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The ANTI-INFECT dental spray

The toothbrush – Source of infection by accumulation of pathogen germs

Experts know about the risk of bacteria, viruses and fungi on the toothbrush. So German professional journal „Deutsches Ärzteblatt“ quotes a study from 2008 which determines that due to daily dental care oral bacteria can be detected in the blood. The contamination of toothbrushes by bacteria of the oral flora and by pathogen bacteria, viruses and fungi has already been proven years ago.
Despite thorough care toothbrushes, braces, splints and dentures shelter various pathogens. In bathrooms these germs do not have to come only from the user himself, they also can come from a third party. The reason: a saliva aerosol produced by brushing the teeth diffused through the air, dispersing germs. The moist toothbrush does hardly dry in a damp room so these germs can reproduce optimally. Streptococci like streptokokkus mutans as germs for caries and parodontitis, a-streptocci causing scarletina, the oral thrush agent candida albicans, viruses like influenza, herpes and hepatitis can be detected even on thorougly cared toothbrushes.
A toothbrush is kept in a damp room, causing especially the bristles at the brush´s bottom to dry slowly. This is a significant weakness concerning hygiene. A long period of use even prolonges the time of drying due to single bristles getting micro crazes. In consequence the number of germs on the toothbrush increases. Drying between the bundles of bristles is even  slower, so biofilms containing pseudomonads, klebsiellae and enterococci can occur. It´s therefor probable that the spectrum of pathogens on the toothbrush is not identical with the user´s oral cavity.

The oral cavity is the most relevant gate for extraenous germs, so normally its defence mechanism works very effectively. But this only applies to healthy humans. As soon as the immune defence is weakened, the oral cavity is passable for pathogens. So persons who have just had surgery (also dental patients!), persons having acute diseases or chemotherapy have to be strictly protected against germs on toothbrushes, braces and dental protheses. The same applies to pregnant women who shelter the unborn child.

Even bacteria causing caries is transferable

An ideal example is streptococcus mutans: this bacteria causing caries is transferable. Often parents infect their own babies: First mothers and fathers transfer the bacteria by licking off pacifiers, spoons, etc. and then giving them to their children. Followed by a poor oral hygiene with bacteria charged toothbrushes, the reinfection is quite likely. Microorganisms can deposit on the teeth´s surface again and again, just a few hours later first colonies form. After a few days these become fully developed dental plaque which forces the danger of caries. Especially the area of the bristles at the toothbrush´s heading presents an optimal surrounding for the development of biofilms (low flow of liquid, fermented carbohydrates and proteins). Finally this leads to a significant source of reinfection after oral cleansings and surgery.

Especially hazardous: the presence of biofilms on the toothbrush

The occurence of plaque (and finally calculus) plays a decisive role concerning the development of diseases in the oral cavity. Plaque is a specific dental form of biofilm that appears naturally as a symbiosis of bacteria, viruses and fungi. Bacteria of this biofilm are a thousand times more resistant against external influences than bacteria not having this organisational combination of pathogens.
Likewise plaque is a source for general and chronic infections in the oral cavity. Streptokokkus mutans and sobrinus just need a few hours to create a biofilm which cannot be rinsed off anymore. Glycoproteins from the saliva cover the teeth and hence form a basis for the colonialisation and organisation of streptococci. This biofilm presents no bacterial balance unlike the rest of of the oral cavity. The germs of the biofilm are pathogen, causing diseases. Furthermore these germs can exchange their genes, creating new, highly virulent / infectious types.

Hospital germs on the toothbrush

Not only experts are interested in the topic of nosocomial infections (NI). German quality newspaper´s „Welt am Sonntag“ headline of 21st of August 2011 was „Deadly germs: sick through hospitals“, popular TV channel ZDF broadcasted the documentary „When hospitals make you sick“ at primetime in the beginning of September 2011 and famous talkshow host Nina Ruge discussed about „The underestimated threat: sick due to in-hospital germs“.

What are nosocomial infections?

NI are infections received in hospitals, clinics and other institutions of health care. These so called in-hospital infections not only lead to additional distress of the patients and their relatives, they also increase the expenses significantly. Primarily NI causes urinay tract infections (40%), respiratory diseases (20%), post-operational infections of the wound (15%) and primary sepsis (8%).

