Contaminated Toothbrushes and Their Disinfection

Introduction History:

The concept that all toothbrushes were contaminated after a single use was proposed as early as 1920 by Dr. Cobb, who implicated the toothbrush as a cause of repeated oral infections. Bacteremias as a consequence of daily brushing are well documented in the literature, and bacteremias by oral bacteria are recognized as a cause of endocarditis by dental and medical professionals. In fact, authors now hold that it is more important to reduce the daily bacteremias resulting from brushing than it is to implement antibiotic prophylaxis prior to specific invasive dental procedures.

Svanberg examined toothbrushes and toothpaste tubes used by persons infected with Strep. Mutans. 15 minutes after brushing more than 10/6 S. mutans were isolated from the toothbrush and after ordinary storage for 24 hours 10/4 were recovered from 2 out of 10 toothpaste tubes. All subjects stated than the toothbrush was rinsed with water and allowed to air dry.

In spite of the millions of toothbrushes sold each year in North America, there is little awareness that their bristles become contaminated by the resident micro-organisms with use. Some have pathogenic potential and are able to grow on the minuscule food particle that remains trapped within the bristles of the brush after use. When left in a moist humid bathroom, bacterial and viral growth is facilitated. The next time of "use", the brush is now teeming with microorganisms.

Most consumers buy less than 1 toothbrush every 12 months. Studies by Glass and others strongly recommend a new brush every 3 months and if the patient is sick with respiratory infections it is recommended the use of a new brush every 3-4 days. Studies by Glass found the toothbrushes to be completely saturated with bacteria after 3 weeks.

Which ANTI-BACTERIAL compounds have been tested?

1.      Hydrogen Peroxide (3%)

2.      Listerine Mouth Rinse

3.      Chlorhexidine gluconate (0.2%)

4.      REACH (cetylpyridinium chloride 0.5%)

5.      Heat (boiling water, microwave, washing in dishwasher)

6.      UV radiation

7.      Parox

RESULTS:

From the tested list above, ONLY Parox was found 100% effective on the organisms found in the mouth!  Some of the above tests (excluding Parox), even damaged the toothbrush!   More importantly, there was no study on viral contamination.

RECOMMENDATIONS FOR A HEALTHY MOUTH:

                IT'S SIMPLE!

Disinfect your standard or mechanical toothbrush every 3-4 days.

The Hospital Disinfectant "Parox" has EPA approval for tooth brush disinfection. There are some 400 different species of bacteria, viruses, and fungal (yeast) organisms in the mouth. No other pesticide recommended to reduce contamination of dental appliances and toothbrushes has the level of "kill" that Parox possess for medical or dental devices.

Clinical Recommendation: 

Dental professionals should advise patients who have systemic, localized or oral inflammation to disinfect or frequently replace their toothbrushes. Patients with "bleeding gum" or periodontal problems must disinfect the brush after each use. Bacteria that have been taken from the veinous system have been identified to have originated from the mouth. 

 Exceptions will be found to exist among and between the various susceptibility groups listed, but the broad outline of comparative susceptibility has become the basic principle in disinfectant biology. 

When possible, refer to the EPA registrations for information on the desired pesticide based on the scale below for infection control on the object to be disinfected. For example, if you want to kill respiratory viruses you need to select a pesticide that kills group 5. The agent will also kill every organism in group 1 to 5. 

SCALE OF RESISTANCE

Parox kills the groups 1-5 on the scale of susceptibility below.  Parox demonstrated sporicidal activity on group 6.

Approximate disinfection scale for all organisms of increasing resistance.  (response to commercial disinfectants)

Microbial Susceptibility

Group                                  Micro-organism (dried on carriers)

1.                                           Paramyxoviruses, herpes viruses, vaccine, corona, other

                                              enveloped viruses, gram-negative rods and some

                                              filamentous fungi, yeasts and algae, some gram

                                              positive cocci, human hepatitis B virus.

2.                                           Staphylococcus aureus, some diphasic and filamentous

                                              fungi, yeasts and algae, some gram negative rods.

3.                                           Adenoviruses

4.                                           Mycobacterium tuberculosis (BCG strain) rotaviruses,

                                              reoviruses, some mold ascospores.

5.                                           Picornavirus (non-enveloped human pathogenic viruses)

                                              Caliciviruses, coxsackle viruses (pneumonia, colds,

                                              diarrhea, etc.)  Echoviruses, enteroviruses, Hepatitis A,

                                              parvovirus, polio virus, rhinovirus, and rotavirus.

6.                                           Bacterial endospores (Bacillus clostridium)

7.                                           Prions

Exceptions will be found to exist among and between the various susceptibility groups listed, but the broad outline of comparative susceptibility has become a basis principle of disinfectant biology.

Recommended Toothbrush Care:  Minimal care is to disinfect every 3-4 days.

Using Parox  Disinfectant with a 5 minute kill time: 

1.   After brushing, rinse your toothbrush thoroughly to ensure the removal of toothpaste and debris.

2.   Follow the mixing instructions on the Parox label to develop the activated soak solution of 3-4 ounces. The chloroperoxyl compound will have a distinct yellow color that is an indicator as to how long you can re-use the same solution. For those that have an active periodontal disease or a respiratory disease, it will be imperative to disinfect the brush (standard or mechanical) after each brushing to insure a clean brush for each use and not to reinfect.

3.    Place the brush in the disinfecting solution and vortex the bristles against the sides of the cylinder to cause a separation of the bristles for better exposure f the bristles to the solution. Do this for a few seconds and then let the brush soak for a minimum of 5 minutes.

4.   After 5 minutes, remove and tap the brush against a solid object to remove the excess disinfecting solution and place in container to air dry. The residue of the solution is safe and has the non toxic elements of sodium and chlorine.

The Parox solution should be changed if the soak solution develops a cloudy mixture of toothpaste residue. It is normally used and reused for 10- 14 days unless the yellow color begins to disappear.

It is obligatory for those undergoing radiation, chemotherapy, or those who are immuno-compromised to maintain a healthy mouth.' No one would ever use the same wash cloth for personal hygiene without cleaning it after each use. The same principle holds true for oral hygiene.'