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 Table of Contents  
Year : 2021  |  Volume : 9  |  Issue : 2  |  Page : 73-76

Retention of Candida Species on Plastic and Bamboo Toothbrushes. A Comparative Study

Department of Pediatric and Preventive Dentistry, Kannur Dental College, Kannur, Kerala, India

Date of Submission07-Jul-2021
Date of Decision11-Sep-2021
Date of Acceptance12-Sep-2021
Date of Web Publication30-Nov-2021

Correspondence Address:
A R Avaneethram
Department of Pediatric and Preventive Dentistry, Kannur Dental College, Kannur, Kerala
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/dmr.dmr_19_21

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Background: Tooth brushing is the basic mode of oral hygiene practice. Various studies have shown that microorganisms can colonize on the tooth brush heads. Newer tooth brushes which are biodegradable are available in the market. This study compares the fungal colonization of plastic brush head and bamboo brush head. Materials and Methods: Fifty patients were randomly allocated into two groups with 25 each in both groups. Group 1 was given toothbrush with plastic brush head and group 2 was given toothbrushes with bamboo head. After 30 days, toothbrushes were collected. The bristles of the brush was removed from its base and put on to the petri dishes with sabouraud dextrose agar and, incubated at 28°C, with chloramphenicol and cycloheximide for 5 days. After growth was identified, pure colonies were transferred on Chromagar for the identification of Candida species. Results: Fungal growth was observed in 48% of plastic brush heads and 76% in bamboo brush heads. Candida Albicans was the most common species isolated from both plastic and bamboo tooth brushes, followed by Candida tropicalis. C. Albicans were seen as light green-colored smooth colonies; Candida tropicalis appeared as metallic blue-colored raised colonies. Candida tropicalis, Candida glabrata, Candida krusei and Candida guilliermondii were also observed. Conclusion: Fungal growth was more in bamboo tooth brushes than in plastic tooth brush even though it is statistically insignificant C. albicans is most predominant species found in the tooth brush head.

Keywords: Bamboo tooth brush, Candida albicans, plastic tooth brush

How to cite this article:
Avaneethram A R, Peedikayil FC, Chandru T P, Kottayi S, Aparna T P, Ismail S. Retention of Candida Species on Plastic and Bamboo Toothbrushes. A Comparative Study. Dent Med Res 2021;9:73-6

How to cite this URL:
Avaneethram A R, Peedikayil FC, Chandru T P, Kottayi S, Aparna T P, Ismail S. Retention of Candida Species on Plastic and Bamboo Toothbrushes. A Comparative Study. Dent Med Res [serial online] 2021 [cited 2022 Dec 3];9:73-6. Available from: https://www.dmrjournal.org/text.asp?2021/9/2/73/331393

  Introduction Top

Proper oral hygiene maintenance helps in reducing the microbial load in the oral cavity thereby controls the initiation of oral diseases. Tooth Brushing is the basic mode of oral hygiene practice. Various natural materials such as Miswak, Neem, and Babul were used by different populations are used for maintenance of oral hygiene since Sumerian times.[1] In 1844, the first toothbrush was manufactured by hand and patented as a three-row brush of serrated bristles with large tufts by Dr. Meyer. L. Rhein.[2]

Even though various types of tooth brushes are available in the market, manual tooth brushes are considered as a gold standard in oral hygiene aid since 1930s. Manual toothbrushes vary in size, shape, texture, and design more than any other category of dental products it consists of a head with bristles and a handle. More recently, toothbrush heads have been altered to vary bristle lengths and placement in attempts to better reach interproximal areas. Handles have also been ergonomically designed to accommodate multiple dexterity levels.[3] Owing to its low cost, easy production process, versatility, and imperviousness to water, plastic has prevailed as a material for tooth brush handles.

The normal toothbrush has a plastic handle and nylon bristles, both of which are nonbiodegradable. Considering the world's population of 7.5 billion, it is likely that 29.5 billion toothbrushes are used every year. On average, a plastic toothbrush weighs around 20–25 g.[4] Therefore, it can be calculated that the whole of humanity produces 600 million kg of plastic toothbrush waste in a year. Therefore, nower days there is a lot of interest for environmental friendly personal consumer products. Bamboo toothbrushes are made of bamboo, an environmentally sustainable timber. The bamboo is heat-treated to carbonize the surface of the bamboo, giving it a quality finish and good service life.[5]

A review of literature shows that microorganisms are strongly adhered to the toothbrush.[6] Most microorganisms found in toothbrushes form part of the native oral microbiota retention and survival of microorganisms on toothbrush after brushing represents a possible cause of re-contamination of the mouth. Little is known about the type of fungal species found in toothbrushes even though some studies show the contamination of toothbrushes with Candida.[7] Bamboo is an organic material; therefore, it may encourage the growth of fungus. Therefore the aim of the study is to compare the Candida contamination in toothbrush head between bristle tuft in plastic brush head and bamboo brush head.

