Blog

This week, in advance of the Child Health Technology Conference, we’re focusing on the subject of child health technology and some of the innovators who are developing solutions specifically for children and young people. Today’s blog focuses on children’s dental health and is written by Ben Underwood who is a dentist, Founder of Brush DJ Ltd and an alumni of the NHS Innovation Accelerator programme. The Brush DJ app is designed to make the mundane task of brushing effectively more enjoyable and therefore more likely to happen.

You’d be forgiven for not being aware of the scale of the challenge we face in children’s oral health. There are so many other headline grabbing priorities in healthcare right now that mean this area is often overlooked. So, to set the scene, let’s consider these facts:

• 45,108 children (under 19’s) in England had a general anaesthetic to remove decayed teeth in 2019-20
• Tooth decay is still the most common reason for 5-9 year old children being admitted to hospital in England
• The cost of this to the NHS is £50.5m a year

All this for a disease that is almost always preventable. Moreover, just as in all other areas of our health and care system, the dental health of our children has been significantly impacted by the COVID-19 pandemic. Routine face-to-face dental care was stopped in March last year and this has placed an additional burden on already stretched secondary care services.

We often hear about how COVID-19 has highlighted the challenges our society faces around health inequalities. This is no less the case when it comes to children’s oral health. For example, children from lower income families are:

• Almost twice as likely to have tooth decay
• More likely to experience toothache
• Likely to have difficulty in finding an NHS dentist
• Report problems in their daily life caused by their oral health

From a regional perspective, this challenge around oral health inequalities is particularly acute in the Yorkshire and Humber region.

If we are going to try and overcome these challenges, then we’re going to have to go beyond dental surgeries to try and effect children’s behaviour and support healthy oral hygiene habits.

That’s where Brush DJ comes in. My innovation journey was born out of the frustration of seeing children suffering from the pain of preventable tooth decay. I had recently started in a new dental practice and was taking on new patients and every day I was seeing children with tooth decay that was preventable. When I asked them how long they brushed their teeth for, the answer was ‘bout a minute’ and when I asked them how many times a day – it was often once and most of them were rinsing the toothpaste away after brushing. So, the challenge was clear: how could I get them doing the basics at home?

First, I needed to make them, or their parents and carers aware of what they needed to do every day and, probably the bigger challenge, motivate them to actually do it. The challenge was not just about raising cognitive awareness, but about affecting long-term behaviour change. But how could I compete with all the other people trying to grab their attention?

It occurred to me that the ideal tool to help do this was a smartphone or tablet.

I didn’t think this approach could get the number of decayed teeth down to zero, but it could be a very low-cost part of the solution.

Very simply, the Brush DJ app plays 2 minutes of music taken from the users device or streaming service to make the boring task of brushing for 2 minutes fun and therefore more likely to happen. Music is the hook to get people engaged. Music is fun. Make a task fun and people are more likely to carry it out… a recent study found the most common reason children gave for not brushing was because it was boring!

As well as being fun to use, the app uses a number of recognised behaviour change techniques including:

• Instructions on how to perform an activity
• Demonstration of the behaviour
• Prompts
• Cues – scrolling information of what you should be doing whilst you are brushing
• And non-specific rewards

Alongside the app there is also a website where the top five most voted for songs to listen to whilst brushing is published each week. We also publish this on Twitter and Facebook and, most importantly I think, on a YouTube page. Video is a hugely important medium and this saying is very true – if a picture is worth a thousand words a video is worth a million.

The app already has videos showing how to brush, floss and use interdental brushes for adults and videos for parents and children will be added next month.

We know patients often forget the information we provide them in the surgery, so we need to make more use of videos that patients can watch at home as many times as they like, even in their own bathrooms!

Brush DJ has been designed to use Voiceover on Apple devices and TalkBack for Android, which allows blind and low-vision users, as well as users with dyslexia to enjoy the app. It’s one of only 70 apps that made it into the NHS digital apps library and is the only dental app listed and it’s been endorsed and is kindly being promoted by the British Dental Association (BDA).

So far, the app has been translated into 10 different languages – hopefully with more funding the number of languages can be increased – and has been downloaded in 207 countries onto almost half million devices – we are on about 450,000 downloads.

Brush DJ is free to download and contains no advertising or in app purchases so, how has this success been funded? Until 2015 I self-funded everything. With our successful application to join the NHS Innovation Accelerator programme came a bursary which I used to fund a new version of the app, translations and more videos. Recent funding from Health Innovation Manchester has helped develop an e-learning package for health care professionals.

I’m currently gathering funding to build a new version with enhanced features so if anyone has any funding available please do get in touch with me at info@brushdj.com

Find out more about Brush DJ.