The Toothbrushing Boost Toolbox: competence-building behavioral strategies for oral health

Oral disease is the most prevalent noncommunicable disease globally, affecting an estimated 3.7 billion people and imposing an annual economic burden of roughly US$710 billion-even though preventive recommendations for oral health are clear and widely known. This striking gap between knowledge and behavior points to a need for complementary approaches that help people translate awareness into action. Despite this need, behavioral science is an underexamined approach in oral health: Our bibliometric review found only 360 behavioral science publications addressing oral health compared with thousands in other domains, and most oral health studies were non-experimental. We argue that boosting, an approach from behavioral science that builds competences and respects autonomy, is a practical complement to traditional oral health education. We introduce the Toothbrushing Boost Toolbox: a set of simple, memorable strategies that map onto common behavioral barriers. These boosts are low-cost, adaptable across age groups and literacy levels, and could be integrated into clinical practice, public health programs, and digital tools. We further argue that boosting should be embedded within a broader agenda of system-level reform, including universal access and subsidized preventive care, and propose practical steps for implementing, evaluating, and co-designing boost interventions. An oral health agenda that is informed by behavioral science can help shift oral health promotion from providing information to fostering competence and sustained daily practice.