SEM images comparing new and used toothbrush bristles (Used with permission from Applied Science Accessed April 25, 2016).

Toothbrushes have been shown to harbor bacteria (including fecal coliform bacteria that can be released into the air when the toilet is flushed or can be spread to the toothbrush when the owner touches a contaminated surface before handling his or her brush).10  While toothbrushes have been shown to harbor bacteria, there is no evidence that these bacteria cause adverse health effects.  Nonetheless, some patients may be interested in sanitizing their toothbrushes.  While there is little data in the literature regarding toothbrush sanitizing, one study indicates that soaking a toothbrush in 3 percent hydrogen peroxide or Listerine mouthwash greatly reduces (i.e., 85 percent) bacterial load.11  Microwaving or putting toothbrushes in the dishwasher is not recommended as such high heat may damage the brush.  Toothbrush sanitizer devices are available. Patients should look for a device that has been cleared by the U.S. Food and Drug Administration (FDA).

A myriad of toothbrush head design options are available.12 One systematic review found that toothbrushes with either multi-level bristles or angled bristles perform better than the conventional flat-trimmed bristles in removing plaque.13 Although toothbrushes with medium bristles have been shown to be effective at biofilm removal, the ADA recommends use of a toothbrush with soft bristles because they minimize the risk of gingival abrasion.6

The ADA Seal Category section on ADA.org provides a list of manual toothbrushes that currently have the ADA Seal of Acceptance. The Seal of Acceptance indicates that the toothbrush is both safe and efficacious for the removal of plaque and reduction of gingivitis. In addition, ANSI/ADA standards are used for testing the safety of manual toothbrushes.14

If a toothbrush differs significantly from previously accepted toothbrushes, the Council may request clinical studies to demonstrate that the toothbrush could be used without supervision by an average adult to achieve a significant decrease in mild gum disease and plaque over a 30-day period.14

Department of Scientific Information, Evidence Synthesis & Translation Research, ADA Science & Research Institute, LLC.

Content on the Oral Health Topics section of ADA.org is for informational purposes only.  Content is neither intended to nor does it establish a standard of care or the official policy or position of the ADA; and is not a substitute for professional judgment, advice, diagnosis, or treatment.  ADA is not responsible for information on external websites linked to this website.