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USA Today Health News Reports Your toothbrush may be a biohazard

April 27, 2000

By John Morgan
With medical adviser Stephen A. Shoop, M.D.
A Doctor In Your House.com

The most serious threat to your everyday health may be hanging in plain sight in your bathroom.

It may come as a shock, but if you're like most people, every time you put your trusty toothbrush in your mouth, chances are you're giving a gang of nasty germs a free ride straight into your system.

"Let me make it perfectly clear that in no way should this be construed to mean you shouldn't brush your teeth. You absolutely should," advises Dr. R. Tom Glass, a leading research authority on toothbrush hygiene and professor emeritus of oral pathology at the University of Oklahoma Health Sciences Center. "But if it's not cared for properly, your toothbrush is a substantial health risk, with the razor blade being a close second."

A substantial amount of research confirms that a variety of bacteria and viral agents can survive for substantial periods of time on your toothbrush. Among these microbes are influenza viruses, herpes simplex I, streptococcus, staphylococcus, candida, gingivalis and bacteroides that causes gum disease.

"Your toothbrush is the perfect breeding ground for these bugs," says Glass. "There's food and water, and the brush itself provides the portal of entry into your body." In effect, "Your toothbrush is an enriched petri dish on a stick."

Toilet brush?

"To make matters worse, we keep our toothbrush in the outhouse," reveals Glass. "The bathroom may be inside now, but it is clearly the most unsanitary room of the house. Every time you flush, you propel the germs in your toilet into the air where they can land on your nice, wet toothbrush."

And if you think hanging your toothbrush in the medicine cabinet is a solution, think again. Germs like dark, wet, warm environments even more than the open air.

Studies have demonstrated that toothbrushes become infected sometime after one week of use, but before one month. As a result of his research, Glass advises that you replace your toothbrush with a new one every two weeks.

This recommendation is at odds with the American Dental Association's counsel that toothbrushes should be changed "every 3-4 months or sooner if the bristles become frayed." Most Americans don't even do that, replacing their brushes on average only twice a year.

But Glass's research reveals that 66% of the initially rounded bristles of your toothbrush become pointed, "tiny little needles" in as little as two weeks of use. The sharp tips can cause tiny lacerations in the gums that allow infections to enter the body. Electric-powered brushes with old bristles can make matters even worse because they're harder on gums.

"It's almost impossible to determine how many people are getting sick from their toothbrushes, but in my practice I've found that just changing the toothbrush alone can reduce the disease process in 25% of my patients," says Glass. "I take all my patients suffering from chronic infectious diseases off their electric toothbrushes to prevent them from re-infecting themselves."

And because family members sometimes forget to change heads on their power brushes, cross contamination can occur, especially when someone in the household is sick.

Even worse, whether ill or not, the family may not be the only ones using your brush. According to Glass, pets - particularly cats - as well as cockroaches and even rats can be attracted to the food and water trapped on the brush.

Existing scientific research clearly shows that infectious agents like the influenza and herpes viruses can thrive for significant periods on a toothbrush. In one study, herpes had only decreased by 50% after one week of being introduced to the brush.

But strangely, the ADA "does not think it necessary for consumers to change their toothbrushes after recovering from a cold or other infectious disease." According to their official Web site, detergents in toothpaste kill microorganisms that may linger on the bristles between brushings.

But Glass's findings don't support that contention. "No one has ever refuted any of my science, and I stand by it," he counters. "I'd like to review their research."

Put your money where your mouth is.

While changing your brush every two weeks may seem like an unnecessary expense to some, Glass points out that antibiotics to treat periodontal infections cost easily as much or more. The cost of buying a couple dozen new toothbrushes each year also pales in comparison to the money you can spend treating more serious illnesses such as heart disease, stroke, diabetes, ulcers, and pneumonia - all of which have significant correlations to gum disease.

And if you think you're safe just using a new toothbrush, you may be dismayed to learn that in one study four out of five brand new brushes straight out of the package were already contaminated with staphylococcus epidermidis.

So what can you do to minimize the health hazards of a contaminated toothbrush?

Unfortunately, microorganisms are not effectively killed by such techniques as soaking the brush in antibacterial mouthwashes or cleaning the brush in a dishwasher. And methods that do kill the requisite number of microbes, such as boiling and microwaving, generally render the brush unusable.

According Glass several studies have proven that, "the most successful way to eliminate bacteria and viruses from your brush is ultraviolet light." He has tested two products featuring this technology: the Pollenex Daily Dental Sanitizer and the Purebrush Antibacterial Toothbrush Purifier.

While the Pollenex product was effective in killing microorganisms, it is not currently available. That leaves the Purebrush device, which costs $79.95 and works with any toothbrush (manual, electric or sonic). Studies show it effectively kills any germs left after brushing and rinsing, and it protects the brush from airborne or other opportunistic contaminations.

After extensive research on toothbrush hygiene, Glass has signed on as medical advisor to Purebrush. He stresses that he does not profit from sales. "With UV sterilization you won't have to worry about contamination, but you should still change your brushes every two weeks to avoid creating portals of entry."

Toothbrush tips.

But not everyone can afford to purchase an ultraviolet light system or even replace their high-tech toothbrush every fortnight. So here are some general recommendations to help avoid "brushborne" germs:

Don't keep your brushes in the bathroom. Store them in the open air in the bedroom, the cleanest room in the house.

Every family member should have a clearly identifiable, color-coded brush to avoid cross contamination.

Transparent or translucent colored brushheads seem to resist contamination better than opaque or solid colored brushheads. The reason for this is unclear, but it may be that natural UV rays travel more freely through non-opaque substances.

Brushes with less dense configurations of bristles, such as two- and three-row brushes, are generally more germ resistant than those with four and five rows.

When traveling, always use a new toothbrush, and replace it after the trip. Studies show that the cheaper your hotel room is, the greater the amount of germs in the bathroom.

Brushes should be changed at the beginning of an illness and after you feel completely better.

In general, it's better to buy a bunch of cheaper brushes and change them more often than to spend so much on a fancy brush that you feel you should keep it around. "You should think of it like disposable contact lenses," explains Glass. "Your toothbrush isn't a lifelong friend."

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