Use & Handling of Toothbrushes

The Centers for Disease Control and Prevention is unaware of any adverse health effects directly related to toothbrush use, although people with bleeding disorders or who are severely immunosuppressed may suffer trauma from tooth brushing and may need to seek alternate means of oral hygiene.

The mouth is home to millions of germs. In removing plaque and other soft debris from the teeth, toothbrushes become contaminated with bacteria, blood, saliva, oral debris, and toothpaste. Because of this contamination, a common recommendation is to rinse one's toothbrush thoroughly with tap water following brushing. Limited research has suggested that even after being rinsed visibly clean, toothbrushes can remain contaminated with potentially pathogenic organisms. Various means of cleaning, disinfecting, or sterilizing toothbrushes between uses have been developed, but no published research documents that brushing with a contaminated toothbrush has led to recontamination of a user's mouth, oral infections, or other adverse health effects.

Recommended toothbrush care:

• Do not share toothbrushes. Toothbrushes can have germs on them even after rinsing that could raise the risk of infection, especially for people with immune suppression.
• After brushing, rinse your toothbrush with tap water until it is completely clean, let it air-dry, and store it in an upright position. If more than one brush is stored in the same holder, do not let them touch each other.
• You do not need to soak toothbrushes in disinfecting solutions or mouthwash, which may actually spread germs under the right conditions.
• You do not need to use dishwashers, microwaves, or ultraviolet devices to disinfect toothbrushes. These methods may damage the toothbrush.
• Avoid covering toothbrushes or storing them in closed containers, which can cause the growth of bacteria.
• Replace your toothbrush every 3 to 4 months, or sooner if the bristles look worn out. This is because a worn-out toothbrush may not work as well, not because it might carry more germs.

Tooth brushing in group settings should always be supervised to ensure that toothbrushes are not shared and that they are handled properly. The likelihood of toothbrush cross-contamination in these environments is very high, either through children playing with them or toothbrushes being stored improperly. In addition, a small chance exists that toothbrushes could become contaminated with blood during brushing. Although the risk for disease transmission through toothbrushes is minimal in group settings, it is a potential cause for concern. Therefore, officials in charge of tooth brushing programs in these settings should evaluate their programs carefully.

Recommended measures for hygienic tooth brushing in schools:

• Ensure that each child has his or her own toothbrush, clearly labeled. Do not allow children to share or borrow toothbrushes.
• To prevent cross-contamination of the toothpaste tube, ensure that a pea-sized amount of toothpaste is dispensed onto a piece of wax paper before dispensing any onto the toothbrush.
• After the children finish brushing, ensure that they rinse their toothbrushes thoroughly with tap water, allow them to air-dry, and store them in an upright position so they cannot contact those of other children.
• Provide children with paper cups to use for rinsing after they finish brushing. Do not allow them to share cups, and ensure that they dispose of the cups properly after a single use.