  Materials and Methods Top

A prospective comparative study was conducted in toothbrushes given to the participants who were in the age range of 12–15 years. The sample size was calculated using the formula n = Z2 1-α/2/d2 n is the required sample size; Z1–α/2 is a constant, i.e. 1.96 for 95%; d is absolute precision 20% = 0.2%. As calculated from the above formula, the sample size is 45 which was rounded to 50 and were randomly allocated to two groups of 25 each. Ethical committee clearance was obtained prior to the study (KDC/20/411P). Patients are counseled, and informed consent is taken from each participant's parents.

Participants of group 1 were given toothbrush with the plastic brush head and group 2 participants were given toothbrushes with bamboo head. The participants were provided with the same brand of toothpastes to use it during the study. They were educated on the brushing technique and asked to use the brush daily in the morning and night for 3–5 min. They were also instructed to wash the toothbrush in the running water for at least 1 min after brushing and store the brush in a dry environment.

After 30 days, the toothbrushes were collected and submitted to fungal determination. The bristles of the brush were removed from its base were put onto the petri dishes with Sabourds Dextrose broth and, incubated at 28°C, with chloramphenicol and cycloheximide for 5 days. Culture is said to be negative if there is no growth even after 72 h of incubation. After the growth was identified, pure colonies were transferred on CHROMagar Candida (HiMedia, Mumbai, India) for the identification of Candida species. The Candida isolates were identified after incubation for 48 h at 37°C. Candida albicans were seen as light green-colored smooth colonies; Candida tropicalis appeared as metallic blue-colored raised colonies. Candida glabrata colonies appeared as cream smooth colonies, while Candida krusei appeared as purple fuzzy colonies and Candida Candida guilliermondii as purple colour colonies.

The statistical analysis was of the descriptive type from the percentages found. The Chi-square test, “Mann–Whitney U test,” was done in SPSS Version 21.0 (SPSS Inc. Chicago, Illinois, USA). The results were considered statistically significant at P ≤ 0.05.

  Results Top

Candida was identified by its morphological features of cream, smooth, pasty convex colonies on sabouraud dextrose agar as shown in [Figure 1]. [Table 1] shows Candida species were present in 12 out of 25 plastic toothbrushes (48%), whereas 19 out of 25 brushes (76%) showed the presence of Candida species. The results were not statistically significant.
Table 1: Comparison of plastic and bamboo tooth brushes

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Figure 1: Shows fungal growth colonies on Sabouraud dextrose agar

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[Table 2] shows various Candida species present in the tooth brushes. C. albicans was the most common species in plastic and bamboo toothbrush heads at 44% and 60%, respectively. Candida Tropicalis was seen 16% of the plastic toothbrushes and 36% of the bamboo toothbrushes. Candida Krusei is seen 8% of the plastic toothbrush and 24% of the bamboo toothbrushes. Candida guilermondii is seen 12% of the plastic toothbrush and 12% of the bamboo toothbrushes, Candida Glaberalata is seen 8% of the plastic toothbrush and 12% of the bamboo toothbrushes.
Table 2: Comparison of candida species Candida among plastic and bamboo tooth brushes

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  Discussion Top

There has been growing consciousness about the environment worldwide, where consumers demand products that are made from materials that are sourced in a sustainable manner and have a low environmental footprint.

Bamboo is an eco-friendly timber substitute for nondegradable materials. The past couple of decades have witnessed rapid growth in commercial applications of bamboo.[8] According to world bank report, the use bamboo toothbrushes is reported to have gone up exponentially since 2018.[9]

Various studies show that toothbrush head between the bristle tufts harbors microorganisms but also provides a favorable environment for their growth. In this study, the candidal retention in tooth brushes made of plastic and toothbrushes heads were compared.[2] The bristles of the toothbrushes in both the groups are made of nylon. The results of this study show that the Candida retention in bristles with bamboo brush heads was more than in bristles of plastic brush heads even though it is not statistically significant.

