Clinical Studies
An Infection Control Procedure That Is The Patients Responsibility
- Mary Zolnowski-Casey, D.D.S.
Not immediately recalling anything specific, I looked at the toothbrush boxes to see what the manufacturers recommended. Nothing. Even my dinnerware comes with more information on upkeep and hygiene. What followed was the topic my daughter has been looking for her sixth-grade science fair project. Which method cleans a toothbrush best?
SPARSITY OF PUBLISHED INFORMATION
As part of the research for her project, my daughter performed a
MEDLINE search on toothbrush hygiene. Out of more than 16,000
articles about toothbrushes, she found only two articles pertaining
to sanitization. One article recommended use of a sanitizer that
uses an ultraviolet light to decontaminate the brush. This device
may be in your office, very likely is not in your home. The other
article tested various mouthwashes in a bath to disenfect the
toothbrush. How many of us know what type of mouthwash t o use or
what the recommended soaking time is? (The study found that soaking
the toothbrush in Listerine {Warner-Lambert Co. } for 20 minutes was
the most effective procedure.)
I strive to prescribe reasonable
and effective treatments for my patients so that under the "keep it
simple" principle, these treatments will become part of their
rtoutine care. Only the most health-compromised patients would
probably consider buying a sa nitizer. The mmouthwash soak is a
fairly reasonable idea if one has from 20 minutes to two hours free
in the morning or evening. What can we do now, at home, to clean and
sanitize our toothbrushes?
Think of the procedures and materials
we use in our offices: chair disinfection, plastic wrapping, counter
decontamination, enclaving, gloves, goggles, and masks. Yet we are
satisfied with only rinsing our toothbrush when we get home. Which
infection cont rol guideline does that satisfy?
For the science
fair project my daughter tested four at-home cleaning
methods;
- rinsing only;
- soaking in boiling
water;
- soaking in dishpan soap;
- washing in a
dishwasher.
RESULTS
Using agar dishes to culture the results of each claning method, my daughter found that the dishwasher was the most effective method of cleaning toothbrushes. It sustains a higher heat for a longer period of time than anyone can tolerate while hand-washin g dishes. If you consider the dishwasher to be better for your forks than hand washing, isn't it also better for your toothbrush? If a dishwasher is not available, hot water and dishpan soap are the next best choice.
Boiling water was more damaging to the brushes than were the
other methods: they bent and warped, but were clean. The dishwasher
was, in fact, kinder to the brushes over the normal life of a
toothbrush, which I remember is about three months. Which was th e
worst method to clean the toothbrush? Rinsing. Even if the brush has
been used only one time, rinsing alone is not going to clean
it.
A few other interesting results came out of this experiment.
We found that the toothbrush should be cleaned after every use, and
why not? That is the routine protocol in my office for any
instrument. The toothbrushes in our home are now color-coded, with
each family member having his or her own assigned color. We each
have three or four toothbrushes to rotate in case the dishwasher
doesn't get unloaded in time for the next use. Only cleaned brushes
go into the bathroom.
Interestingly, even when one of us gets a
cold, it doesn't seem to linger. My children haven't missed any
school since we began this protocol. It is not all due to this
cleaning procedure, but also the awareness of our own infection
control responsibilities.
So Megan won her science fair project.
She then went on to win first place in the junior division at the
42nd Southeast Wisconsin Science and Engineering fair held at
Marquette University. She also was awarded the Wisconsin Society of
Periodontists Award for Excellence in Table Clinic Dental Hygiene at
the 126th Annual Session of the Wisconsin Dental Association. All of
this in search of an answer to a simple question: Which method
cleans a toothbrush the best?
Dr. Zolnowski-Casey is in general practice in Codahy and Waterford, Wis
Dr. Tom Glass' Clinical Response To Dr. Zolnowski-Casey's Article
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