How wide is the dimension of nosocomial infections?

Robert-Koch-Institut assumes that there are at least 500,000 to 800,000 cases of NI per year in Germany.  Various sources indicate a mortality rate of 15,000 to 30,000 per year – which doubles e.g. the mortality risk of surgical patients when they get in-hospital infections. Gastmeier/Geffers of Berlin Charité number a lethality of 2.6% which leads to at least 10,000 to 15,000 deaths due to nosocomial infections a year (annual average of 38 to 86 or rather 3 to 7 a month). Concluding the deaths due to NI outnumber the number of traffic deaths significantly!
The European Centre for Prevention and Disease Control (ECDC) estimates the number of nosocomial infections to 3 million a year for the whole of Europe, 50,000 of them being lethal. Additionally experts complain a high number of unreported infections, due to the fact that statistics are often based on material of high standard hospitals.

How do NI occur?

The progress in modern medicine allows more and more operations as well as invasive diagnostic and therapeutical methods (e.g. catheter, respiration, dialysis) in order to prolong life. These methods increase the risk of agents entering the body or they influence the immune system negatively. Moreover patients become older, they have developed a diminished defense system or rather an antibiotic resistance. So the occurance of NI is gaining signifcance.
The sourrounding of a hospital itself supports the spread of nosocomial agents through e.g.  non-desinfected hands of the personnel and contact to other patients. Today´s medical staff has a large variety of tasks to fulfill, less time for their own hygiene is sometimes a consequence. Though the harm should not be underestimated, every known case of an in-hospital infection affects the reputation of the institution. Especially accumulations of infections, possibly being published by the local press, ruin the standing of a hospital.

Which costs do NI cause?

An infection prolonges the patient´s stay, additional diagnostics are due, operations, medical treatments or other therapeutical actions are necessary. Considering the costs, the prolonged stay is the most consuming effect. Germany´s Robert-Koch institute numbers the prolonged stay due to NI for pneunomia 5 to 25 days, for primary sepsis 5 to 8 days and for post-operational infections of the wound 6 to 24 days. Average hospital costs per NI case are estimated to 10,000 euro. A British study concerning the socio-economic cosequences calculated an increase of 2.8 times higher hospital costs. For Britain this leads to additional hospital costs of 930 mio. pounds a year.
Evaluations calculated an economic charge in the USA due to nosocomial infections of 4.5 bil. USD, this study also regards indirect costs like the loss of productivity (temporarily or permanently) and decreasing tax revenues. The prevention of NI is appealing for every single clinic, because since the implementation of lump compensation additional costs for the hospital are not compensated.

Which actions help against NI?

The prevention of NI is proven in the Netherlands: The infection rate there is only 0.6% compared to 3.5 to 5% in Germany. The hospital´s hygiene is in predominant focus and more budget is spent on the prevention of NI. This includes hand disinfection, vaccination of the staff, isolation of infectious patients, strict control of antibiotic usage and the cleaning, disinfection and sterilisation of instruments, equipment und surrounding of the patient.
Especially the disinfection of surfaces is the basis for hygiene concepts. But sometimes
„a bit“ is ignored – also the head of a toothbrush has an considerable surface area. Together, the roughly 3,000 bristles of a toothbrush have a surface area of 150 square centimetres, making them an ideal source of transmission for nosocomial infections, particularly as proteins, sugar molecules and moisture in the gaps between the bristles provide an ideal environment for bacterial growth.
Germ-containing aerosols are released when people brush their teeth. These settle in closed rooms, again leading to the colonisation of surfaces on inanimate and animate objects within the rooms. The routine use of toothbrushes additionally plays a major role in this context: The contact between the bristles and the hand inevitably leads to the transmission of further (hospital) germs to the toothbrush, resulting in additional potential for colonisation by nosocomial bacteria, fungi and viruses.
Hygiene expert Dr. Widulle stresses that the second-most important prevention of NI next to hand disinfection is the the replacement or disinfection of the toothbrush. However single-use toothbrushes are often seen as too hard or soft and impersonal. With their own toothbrush many patients take a piece of “home” into the clinic. The daily replacement of a quality toothbrush is expensive; a central disinfection of all patient´s toothbrushes also seems very inefficient, causing logistic complexity. Therefore a regular disinfection of the toothbrush with the anti-infect dental spray offers a reasonable prevention against NI.

