Toothbrushing: Infection contol in the school setting

Infection control practices, though, may be missing from the lunchroom

I walked into the school cafeteria. It looked like a plume of dust was rising. It wasn’t until I heard that familiar tune, “Well, you wake up in the morning. It’s a quarter to one and you wanna have a little fun. You brush your teeth…” that I realized what was happening. Over a 100 children who just finished lunch were brushing teeth all at once. Two boys were “dulling” toothbrush swords. Two girls declared they were trading toothbrushes; one wanted the Trolls toothbrush and the other one wanted the Minnie Mouse toothbrush.

The intention of this afternoon brushing program was noble; the action may be doing more harm than good.

I discussed the issue with the school nurse and soon found out that many times not even the school nurse is aware of the contagious nature of dental diseases. I gave the nurse the example of dental caries. I explained this is the simple most common chronic childhood disease. It is a contagious infectious disease. Family members, caregivers, and even playmates can transmit caries producing oral bacteria. This can happen by sharing a spoon, kissing, and even wiping off a pacifier that has fallen on the ground in the mouth.1,2,3 The nurse was shocked. She said she had no idea.

In the school setting, the Centers for Disease Control and Prevention takes a strong stand in this area on the need for both a protocol and a high level of supervision. They state that the likelihood of toothbrush cross-contamination in the school setting in toothbrushing activities is very high. Improper storage and children’s behavior can have a big impact. There is also a small chance exists that toothbrushes could become contaminated with blood during brushing (gingivitis, trauma, etc.).4