Liverpool, Institute of Translational Medicine, Crown Street, Liverpool, L69 3BX, United Kingdom. g.burnside@liverpool.ac.uk.
authors.forename: Girvan
authors.initials: G
authors.lastname: Burnside
authors.affiliation: Centre for Oral Health Research, Institute of Health and Society, Newcastle University, Framington Place, Newcastle upon Tyne, NE24BW, United Kingdom. paula.moynihan@ncl.ac.uk.
authors.forename: Paula
authors.initials: P
authors.lastname: Moynihan
authors.affiliation: Centre for Immunobiology, Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, 4 Newark Street, London, E1 2AT, United Kingdom. w.wade@qmul.ac.uk.
authors.forename: William
authors.initials: W
authors.lastname: Wade
authors.affiliation: Centre for Immunobiology, Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, 4 Newark Street, London, E1 2AT, United Kingdom. j.kistler@qmul.ac.uk.
authors.forename: James
authors.initials: J
authors.lastname: Kistler
authors.affiliation: NHS Tayside, Tweed Place, Perth, PH1 1TJ, United Kingdom. Morag.curnow@nhs.net.
authors.forename: Morag
authors.initials: M
authors.lastname: Curnow
authors.affiliation: Kent Community Health NHS Foundation Trust, Capital House, Jubilee Way, Faversham, Kent, ME 13 8GD, United Kingdom. Mary.henderson3@nhs.net.
authors.forename: Mary
authors.initials: M
authors.lastname: Henderson
mesh_terms: D000367:Age Factors; D001878:Books, Illustrated; D002648:Child; D002652:Child Behavior; D002675:Child, Preschool; D002985:Clinical Protocols; D003731:Dental Caries / Q000175:diagnosis / Q000382:microbiology / Q000517:prevention & control* / Q000523:psychology; D019422:Dietary Sucrose / Q000009:adverse effects; D005247:Feeding Behavior; D005260:Female; D015438:Health Behavior; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D008297:Male; D009909:Oral Health; D009910:Oral Hygiene; D010290:Parents / Q000523:psychology; D010353:Patient Education as Topic; D012107:Research Design; D012571:School Dentistry / Q000379:methods*; D012574:Schools; D020377:Self Efficacy; D013997:Time Factors; D014099:Toothbrushing; D014100:Toothpastes; D006113:United Kingdom
chemical_list: D019422:Dietary Sucrose; D014100:Toothpastes