Toothbrushes have been used as therapeutic devices for hundreds of years in the prevention of the two major dental diseases: dental caries and periodontal disease. In the 1980’s while treating recurrent oral infections and ulcerations, Glass and his co-workers discovered that the same microorganisms that were cultured from the patients’ infections were also found on their toothbrushes. A host of both in vitro and in vivo studies followed which showed that bacteria and yeasts not only contaminated the toothbrush, but also could proliferate there, especially in the moist, dark environmental of the bathroom.

These investigators also were able to demonstrate that viruses such as Herpes simplex could contaminate toothbrushes, could be retained for more than seven days, and could cause infection. A blind study of toothbrushes from HIV positive and negative individuals demonstrated that HIV pro-viral DNA could be found on the toothbrush of HIV positive patients and therefore, could be a potential risk for disease transmission.

One of the most important studies was a triple crossover study of transmission of disease by the toothbrush in dogs. Dogs’ teeth were brushed each day for a month with new sterile toothbrushes; new sterile toothbrushes that had been contaminated with a known microorganism; and repeated brushing with the same toothbrush. These studies showed that both local and systemic transmission was greatest with repeated brushing with the same toothbrush. Additional studies showed that end rounding of toothbrush bristles broke down after only a week of use so that the toothbrush could easily infect the soft tissue of the oral cavity and be injected in the blood stream.

The importance of the toothbrush studies will be presented in the light of not only local dental disease but also its effect on the heart and vascular system. The toothbrush will also be considered in its possible role as a bioterrorism instrument by considering the anthrax issue. Most importantly, recommendations will be made regarding toothbrush care and disposal, based on scientific evidence.

While toothbrush transmission was being examined, similar studies were being conducted on methyl methacrylate dentures and dental appliances. These studi0es show a wide range of both pathogenic and opportunistic microorganisms. These microorganisms could not only produce oral diseases but also systemic diseases. The results of these studies will be considered; and more importantly, recommendations will be made on denture care, again based on scientific evidence.

Because the American Dental Association has advocated that athletic mouthguards be worn in contact sports, the recent research by Dr. Glass and his co-workers on these devices will be considered. Studies of mouthguards from hockey players revealed different microorganisms from those of football players. The implications of mouthguard wear and possible disease production will be considered. Mouthguard use and are will be discussed. Finally, disease transmission by cosmetic devices will be considered.

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