How clean is your toothbrush?

shutterstock_2345735-powered toothbrush

The aim of this review was to evaluate the cumulative state of knowledge related to toothbrush contamination, its possible role in disease transmission, and in preparation for a research study related to toothbrush contamination in critically ill adults.

The Pub Med, CINAHL, Cochrane Library, National Guidelines Clearinghouse, Web of Science, and Google Scholar databases were searched for  experimental and non-experimental studies in hospitalised and non-hospitalised patients that looked at bacterial contamination of toothbrushes. Only English language studies were included.

They  included  seven experimental and three descriptive studies. The majority of the studies had small sample sizes. They  identified multiple concepts related to toothbrush contamination to include contamination, methods for decontamination, storage, design, and environmental factors.

The selected studies found that toothbrushes of healthy and oral diseased adults become contaminated with pathogenic bacteria from the dental plaque, design, environment, or a combination of factors.

The authors concluded

There are no studies that specifically examine toothbrush contamination and the role of environmental factors, toothbrush contamination, and vulnerable populations in the hospital setting (e.g., critically ill adults) and toothbrush use in nursing clinical practice.

Frazelle MR, Munro CL. Toothbrush contamination: a review of the literature. Nurs Res Pract. 2012;2012:420630. Epub 2012 Jan 24. PubMed PMID: 22315679; PubMed Central PMCID: PMC3270454.


The reviewers did not find many studies to include in their review and their findings are perhaps not too surprising as the mouth harbours an abundant and diverse microbial community, but it is an interesting read.  As dentists we spend a lot of time encouraging people to use their toothbrushes to keep their mouth clean perhaps we also need to take some time to encourage people to keep their toothbrushes clean as well?

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Derek Richards

Derek Richards is a specialist in dental public health, Director of the Centre for Evidence-Based Dentistry and Specialist Advisor to the Scottish Dental Clinical Effectiveness Programme (SDCEP) Development Team. A former editor of the Evidence-Based Dentistry Journal and chief blogger for the Dental Elf website until December 2023. Derek has been involved with a wide range of evidence-based initiatives both nationally and internationally since 1994. Derek retired from the NHS in 2019 remaining as a part-time senior lecturer at Dundee Dental School until the end of 2023.

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