Toothbrush contamination: Often neglected health hazard.

Dear Editor,

We read the article by Naik et al.[1] on contaminated toothbrushes with interest. In this study, the authors have attempted to evaluate the presence of streptococcal microorganisms in toothbrushes and the effect of various disinfectants to decontaminate them.

However, we were disheartened by the fact that the study was lacking on standardization methods used and is silent on several significant aspects. No information is provided regarding the nature of toothbrushes used or whether the type of bristle material or their arrangement could have a role in the contamination/adhesion of microbes.

The authors should have mentioned as to how the toothbrush cleaning was standardized after brushing. Was the child in Class 1 was able to clean the brush with the same efficacy as 7th standard child? The study is also silent about the manner of cleaning after brushing (whether washing it under running water or just dipping in water or using soap and water to clean the brush). Similarly, no information is provided with regard to the storage of brushes; were they stored in a dry place or in a humid environment which could significantly alter the flora as also pointed out by the author themselves.[1]

No standardization was done regarding the manner the toothbrush was handled during the study period. For example, if the brush fell on floor or wash-basin sink was it discarded and a new brush used again for the same or remaining time period and if same brush was used how, if-at-all, was it cleaned and used again inside mouth? It has not been mentioned whether toothpaste was used by all or not. The role of the composition of toothpaste used has not been taken into account; whether same paste was used by all the participants and in what quantity. There is no mention about the use of antimicrobial or anticavity mouthwashes by the participants. Similarly, the role of eating habits or daily sugar intake which could directly influence the number of microbes should have been taken into account.

Furthermore, it is just mentioned that microbial colony detection was taken as a sign of contamination, no bacterial count values have been provided above which they were considered to be contaminating. Swabs from the oral cavity could have been taken to evaluate and compare the relationship between the normal commensals and detected organisms; controls are missing from the study. Some of the references cited on contamination are as old as 1920–1940's are such scientific data still valid today?

In our opinion, getting microbial swabs could have been a better way of collecting oral flora after a standardized regimen of tooth brushing, instead of using the tooth brush as a medium of bacteria sampling. Nonetheless, the authors still have done a commendable role in bringing out one of the neglected aspects of oral health care, i.e., routine change of toothbrushes as with time and use the toothbrushes also lose their cleaning efficacy.

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Conflicts of interest

There are no conflicts of interest.