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References

Frazelle MR, Munro CL. Toothbrush contamination: a review of the literature. Nursing Res Pract. 2012;
American Dental Association. Toothbrush care: cleaning, storing and replacement. http://www.ada.org/en/about-the-ada/ada-positions-policies-and-statements/statement-on-toothbrush-care-cleaning-storage-and- (Accessed: January 2018)
Centers for Disease Control and Prevention. Use and handling of toothbrushes. https://www.cdc.gov/oralhealth/infectioncontrol/questions/toothbrush-handling.html (Accessed: January 2018)

Patient advice concerning toothbrush care

From Volume 45, Issue 2, February 2018 | Page 173

Authors

Charles John Palenik

GC Infection Prevention Consultants, 5868 East 71st Street, E-117 Indianapolis, Indiana 46220, USA

Articles by Charles John Palenik

Article

Toothbrushes are an important part of everyday personal oral hygiene. During plaque and soft debris removal, toothbrushes readily become contaminated with microbes, blood, saliva, oral debris and toothpaste. Toothbrushes can also become contaminated from environmental surfaces and aerosols, user hands and storage containers. Toothbrushes have been suggested as having a role in disease transmission.1

A number of recent studies have investigated whether microorganisms present on toothbrushes could cause oral and/or systemic infections. The human body is constantly exposed to potential pathogens; however, humans are usually able to resist infections. There are two human defence mechanisms – innate host defences (eg physical and mechanical barriers and antimicrobial chemicals) which are always active and acquired immunity (cell- and antibody-mediated responses) which must be stimulated to become active.2

Although there have been studies that indicate a variety of microbes can grow on toothbrushes after use, there is insufficient clinical evidence that a contaminated toothbrush has led to recontamination, oral infections or other adverse oral or systemic health outcomes.2 CDC is unaware of any adverse health effects directly related to toothbrush use.3

Because toothbrushes readily become contaminated during use, a common recommendation is to rinse with running tap water after brushing. Limited research indicates that toothbrushes remain contaminated even after rinsing. Various methods for cleaning, disinfecting and sterilizing a toothbrush between use have been advocated; however, no published research supports the use of such procedures.3 There are general recommendations for toothbrush care.2,3 These include:

  • Do not share toothbrushes. Sharing can occur in certain situations, such as schools, long-term care facilities and some institutions. Sharing can result in the exchange of body fluids and oral flora between users. This can be especially important for immunosuppressed persons and those with existing infections.
  • After brushing, rinse toothbrushes with tap water until cleaned. Let the brush air dry. Store in an upward position. If brushes share a common holder or area, do not let them touch.
  • Avoid covering toothbrushes or storing them in closed containers. Covering/closing retards drying and could lead to greater bacterial growth.
  • Do not soak toothbrushes in disinfecting solutions or mouthwashes. Soaking may actually spread microbes under certain conditions.
  • Do not use dishwashers, microwaves or ultraviolet devices to disinfect toothbrushes. Such methods could damage toothbrushes because they may not be designed to withstand such treatments.
  • Replace toothbrushes every 3-4 months or sooner if bristles become worn. When toothbrushes become worn-out, their cleaning efficiency decreases and might carry more microbes. Some people rotate the use of 2–3 toothbrushes, especially when ill.

    • A pragmatic approach may be needed for situations where there might be an increased risk for infection or reinfections due to toothbrush use. This includes patients or family members who have systemic diseases transmissible by blood or saliva or who are immunosuppressed due to disease, chemotherapy and radiation therapy. Such individuals may experience trauma from toothbrushing and may need alternative forms of oral hygiene, disposable toothbrushes and use of antimicrobial soaking and sanitizing machines.