Toothbrushes get contaminated by a various microorganisms present in the oral cavity or external environment. Streptocuss mutans was identified 100% of the toothbrushes. Candida, corynebacteria, pseudomonads, and coliforms were identified in 70%, 60%, 50%, and 30% of tooth brushes.[10],[11],[12],[13]

Microorganisms can multiply, and their number increase in toothbrushes, which may become a potential hazard, mainly for immunocompromised individuals, diabetics, individuals with vascular diseases, and elderly people.[14]

Most studies were conducted on bacteria and very few on fungi. Therefore, it is not known how fungi behave, how the host-fungus relationship is established in the oral cavity or how the transition from a commensal to a parasite takes place.[15] The fungal retention in bamboo toothbrushes are more in this study. It may be due to that Bamboo is a hydrophilic material absorbs a significant amount of moisture at standard humidity conditions.[16] The moisture-rich environment in the toothbrush head can be a harbors Candida and favours its growth.[2],[12] It is said that the carbonization finishing process provides water resistance in bamboo and prevents the growth of microbes during normal use.[5]

Our results show that different species of fungi are present in toothbrushes after their use. Although its presence in the mouth is currently considered as a normal commensalism condition, C. albicans is known to cause most of the fungal infections in immunocompromised patients.[17] Another factor that may favor fungal survival and proliferation besides lack of hygiene and subsequent residue accumulation is keeping the toothbrush wet in a closed environment.[2],[14]

Pesevska et al. found that C. albicans was reported in 5% of toothbrushes.[18] In contrast, in an in vitro study, Nascimento et al.[19] reported C. albicans in 37.3% of toothbrushes. Wetzel et al.[20] reported that toothbrushes could retain C. albicans. Another study reported that contamination of toothbrushes with Candida was significantly higher in the samples of diseased individuals compared to healthy individuals.[21] C. albicans may colonize the mucosal surfaces, including periodontal tissues, especially in immunocompromised individuals and patients with extended antibiotic treatment.[22] The source of the C. albicans in the current study could have most likely been the oral cavity where it is a normal flora.

In this study, Candida tropicals is the second-most common species identified in both the type of brush heads. Candida tropicalis has been widely considered the second most virulent Candida species, only preceded by C. albicans. In addition, it produces a wide range of other virulence factors, including: adhesion to buccal epithelial and endothelial cells; the secretion of lytic enzymes, such as proteinases, phospholipases, and hemolysins, bud-to-hyphae transition. C. tropicalis has been considered an osmotolerant microorganism, and this ability to survive to high salt concentration may be important for fungal persistence in saline environments.[23]

The virulence of the Candida species was not checked in this study, so the presence of these microorganisms cannot be construed as infectious. Moreover, these are commensals of normal oral microbiota. This study cannot accomplish that microorganism growth in toothbrushes may cause adverse oral or systemic diseases. Therefore future studies may be directed towards finding the virulence and pathogenicity of the microbes on toothbrush head. As more of bamboo toothbrushes are reaching the market, the quality of the bamboo used in tooth brush, the chemical and carbonisation process of the bamboo material has to be standardised so that the microbial growth is reduced. The bamboo toothbrush can certainly reduce the environmental impact of the plastic toothbrushes with the replacement of nylon bristles in near future.

  Conclusion Top

The study shows that retention of Candida is more in bamboo toothbrush heads than in plastic toothbrush heads even though it is not statistically significant. C. albicans was the most predominant Species followed by Candida tropicalis.

Non Albican Candida Species such as C typhi C glabrata, C. guillermondii, C. krusei, C. tropicalis, C. Kyfer were also observed in tooth brush head.

Ethical clearance

Ethical clearance number (KDC/20/411P).

Financial support and sponsorship


Conflicts of interest

There are no conflicts of interest.

  References Top

Malik AS, Shaukat MS, Qureshi AA, Abdur R. Comparative effectiveness of chewing stick and toothbrush: A randomized clinical trial. N Am J Med Sci 2014;6:333-7.  Back to cited text no. 1
Karibasappa GN, Nagesh L, Sujatha BK. Assessment of microbial contamination of toothbrush head: An in vitro study. Indian J Dent Res 2011;22:2-5.  Back to cited text no. 2
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Frazelle MR, Munro CL. Toothbrush contamination: A review of the literature. Nurs Res Pract 2012;2012:420630.  Back to cited text no. 6
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Mobin M, Borba Cde M, Filho CA, Tapety FI, Noleto Ide M, Teles JB. Analysis of fungal contamination and disinfection of toothbrushes. Acta Odontol Latinoam 2011;24:86-91.  Back to cited text no. 14
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Malmberg E, Birkhed D, Norvenius G, Norén JG, Dahlén G. Microorganisms on toothbrushes at day-care centers. Acta Odontol Scand 1994;52:93-8.  Back to cited text no. 17
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  [Figure 1]

  [Table 1], [Table 2]


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