Even at home: cold and influenza viruses wandering

The first one caught it, the rest of the family will follow – colds and flues are transferred in form of droplets by coughing, sneezing, etc. but also via the toothbrush. Two brushes next to each other in the mug is enough – viruses can wander without any problems, the toothbrush is contaminated. And exactly this brush man, woman and child are using over and over again. Same problem occurs with „borrowed“ toothbrushes from others.

Herpes viruses are really tough

Herpes-simplex-viruses are exceptionally tough: even after seven days toothbrushes kept in  bathrooms (an environment with a high air moisture) still show half of these infectious pathogens.  The crux: once you have had herpes, you always get it again. The first infection often occurs without being realized in early childhood. This leads to the formation of V-anti-bodies as well as the pathogen´s masking and resettlement in the body´s tissue. If the immune system is weakened due to disease (e.g. a flu) or surgery, the virus is reactivated and can be transferred again. So it is essential for herpes infected persons to disinfect their toothbrushes permanently.

Thrush fungi infect dentures

Candida albicans are a fast kind: this noxious yeast fungus settles on the surface of dentures within one hour. Four hours later it has conquered all porous parts and after three more hours the prosthesis is covered completely. In order to prevent permanent reinfection a highly effective cleansing before wearing is needed. Otherwise thrush fungi can enter blood vessels and spread in the whole organism via blood stream. This would paralyze the body´s defense system step by step, halitosis and a white biofilm on the tongue, palate and gum are the first symptoms. Especially chronically sick and elder people are threatened by the systematic risk of a local candida infection.

Chronical infections of teeth and periodontium cause preterm births and underweight newborn children

Apart from direct threats of infections through viruses, fungi and bacteria, indirect consequences of a chronical inflammation of the mouth are hazardous: especially chronical infections of the periodontium cause an inflammation cascade influencing the complete mother´s organism. Due to changes within the immune system, the hormonal constellation, the changed blood circulation and form of the gum (the so called pregnancy epulis) as well as changes of the oral flora, inflammations of the mouth occur quite often. Particularly  gingivitis emerged before pregnancy can become chronical and activate a diversity of inflammations. Cytokines as agents of this cascade have been detected in the amniotic fluids of premature babies.  Studies show that a parodontitis can increase the risk of prematurities by 7.5 times.

How do dental infections affect the rest of the body?

Germs of an inflamed oral cavity can reach every part of the body via blood stream. People with a weakened immune system (elder people, chronically sick, infants, expectant mothers, chemo- and radiotherapy patients, people having immunesuppression against rheumatism and other autoimmune disorders, patients after transplantations) highly react to pathogens finally causing general infections. But also healthy, „immunecompetent“ people should not underestimate this problem of „bacteremia“:

  • So the daily brushing of the teeth can cause bacteria which can enter the blood and cause inflammations of heart valves which may lead to a permanent heart damage.
  • A chronical inflammation of the oral cavity weakens the immune system which promotes the development of further infections.
  • Vice versa unrecognized inflammations in other parts of the body can produce inflammations of the oral cavity. Examples are the enhanced risk of preterm births, the births of underweight children as well as the intoxication of pregnant women with chronical inflammations of the periodontium.
Which role does dental care play?

The head of a toothbrush has an considerable surface area. Together, the roughly 3,000 bristles of a toothbrush have a surface area of 150 square centimetres, making them an ideal source of transmission for infections, particularly as proteins, sugar molecules and moisture in the gaps between the bristles provide an ideal environment for bacterial growth. Germ-containing aerosols are released when people brush their teeth. These settle in closed rooms, again leading to the colonisation of surfaces on inanimate and animate objects within the rooms. The routine use of toothbrushes additionally plays a major role in this context: The contact between the bristles and the hand inevitably leads to the transmission of further germs to the toothbrush.
In order to prevent infections, regular toothbrush disinfection with ANTI-INFECT spray is recommended. Allow your toothbrush the disinfecting, germ-killing special cleansing with the ANTI-INFECT dental spray to prevent from bacteria, viruses and fungi.

