Toothbrush Contamination by Candida spp. and Efficacy of Mouthrinse Spray for Their Disinfection

Knowledge, Attitude and Practice of Toothbrush Contamination and Disinfection Among Undergraduate Students in Selected Universities in Somalia

Background

Oral health is crucial for overall well-being and systemic health and Humans are exposed to several bacteria after birth and will causes systemic illnesses like septicemia, respiratory, gastrointestinal, and renal issues. This study aimed to evaluate undergraduate students' knowledge, attitudes, and practices regarding toothbrush contamination and disinfection.

Methods

A descriptive cross-sectional study was carried out with undergraduates from seven selected universities, including public and private universities. A closed-ended questionnaire containing 24 items was distributed to A total of 490 undergraduate students.

Results

The study showed that (28.6%, n=140) had knowledge about toothbrush cleaning and disinfection. A total of (350, n=71.4%) needed to gain knowledge about toothbrush cleaning and disinfection. Fifty-two percent of the students feel that bacteria are the primary mode of toothbrush contamination. Many of the students had different ways of disinfecting toothbrushes, including, boiling a small pot of normal water (51.4%, n=252), chemical agent (31.8%, n=156), ultraviolet sanitizer (0.2%, n=4), and microwave radiation (0.2%, n=1) does not know (16.1%, n=79). Most students (76.9%, n=377) felt that toothbrush disinfection was necessary.

Conclusion

Fewer students have sufficient knowledge about toothbrush contamination and practice disinfection methods, whereas most students need to be made aware of the contamination of toothbrushes and the use of disinfectant methods.

Assessment of knowledge, attitude and practice of medical and dental students about maintaining and disinfecting toothbrushes

INTRODUCTION

Proper toothbrush care and maintenance play an important role in oral health. This study aimed to investigate the knowledge, attitude and practice of medical and dental students regarding the maintenance and disinfection of toothbrushes.

METHOD

This cross-sectional descriptive study examined 824 medical and dental students of Babol University of Medical Sciences, Babol, Iran. Data were collected using a researcher-made questionnaire and analysed using chi-square test and independent t-test. The level of statistical significance was considered to be <0.05.

RESULTS

Nearly 63.7% of the students had a good level of knowledge regarding toothbrush maintenance, 62.2% had a positive attitude toward toothbrush care, and 53.7% had a good practice. The mean scores of knowledge, attitude, and practice were significantly higher in dental, clinical, and female students as compared to medical, preclinical, and male students, respectively. Based on the results, about 54.3% of the students kept their toothbrushes outside the bathroom; 68% kept them vertically with the bristles upright; and 54% kept them in a separate container. Also, 50.6% of the students believed that toothbrush disinfection was necessary, while 31.9% believed that only certain groups of people needed toothbrush disinfection.

CONCLUSION

This study indicated the moderate level of knowledge, attitude, and practice of medical and dental students in maintaining and disinfecting their toothbrushes. The students' oral health habits were also at a moderate level; therefore, further improvements seem essential. To achieve this goal, educational intervention programs need to be developed in the future.

The role of toothbrush in the transmission of corona- and influenza viruses - results of an in vitro study

Objectives

The aim of this in vitro study was to investigate viruses’ stabilities on manual toothbrushes using feline coronavirus (FeCoV) as representative of coronaviruses and an Avian influenza A virus H1N1 for influenza viruses.

Material and methods

Two viruses, FeCoV (Strain Munich; titer 107.5 TCID50/ml) and H1N1 (RE 230/90; titer 106.5 TCID50/ml), were used in this study. Manual toothbrushes were disassembled into bristles, bristle fixation, and back of the toothbrush head, contaminated with the viruses and air-dried for 24 h. In a second experiment, whole toothbrush heads were contaminated, rinsed with water (5 ml for 15 s) and then air-dried.

Results

For FeCoV, immediately after contamination, the following average titers were recovered: fixation: 10^6.41, back of head: 10^6.81 and bristles: 10^6.63 TCID₅₀/ml. Following air-drying of 12 (fixation) and 24 h, titers of ≤ 10^2.5, 10^3.75, and 10^2.72 TCID₅₀/ml were found in the respective groups, with a detection limit of 10^2.5 TCID₅₀/ml. For H1N1, immediately after contamination, the following average titers could be recovered: fixation: 10^5.53, back of head: 10^5.97 and bristles: 10^5.75 TCID₅₀/ml. Following air-drying of 8 (fixation) and 24 h, titers were ≤ 10^2.5, 10^3.63, and 10^3.53 TCID₅₀/ml in the respective group, again with 10^2.5 TCID₅₀/ml being the detection limit. In case of water rinse, no infectious virus could be recovered after 12 h.

