11 Gross Things That Could Be On Your Toothbrush

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Before you brush today, consider this: Poop is just the beginning of what could possibly be hanging out on your toothbrush.

1. E. COLI

Guess what? If your bathroom has the sink and toilet in one room, and you flush with the lid open, there is fecal matter on everything within a 5 to 6 foot radius. Flushing aerosolizes your poop, depositing bacteria like Escherichia coli, or E. coli, directly onto your toothbrush—and brushing with an E. coli-loaded instrument could make you sick. “This bacteria is associated with gastrointestinal disease,” says Dr. Maria Geisinger, DDS, an assistant professor and periodontist at the University of Alabama at Birmingham.

Gastroenteritis, or infectious diarrhea, is one such illness. “In bathrooms with a toilet attached, [researchers] looked at toothbrushes in normal use between one and three months,” Geisinger says. “At the three-month mark, they found E. coli colonies. That’s a good reminder to replace your toothbrush every three months.”

Once E. coli and the other bacteria on this list form colonies, they’re a lot harder to kill because “they start to make an extracellular matrix, which protects them from antimicrobial medicines that you might use in the toothpaste, mouthwash, and even antibiotics,” Geisinger says. “One of the reasons you can’t just take an antibiotic and say ‘oh good, my dental disease is cured’ is because they’re actually in a biofilm.”

The colonies on your toothbrush are similar to the algae that grows at the bottom of the pool, according to Geisinger. “Your pool is full of water—you can’t just swish it around and get that algae off,” Geisinger says. “It’s got to be scrubbed off because it’s protected by this extracellular matrix. In fact, complex biofilms have a circulatory system. So they’re almost like a living organism, composed of all this different bacteria.”

So make sure to flush with the lid down, which will greatly decrease aerosolization, and, therefore, the literal crap on your toothbrush. Also, be sure to wash your hands after you use the restroom and before you brush to avoid transferring fecal matter to your toothbrush that way, Geisinger says, and change your toothbrush every three months.

2. STAPHYLOCOCCUS AUREUS

This bacteria typically lives in your respiratory tract and on your skin, and, under the right conditions, can be responsible for some pretty nasty stuff. “It’s often associated with [antibiotic resistant] MRSA infections or necrotizing fasciitis, which is flesh-eating bacteria,” Geisinger says. Necrotizing fasciitis occurs when bacteria enters the skin through an open wound, and, according to the CDC, most often affects people who have other health problems that might hinder their bodies’ efforts to fight infection. Thankfully, this condition very rare, but you still don’t want the stuff that could cause it on your toothbrush.

3. STREPTOCOCCUS MUTANS

It makes sense that this bacteria would be on your toothbrush—it’s responsible for tooth decay. “But again, we’d like it not to be there,” Geisinger says. “You don’t want to take tooth decaying material from one area of your mouth and put it in another while you’re trying to do your due-diligence about removing deposits.”

Keeping bacteria and other nasty stuff to a minimum on your toothbrush could be as simple as what you buy. According to one study, “Toothbrushes with lighter or clear bristles retain up to 50 percent less bacteria than colored toothbrush bristles,” Geisinger says, potentially because clear toothbrush bristles have less porosity than colored ones. And instead of brushes with fancy perforated or rubber handles, opt for solid plastic handles which studies have shown “had less microbio load than larger or perforated or multi-surface handles [because there are] fewer nooks and crannies for the bacteria to hide in,” Geisinger says.

4. FOOD DEBRIS

That thing you had for dinner last night? Yeah, it’s probably still on your toothbrush the next morning … and now it’s food for the bacteria on there, too! (As are your poop particles. Yuck.) Avoid having unintentional leftovers and clear out bacteria by washing your brush before it goes in your mouth in potable tap water or antibacterial mouth rinse, Geisinger says.

5. AND 6. LACTOBACILLUS and PSEUDOMONAS

“These are two bacteria that have been associated with pneumonia type infections, particularly in hospital settings” where a patient is on a ventilator, Geisinger says. Though Lactobacillus is typically considered a “friendly” bacteria—it’s sometimes used to treat diarrhea and is present in foods and our own guts—it can also be linked to cavities and tooth decay. Pseudomonas can cause eye infections if you use contacts and don't clean them adequately.

