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.

7 Facts About the Measles

Abid Katib, Getty Images
Abid Katib, Getty Images

The measles used to be one of the world’s most common childhood diseases. Since the introduction of the measles vaccine, however, the disease is rarely seen in the U.S. But people have a reason to still feel cautious about what might seem like an old-timey affliction: Between January and July 14, 2018, there were 107 reported cases of the measles across 21 states and Washington, D.C. The year before, 118 people from 15 different states (and D.C.) contracted the disease. Here are seven things to know about the infectious respiratory illness.

1. EVERYONE USED TO GET IT.

There was a time not so long ago when getting measles was a near ubiquitous part of childhood. In the 4th century CE, Chinese alchemist Ko Hung wrote of the differences between smallpox and measles, and the disease was described in the 9th century by the famous Persian physician Rhazes. There were major epidemics of the disease in the 11th and 12th centuries [PDF].

In the years before the first licensed measles vaccination appeared in the U.S. in 1963, an estimated 90 percent of children caught the measles before they were 15. The disease was a leading cause of death for children—and in some places without access to vaccinations and medical care, it still is. Today, up to 5 percent of children in places without access to good medical care die of the measles annually.

The CDC estimates that prior to the existence of the vaccine, there were between 3 and 4 million measles cases in the U.S. per year, approximately 400 to 500 of them fatal—but vaccinations have reduced the prevalence of the disease by 99 percent. In some years, less than 100 people contract the disease in the U.S.

2. IT’S HIGHLY CONTAGIOUS.

The measles virus is considered one of the most contagious viruses around: Without vaccination, around 90 percent of people who are exposed to the virus will become infected.

The disease is caused by the spread of a type of virus called morbillivirus, which can spread through the air via breathing, coughing, or sneezing. The virus can live in the air for up to two hours after an infected person coughed—meaning that you don’t necessarily need to be standing next to someone with the measles to get it from them.

3. IT CAN CAUSE MORE THAN JUST A RASH.

A person exposed to measles will begin to show symptoms seven to 14 days after exposure. The disease presents itself with symptoms like coughing, congestion, fever, and most famously, a full-body skin rash. But a third of measles cases involve complications ranging from diarrhea to pneumonia, brain swelling, and coma. Pneumonia causes around 60 percent of fatalities when it comes to measles complications.

Children under 5 are particularly at risk of getting complications and dying from the disease. One in 10 will contract an ear infection, possibly leading to permanent hearing damage, and one in 20 will get pneumonia. One or two out of every 1000 kids who contract the measles will die, according to the CDC, many from pneumonia

4. THE VACCINE IS VERY EFFECTIVE.

The measles is combined with vaccines against two other diseases—mumps and rubella—and when administered as designed, it's incredibly effective. Experts recommend that children get their first dose of the MMR vaccine on their first birthday (but not before). Then, they should get the second dose before they enter kindergarten. If a child doesn’t get vaccinated before they’re 12, they should still get the vaccine: two doses a month apart. In most cases, those two doses of the vaccine should be enough to give you immunity for life (although some experts are now cautioning booster shots may be a good idea for some adults).

If you’re exposed to the virus and haven’t been vaccinated, an immediate dose of the vaccine can provide some protection from the disease, as long as you get it within 72 hours of exposure.

5. IT’S CONSIDERED ELIMINATED IN THE U.S. …

Thanks to effective vaccinations, as of 2000, measles is no longer a threat in the U.S., according to the CDC’s standards. The disease is considered eliminated, which means that it hasn’t been continuously transmitted in a specific geographical location for at least a year. So even if there’s the occasional outbreak of cases, it’s considered eliminated because it’s not a constant threat anymore. In 2016, the World Health Organization declared the disease to be eliminated across the entirety of North and South America.

6. ... BUT YOU SHOULD STILL GET VACCINATED.

Measles isn’t prevalent in the U.S., but that doesn’t mean you can skip your vaccinations: Though home-grown measles has been eliminated, people in the U.S. still come down with it. That’s because measles is still a major issue elsewhere in the world, and travelers can bring it home with them, spreading it to unvaccinated populations in the U.S.

That includes babies. Children under 5 are one of the most vulnerable populations when it comes to measles infections, but babies aren’t generally vaccinated until they’re 12 months old (the CDC recommends that before international travel, “infants 6 months through 11 months of age should receive one dose of MMR vaccine” and then get a shot again when they’re a little older). That makes it incredibly important for everyone around them to be vaccinated, so that the disease can’t spread.

In addition to inoculating individuals against diseases, vaccines operate on the principle of herd immunity. When nearly an entire population is vaccinated, it’s very hard for the disease to spread. That protects people who aren’t inoculated, like babies, or people whose bodies didn’t respond to the vaccine for whatever reason.

7. PEOPLE STILL GET MEASLES IN AMERICA.

Since measles was declared eliminated in 2000, there have been relatively few cases reported here, but a significant number of people have caught the disease in the past few years. In 2004, there were just 37 cases of measles reported in the U.S. Ten years later, in 2014, there were 667—most of whom were people who weren’t vaccinated. (That number was unusually high, and went down to 188 cases the next year.)

The CDC blames recent measles outbreaks on low rates of vaccination. One 2016 review of measles studies found that out of 970 measles cases, almost 42 percent of patients had opted out of getting the vaccine for non-medical reasons.

Europe has also seen a surge in measles cases in the last few years. Between 2016 and 2017, measles cases in Europe quadrupled, from 5273 cases to more than 21,000, according to the World Health Organization. Thirty-five of those 21,000 people died from the disease. This is bad news for Americans, too, since most U.S. measles cases can be linked back to travelers coming into the U.S. from places like Europe. So get your vaccinations!

More Than 100 Cases of Measles Have Now Been Reported Across 21 States

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So far this year, more than 100 people have contracted measles in 21 states, CNN reports. These cases, outlined by the Centers for Disease Control and Prevention in its midyear report, are believed to stem from travelers who carried the disease back to the U.S. from other parts of the world. Most of the affected individuals had not been vaccinated.

Measles is a highly contagious respiratory virus that causes symptoms including a skin rash, fever, coughing, and congestion. Children under the age of five are especially susceptible to the disease and have a higher risk of dying if they contract it.

From January 1 to July 14, 107 cases were reported in Arkansas, California, Connecticut, Florida, Illinois, Indiana, Kansas, Louisiana, Maryland, Michigan, Missouri, Nevada, New Jersey, New York, North Carolina, Oklahoma, Oregon, Pennsylvania, Tennessee, Texas, Washington, and the District of Columbia.

Measles were declared “eliminated” from the U.S. in 2000, meaning that a continuous transmission of the disease did not occur for 12 months in any specific geographic area. However, that doesn’t mean it’s no longer an issue.

In 2014, 667 people contracted measles in the U.S., and 383 of those cases occurred among unvaccinated Amish communities in Ohio. Others were tied to an outbreak in the Philippines.

In recent years, that number has come down, with 86 cases having been reported in 2016 and 118 reported in 2017.

One dose of the measles, mumps, and rubella vaccine is 93 percent effective at preventing measles, while two doses are 97 percent effective. If you believe you've been exposed to measles and aren't sure if you're immune, the CDC recommends calling your doctor to check up on your vaccination record. For unvaccinated patients, a treatment called immune globulin may reduce the risk of contracting measles.

[h/t CNN]

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