Conclusion

Viral load of both viruses is reduced by air-drying, especially following water rinsing.

Clinical relevance

The toothbrush itself plays an insignificant role in the self-transmission of coronavirus and influenza virus.

Efficacy of Different Sterilization Techniques for Toothbrush Decontamination: An Ex Vivo Study

Background

Contaminated toothbrushes can cause several oral and systemic illnesses. This study aimed to identify the most rapid, effective, and affordable method for toothbrush decontamination. In addition, the most prevalent bacterial species colonizing toothbrushes were determined.

Methodology

Toothbrushes were collected after two weeks of use by 55 volunteers. The bacterial count was measured before and after sterilization using 0.2% chlorhexidine gluconate, 0.1% Listerine, 70% white alcohol, 10% povidone-iodine, 1% sodium hypochlorite, 2% glutaraldehyde, ultraviolet radiation, microwave irradiation, 3% hydrogen peroxide, and 100% white vinegar, with tap water rinse as the control.

Results

A marked reduction in the bacterial count was observed pre- and post-sterilization. All sterilization methods were effective for toothbrush disinfection. Sterilization using 2% glutaraldehyde and 3% hydrogen peroxide solutions resulted in the most significant reduction in the mean bacterial count and percentage reduction in the total bacterial count, respectively. The toothbrush samples were also colonized by several different types of bacteria. The most common colonizing bacterial species included Bacillus subtilis (28% prevalence), Sacrina (26% prevalence),and Streptococcus pneumoniae (24% prevalence).

Conclusions

Because bacterial contamination cannot be eliminated and different species colonize toothbrush surfaces, cleaning and disinfection are essential to prevent disease transmission.

The Toothbrush Microbiome: Impact of User Age, Period of Use and Bristle Material on the Microbial Communities of Toothbrushes

Toothbrushes play a central role in oral hygiene and must be considered one of the most common articles of daily use. We analysed the bacterial colonization of used toothbrushes by next generation sequencing (NGS) and by cultivation on different media. Furthermore, we determined the occurrence of antibiotic resistance genes (ARGs) and the impact of different bristle materials on microbial growth and survival. NGS data revealed that Enterobacteriaceae, Micrococcaceae, Actinomycetaceae, and Streptococcaceae comprise major parts of the toothbrush microbiome. The composition of the microbiome differed depending on the period of use or user age. While higher fractions of Actinomycetales, Lactobacillales, and Enterobacterales were found after shorter periods, Micrococcales dominated on both toothbrushes used for more than four weeks and on toothbrushes of older users, while in-vitro tests revealed increasing counts of Micrococcus on all bristle materials as well. Compared to other environments, we found a rather low frequency of ARGs. We determined bacterial counts between 1.42 × 10⁶ and 1.19 × 10⁷ cfu/toothbrush on used toothbrushes and no significant effect of different bristles materials on bacterial survival or growth. Our study illustrates that toothbrushes harbor various microorganisms and that both period of use and user age might affect the microbial composition.

Prevalence and susceptibility profile of Candida spp. isolated from patients in cancer therapy

OBJECTIVE

This study determined the prevalence of Candida spp. in the saliva of cancer patients. Furthermore, we assessed the antimicrobial activity of mouthwashes against the isolated strains and its susceptibility to amphotericin B and fluconazole.

METHODS

Thirty-four cancer patients undergoing radiotherapy, chemotherapy alone or combined treatment were investigated for oral Candida spp. colonization and compared in regard to mucositis presence. The maximum inhibitory dilution was used to assess the antimicrobial activity of Periogard®, Cepacol® Cool Ice and 0.12 % Chlorhexidine Digluconate mouthwashes against the isolates. In parallel, susceptibility to amphotericin B and fluconazole was determined by agar-based E-test. Data did not adhere to normal distribution as inferred by the Shapiro-Wilk test and statistical analysis was conducted by non-parametric McNemar test (α0.05).

