Commentary

The average mouth is teeming with bacteria so it is not surprising that toothbrushes become contaminated with bacteria. The question is, is this contamination of significance? The authors of this review have addressed this question from the nursing perspective looking to assess whether there is a risk of disease transmission in the hospital and community setting. Recently there has been significant interest in the role of oral hygiene in the prevention of ventilator-associated pneumonia (VAP). For example a basic search using the terms ‘oral hygiene' and ‘ventilator associated pneumonia’ on Medline had 89 hits, mainly from the nursing literature, including a number of reviews.1,2Therefore this interest in the humble toothbrush is perhaps not surprising. What is surprising is the limited number of studies that were identified from what was a broad search of a number of databases.

The largest included study examined 103 toothbrushes, the smallest three, and the findings were discussed qualitatively owing to the heterogeneity of the available studies.

The recent interest in the importance of good oral hygiene in relation to VAP, and the focus of attention on hospital acquired infections highlights the importance of clear recommendations both regarding appropriate oral care for hospitalised patents of any age, particularly in view of recent systematic review highlighting the negative impact of hospitalisation on oral health,3 and the storage of toothbrushes in hospital environments. While storage issues for toothbrushes of healthy adults in the community may not be a particular concern, perhaps consideration should be given to the needs of the frailer members of the community. However while this review does give some indication of a potential risk this is a long way short of an actual risk and more research is necessary to elicit this.