Bacteria thrives on brushes that have frayed bristles, by the way, so Geisginer (and the American Dental Association) recommend replacing your toothbrush if the bristles are looking like they’ve seen better days—even if you haven’t hit the three-month mark yet.

7. HERPES SIMPLEX TYPE ONE

And now, a virus! “Herpes simplex type one used to be called oral herpes, but now almost 50 percent of genital lesions are also herpes simplex type one,” Geisinger says. “The viruses are different than bacteria because they come in little capsules, and they’re not technically alive—they need your cells to replicate. In a patient who has an active herpes outbreak, an oral cold sore, that virus can be retained on the toothbrush up to a week.”

Geisinger says she's not aware of any research into "the viability of the viruses on the toothbrushes," but says that transfer of a virus from one person to another by sharing toothbrushes is a possibility under the right circumstances. "HSV can be transmitted in saliva, so sharing toothbrushes during an oral herpes outbreak could lead to a higher risk transfer of viral particles and therefore disease," she says.

8. HPV

Another virus that can make a home on your toothbrush is Human papillomavirus, or HPV. “It’s linked to both cervical cancer and esophageal and oral cancers,” Geisinger says. “The interesting thing about HPV is that the presence of HPV in your mouth seems to decrease if you do a good job with toothbrushing.” And once again, if you share toothbrushes with someone who has HPV, you could be at risk for contracting it yourself. "Both viruses are transmissible in saliva," Geisinger says, "so viral transmission through shared toothbrushes is a possibility."

9. CANDIDA

This fungus is responsible for yeast infections and diaper rash. The most common species in the mouth is called Candida albicans, which causes oral thrush—basically, a yeast infection in your mouth. “[C. albincans] is linked to higher decay rates in kids,” Geisinger says. “In kids that have candida infections, about 15 percent have candida reservoirs on their toothbrush, and it can certainly be passed among siblings or other toothbrushes stored in the same area.” To keep candida from infecting multiple toothbrushes, make sure that the instruments are stored upright and away from each other.

10. MOISTURE

According to Geisinger, one of the worst things you have on your toothbrush is moisture because it encourages bacteria to grow. “There’s a precipitous drop in bacteria [on toothbrushes] after about 24 hours, and that’s really because the toothbrush dries out," she says. "So, if you can, having two toothbrushes is probably advantageous.” If you’re using a toothbrush just once every 24 hours, it will stay nice and dry, and bacterial loads will be low.

Another thing you shouldn’t do: Cover your toothbrush. “Even though it’s tempting because of the fecal matter from the toilet, covering toothbrushes or putting them in your medicine cabinet does not allow them to dry out,” Geisinger says. “Bacterial counts on those toothbrushes are considerably higher than on toothbrushes that are stored upright, separate, and allowed to dry completely.”

11. BLOOD

Up to 70 percent of adults in the United States have gingivitis, and about 47 percent of people over the age of 30 have destructive gum disease. "That means they have ulcerations or microscopic breaks in the tissue underneath the gum lines where they can’t see, which allows blood to get on the toothbrush,” Geisinger says. “It also allows a pathway for bacteria to get into the bloodstream. In patients with inflammation, bacteria in your bloodstream spike after things that would irritate those inflammations—including mastication, eating, toothbrushing, even a visit to your dentist to have a cleaning.” That’s how dental and oral bacteria end up in plaques that are associated with heart disease.

“The amount of bacteria in the bloodstream is actually proportional to how much inflammation and dental disease is present in the mouth,” Geisinger says. “Patients who are receiving regular dental care—that includes dental cleaning and exams—have improved levels of gingival inflammation, less blood in their saliva, and less blood on their toothbrush. So go see your dentist!”

This piece originally ran in 2016.

A Generic EpiPen Coming in Early 2019 Could Save You Money

Brand-name EpiPens at a Congressional hearing on the escalating cost of the drug in 2016
Brand-name EpiPens at a Congressional hearing on the escalating cost of the drug in 2016
Alex Wong/Getty Images

For an incredibly common, life-saving medication, EpiPens (epinephrine auto-injectors) are surprisingly difficult for many consumers to get ahold of. Their cost has skyrocketed in recent years from less than $100 for a pack of two to more than $600. They’ve gotten so expensive that some EMTs have resorted to using syringes to manually administer epinephrine rather than purchasing the standard auto-injectors, which are almost exclusively made by the pharmaceutical company Mylan. Generic options have been slow to come to market, but according to Business Insider, a recently approved EpiPen rival is coming in the first few months of 2019, and it could save consumers a significant chunk of change.