RESULTS

Twenty-seven participants (79.4 %) were male, 19 (55.9 %) had mucositis and 9 (26.5 %) were colonized by Candida spp. 12 different strains of Candida spp. were isolated, being Candida albicans the most prevalent strain. Risk of Candida spp. colonization was increased by almost twofold among the participants with mucositis (odds ratio: 1.84; 95 % confidence interval: 0.37-9.07). Mouthwash Cepacol® Cool Ice presented better antimicrobial activity against Candida spp. while 0.12 % Chlorhexidine exhibited the worst activity. All strains were sensitive to amphotericin B, and 2 non-albicans strains were dose-dependent sensitive to fluconazole.

CONCLUSION

Considering the increased risk of colonization byCandida spp. in patients with mucositis, and the emergence of antifungal drug resistance, the antiseptics use could benefit the maintenance of cancer patient's oral health.

Microbial Contamination and Disinfection of Sport Mouthguard: In Vitro Study

Mouthguards in Ethylene Vinyl Acetate (EVA) should be sanitized to prevent alteration of oral microbiota. The present study determined, in vitro and by SEM observation, the decontaminating effect of different substances on EVA mouthguards previously contaminated with saliva and broth culture of Enterococcus faecalis ATCC 29212 and Candida albicans CH 34 (clinically isolated). Subsequently, the mouthguards were subjected to the following treatments: (A) Untreated; (B) 5 min with sterilized distilled water (H₂O d); (C) 5 min with H₂O₂; (D) 5 min with a physiological solution; (E) toothbrush and fluoride toothpaste; (F) 5 min with 0.5% NaOCl; (G) 5 min with Oral Care Foam™; (H) 5 min with Bite Sept™. The highest efficacy against E. faecalis was demonstrated by H₂O₂ (84.19% bacterial load reduction). H₂O₂ and Oral Care Foam™ showed a greater reduction of salivary cell load. The highest efficacy against C. albicans was demonstrated by 0.5% NaOCl which caused a 92.95% reduction of cell load. In conclusion, hydrogen peroxide, 0.5% sodium hypochlorite and the solution Oral Care Foam™ allowed to obtain an optimum disinfection of the mouthguard. SEM observation showed that different substances demonstrated a decontaminating effect decreasing the microbial communities on the EVA surface.

Evaluation of toothbrush disinfection via different methods

The aim of this study was to compare the efficacy of using a dishwasher or different chemical agents, including 0.12% chlorhexidine gluconate, 2% sodium hypochlorite (NaOCl), a mouthrinse containing essential oils and alcohol, and 50% white vinegar, for toothbrush disinfection. Sixty volunteers were divided into five experimental groups and one control group (n = 10). Participants brushed their teeth using toothbrushes with standard bristles, and they disinfected the toothbrushes according to instructed methods. Bacterial contamination of the toothbrushes was compared between the experimental groups and the control group. Data were analyzed by Kruskal-Wallis and Duncan's multiple range tests, with 95% confidence intervals for multiple comparisons. Bacterial contamination of toothbrushes from individuals in the experimental groups differed from those in the control group (p < 0.05). The most effective method for elimination of all tested bacterial species was 50% white vinegar, followed in order by 2% NaOCl, mouthrinse containing essential oils and alcohol, 0.12% chlorhexidine gluconate, dishwasher use, and tap water (control). The results of this study show that the most effective method for disinfecting toothbrushes was submersion in 50% white vinegar, which is cost-effective, easy to access, and appropriate for household use.

Contaminated tooth brushes-potential threat to oral and general health

BACKGROUND

Tooth brushing is most common method of maintaining oral hygiene. In removing plaque and other soft debris from the teeth, tooth brushes become contaminated with bacteria, blood, saliva and oral debris. These contaminated tooth brushes can be a source of infection.

AIMS AND OBJECTIVES

The aim of the present study was to evaluate the presence of microorganisms in the tooth brushes and to investigate the effect of disinfectants such as chlorhexidine gluconate, sodium hypochlorite and water to decontaminate them.

MATERIALS AND METHODS

Twenty-one children were asked to brush their teeth for 5 days with a tooth brush. The tooth brushes were put in Robertson's Cooked Meat broth and were observed for growth of Streptococcal microorganisms. These tooth brushes were then placed in disinfectants such as 0.2% chlorhexidine gluconate (Group I), 1% sodium hypochlorite (Group II) and water (Group III) for 24 hrs and then cultured again. Reduction of growth of microorganisms was seen in Group I, Group II and remnants of growth seen in Group III.

CONCLUSION

We conclude that the use of disinfectant for a tooth brush is a must for every individual at least at regular intervals.