Why disinfecting the toothbrush and not the oral cavity?

An antiseptic mouth rinse not only minimizes the amount of potential pathogen germs in the oral cavity but also the autochthonous germs which are needed for a functioning infection defence. A balance of germs in the mouth should be maintained for the local defence. The disinfection of the toothbrush on the other hand only reduces the amount of (potential) pathogen germs and supports a „bacterial homeostasis“.

How does ANTI-INFECT work?

ANTI-INFECT easily desinfects toothbrushes, dental braces and protheses. The spray's most important disinfectant constituents are chlorhexidine acetate (CHX) and ethanol. The bactericidal and virucidal effect after just 2 minutes has been confirmed in various experiments. The ANTI-INFECT spray differs from other disinfectants containing chlorhexidine acetate by virtue of its disinfectant concentration and the presence of ethanol. In the composition employed in the ANTI-INFECT spray, ethanol and 1.5% chlorhexidine have a virustatic and virucidal effect (particularly against herpes viruses and hepatitis B viruses), also displaying a bacteriostatic, bacteriocidal, fungistatic and fungicidal effect within the same time. The ANTI-INFECT spray acts against all human pathogenic germs of the oral cavity.

Why is a high acceptance of the ANTI-INFECT spray anticipated?

The reduction of infection rates depends mostly on the compliance regarding existing guidelines and the implementation of hygiene arrangements. In order to assure a high compliance of the users, ANTI-INFECT regards the simplicity of application, the time required for application and tolerance of the product concerned: The head of the toothbrush is sprayed for approx. 2 seconds, holding the spray head at a distance of approx. 2-5 centimetres. The spray head is so designed that the entire head of the toothbrush will be wetted, even if the user fails to observe the specified time and distance. The spray is applied around 2 minutes before using the toothbrush. Compliance is improved further, if the patient is informed about the connections between dirty toothbrushes, infections and chronic diseases.

Result

The prevention of infections and the associated decrease of infection rates avoid the personal harm of the patients. A major connection for the prevention of infections is given by avoiding the transmission of germs via the patient´s toothbrushes, dental prostheses and braces. Regarding this, ANTI-INFECT contributes considerably, because it…
… disinfects manual toothbrushes, heads of electric toothbrushes, dentures, braces etc. in a simple and effective manner
… reduces the risk of infections and reinfections
… offers simple handling and promises a high level of compliance
… fits in with the current health/self-care/body awareness trend.

Sources

Gastmeier/Geffers: Nosokomiale Infektionen in Deutschland: Wie viele gibt es wirklich? Deutsche Medizinische Wochenschrift 2008
Mielke (RKI, Berlin) / Exner (Institut für Hygiene und Öffentliche Gesundheit, Bonn): Ökonomische Aspekte nosokomialer Infektionen und ihrer Prävention (report)

Mins C, Dockrell HM, Goering RV, Roitt I, Wakelin D, Zuckerman M: Medizinische Mikrobiologie - Infektiologie mit Virologie und Immunologie, 2nd edition; Munich 2007

Robert-Koch-Institut (editor): Gesundheitsberichterstattung des Bundes, issue 8: Nosokomiale Infektionen

Rüden/Gastmeier: Rollen und Aufgaben der Hygienefachkräfte und des Krankenhaushygienikers unter besonderer Berücksichtigung von Kosten-Nutzen-Aspekten. Bundesgesundheitsblatt 4/2004

Sato et al.: Antibicobial spray for toothbrush disinfection: An in vivo evaluation. Quintessence International 2005; 36: p. 812-816

Süddeutsche Zeitung of 23.10.2008, p. 16: Dreckspatzen in Weiß. Ein Drittel aller Krankenhausinfektionen ließe sich vermeiden.

Wallhäußers Praxis der Sterilisation, Desinfektion, Antiseptik und Konservierung – Qualitätssicherung der Hygiene in Industrie, Pharmazie und Medizin, Thieme Verlag 2008