The drug’s developers have had an unusually hard time getting the new EpiPen alternative, called Symjepi, onto store shelves. The drug was approved in 2017, but the company, Adamis Pharmaceuticals, had trouble finding investors. Now, Novartis, the Swiss-based pharmaceutical giant that manufactures drugs like Ritalin, is releasing the drug through its Sandoz division (perhaps most famous for it role in discovering LSD in the 1930s).

Symjepi will cost $250 out-of-pocket for a pack of two doses. That’s 16.6 percent less than the Mylan-authorized generic EpiPen or Teva’s generic EpiPen, which both sell for $300. It differs a bit from its rivals, though, in that it’s a pre-filled, single-dose syringe rather than a spring-loaded auto-injector. Auto-injectors are plastic, pen-like devices that keep the needle shielded until the moment of injection, and are specifically designed to help make it easier for untrained (even squeamish) people to use in an emergency. With this version, patients will need to remove a needle cap and inject the needle. Just like the EpiPen, though, it’s designed to be injected in the upper thigh, through clothing if necessary.

If you have health insurance, the difference in cost may not matter as much for you as a consumer, depending on your plan. (I personally picked up a two-pack of Mylan-authorized generic Epipens at CVS recently for $0, using a manufacturer’s Epipen coupon to knock down what would have been a $10 copay.) But it will matter considerably for those with high-deductible plans and to insurers, which, when faced with high costs, eventually pass those costs on to the consumer either through higher co-pays or higher premiums. It also affects agencies that buy EpiPens for emergency use, like local fire departments. And since EpiPens expire after just a year, the costs add up.

However, there’s currently a shortage of EpiPens on the market, according to the FDA, making it more important than ever to have other epinephrine drugs available to those at risk for serious allergic reactions.

[h/t Business Insider]

Brain-Eating Amoeba Kills Seattle Woman Who Used Tap Water in Her Neti Pot

CDC/Dr. Govinda S. Visvesvara, Wikimedia Commons // Public domain
CDC/Dr. Govinda S. Visvesvara, Wikimedia Commons // Public domain

If you use a neti pot to clear out your sinuses, there's one important rule you should always follow: Don't fill it with tap water. Doing so could land you a sinus infection, or worse, a potentially fatal disease caused by a brain-eating amoeba. Although the latter scenario is exceptionally rare, a 69-year-old woman in Seattle died from doing just that, The Seattle Times reports. Experts are also warning that these infections could become more common as temperatures in the northern hemisphere continue to rise.

Physicians at Seattle's Swedish Medical Center initially thought the woman had a brain tumor. She was brought into the emergency room following a seizure, and a CT scan of her brain seemed to reveal a tumor-like mass. The only other known symptom she had was a red sore on her nose, which was previously misdiagnosed as rosacea. When surgeons operated on her the following day, they noticed that "a section of her brain about the size of a golf ball was bloody mush," neurosurgeon Dr. Charles Cobbs told The Seattle Times. "There were these amoeba[e] all over the place just eating brain cells. We didn't have any clue what was going on, but when we got the actual tissue we could see it was the amoeba."

She died a month later of an infection called granulomatous amoebic encephalitis (GAE), according to a recent case report published in the International Journal of Infectious Diseases. The disease is caused by a single-celled amoeba called Balamuthia mandrillaris, and it's extremely deadly. Of the 109 cases between 1974 and 2016, 90 percent were fatal.

According to the FDA, some bacteria and amoebae in tap water are safe to swallow because acid in the stomach kills them. However, when they enter the nasal cavity, they can stay alive for long periods of time and travel up to the brain, where they start eating their way through tissue and cells. Another brain-eating amoeba called Naegleria fowleri can cause a similar disease, except it acts faster and can cause death in just a few days. Although it's also rare, it's usually found in warm freshwater, and infections start by getting contaminated water up one's nose while swimming or by using a nose irrigation device filled with tap water.

Dr. Cynthia Maree, an infectious disease doctor at the Swedish Medical Center, said the changing environment could facilitate the spread of these infections. "I think we are going to see a lot more infections that we see south (move) north, as we have a warming of our environment," Maree says. Researchers say these amoebae are still little-understood. Future studies would need to be conducted to learn more about the risk factors involved.

[h/t The Seattle Times]

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