Knowledge and behavior of dentists in a dental school regarding toothbrush disinfection

The aim of this study was to evaluate the knowledge and behavior of dentists regarding toothbrush disinfection. This study included 147 dentists (88 women and 59 men) who were actively employed at a dental school in Ankara, Turkey. Participants were asked to fill out a standard questionnaire, which contained questions regarding their demographics, brushing habits, toothbrush storage and disinfection habits, toothpaste use, knowledge about toothbrush disinfection, and whether they advised their patients about toothbrush storage. Descriptive statistics were calculated, and statistical analyses were performed with t-tests, chi-squared tests, and Fisher exact tests, where appropriate. Among the 147 surveyed dentists, 62.6% and 85.7% reported that they did not have any knowledge about toothbrush disinfection and did not disinfect their toothbrushes, respectively. However, approximately two thirds of surveyed dentists thought that toothbrush disinfection should be performed by everyone, including healthy individuals. Significant associations were found between knowledge about toothbrush disinfection and the professional title of dentists, how they stored their toothbrushes, and whether their toothbrushes were in contact with each other during storage (p < 0.05). A minority of dentists reported that they disinfected their toothbrushes.

A microbiological assessment of the oral hygiene of 24-72-month-old kindergarten children and disinfection of their toothbrushes

BACKGROUND

The objective of this study is to assess the index of decayed, missing and filled teeth (DMF-T), habit of brushing teeth, and the microbiological agents accumulating on the children's toothbrushes for 4 weeks and response of these agents to disinfection via a chlorhexidine solution, then compare those results with the education and income levels of the children's parents.

METHOD

Included in the study were 187 children (96 in the control group and 91 in the experiment group - chlorhexidine) chosen randomly from 600 kindergarten children whose ages ranged from 24 months to 72 months. The children selected had not taken any antibiotics, antimicotics for three months and dental treatments during this trial. The distribution of these children to the groups was also done randomly. After performing a survey for the education, occupation, and income status of the parents, the children were examined and the number of decayed teeth was recorded. The children were given toothbrushes, toothpaste (with fluroide), and the solutions (including distilled water and chlorhexidine) for four weeks under the condition that toothbrushes were returned at the end of each week. The 14 different microbiological agents observed as a result of the assessment of the samples taken in the first week were also included in the assessments of the samples taken over the four-week period.

RESULTS

The decrease in the DMF-T index was found to be meaningful according to the differences in education, income, and occupation status of the parents. Of all the samples taken from the toothbrushes, the bacteria with the greatest rate of reproduction included Streptococcus mutans, Escherichia Coli, Pseudomonas aeuroginosa, Enterococcus spp, Staphylococcus epidermidis and Candida albicans. Except for Candida albicans, the other microorganisms taken as samples from the toothbrushes reproduced less overall. In the group using the solution with chlorhexidine, a meaningful decrease in bacterial reproduction was discovered compared to the control group.

CONCLUSION

The findings of this study show that the education, occupation, and socioeconomic situations of the parents should be considered when discussing children's oral and dental health. Moreover, the study shows that disinfection of toothbrushes in order to prevent reinfection and contamination oral flora with the bacteria again is important in terms of preventive medicine and family-children health.

Effectiveness of alternative methods for toothbrush disinfection: an in vitro study

OBJECTIVE

This study aimed to evaluate the effectiveness of alternative methods for toothbrush disinfection.

METHODS

Two-hundred eighty toothbrushes were included in the study. The toothbrushes were divided into 7 groups and were contaminated by standardized suspensions of Lactobacillus rhamnosus (L. rhamnosus), Streptococcus mutans (S. mutans), Staphylococcus aureus (S. aureus), and Escherichia coli (E. coli). The following disinfectants were tested: 1% sodium hypochlorite (NaOCl), 100% and 50% white vinegar, microwave (MW) oven, ultraviolet (UV) sanitizer, and mouth rinse-containing propolis (MCP). Data were analyzed with Kruskal Wallis and Dunn's tests.

RESULTS

Statistically significant differences were found between different methods and control group for all tested bacteria. There were statistically significant differences between all test groups for all microorganisms. MW was the most effective for L. rhamnosus and 100% white vinegar was the most effective method for S. mutans and S. aureus. NaOCl was the most effective for E. coli.

CONCLUSION

This study showed that 100% white vinegar was considered to be effective for tested microorganisms. Similarly, 1% NaOCl is cost-effective, easily accessible, and comparatively effective for toothbrush disinfection. Because these agents are nontoxic, cost-effective and easily accessible, they may be appropriate for household use.