Antibiotic Susceptibility Pattern Of Bacterial Contaminants Associated With Toothbrushes

Antibiotic Susceptibility Pattern of Bacterial Contaminants Associated with Toothbrushes

ABSTRACT

This research work “Antibiotic Susceptibility Pattern of Bacterial Contaminants Associated with Toothbrushes”, aims at evaluating bacterial contaminants associated with toothbrushes used daily by individuals. Toothbrushes are small brushes with long handles used for cleaning the teeth and are very important in maintaining oral hygiene. They play important roles in fighting against dental problems as well as serve as reservoirs for microorganisms if not properly treated. In the present research, the level of knowledge of oral hygiene practices was evaluated.

The bacterial contaminants associated with used toothbrushes and their antibiotics susceptibility pattern was also investigated. Thirty samples of already used toothbrushes were used for this study. The heads containing the bristles were soaked in 10ml of distilled water (H­₂O) for duration of one hour via extraction method.  Gram staining techniques, Microscopic and Bio-chemical tests via Oxidase, Coagulase, Catalase, Indole, Sugar Fermentation Tests, Methyl Red tests, test for Haemolysis, Anti-biotics Succeptibility  test and voges-Proskauer test were employed. The analytes were inoculated on solid agar medium, Nutrient agar for non-fastidious organisms, coliforms and Staphylococci respectively using the spread plate technique.

Biochemical characterization was carried out under standard conditions. For the determination of the antimicrobial susceptibility profile of the bacterial isolates. Six genera of bacteria isolates were isolated and these include Staphylococcus aureus, Pseudomonas aeruginosa, Staphylococcus epidermidis, Escherichia coli, Lactobacillus spp. and Enterobacter spp. There were variations in the antibiotic susceptibility patterns of the isolates towards various antibiotics, however; generally most of the isolates were resistant to antibiotics.

It was concluded that the bacteria isolated from the used toothbrushes were of public health importance as their presence could infect and re-infect the users. The presence of Enterobacteriaceae which are not normal oral flora is of interest.  Enlightenment campaign to emphasize importance and increase knowledge of toothbrush care and oral hygiene was recommended.

Antibiotic Susceptibility Pattern of Bacterial Contaminants Associated with Toothbrushes

CHAPTER ONE

INTRODUCTION

Oral hygiene is an integral part of general health. It directly and indirectly reflects the overall well-being of an individual thus maintaining oral hygiene becomes a crucial factor (Karibasappa et al., 2011). Since birth, the microbiota of the oral cavity changes to a variety of microorganisms upon eruption of teeth (Avila et al., 2009; Papaioannouet al., 2009). This may be due to exposure to polluted environment which contains various microorganisms or a change in dietary habits of the child as it grows (Karibasappa et al., 2011).

Oral diseases can be greatly controlled by reducing the microbial load in the oral cavity and this can be achieved by maintaining proper oral hygiene. Oral hygiene aids have been in use since Sumerian times. Brushing the teeth is the primary mode of oral hygiene practise. In early days, chewing stick like ‘Miswak’, ‘Neem’, and ‘Babul’ were the sole oral hygiene aids used by populations (Bhat et al., 2003). Later, toothbrush crept in as a main component among all oral hygiene aids as a result of civilization. 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. Rheine (Toothbrush origin-Toothbrush history, N.D.).

Toothbrush is a small brush with a long handle for cleaning the teeth. It plays a pertinent role in oral hygiene and is commonly found in homes and hospitals. It could play a significant role in disease transmission since it can serve as a reservoir for microorganisms (Downes et al., 2008). The toothbrush is the most efficient tool for removing the oral biofilm and the soft debris out of the mouth especially from the tooth and tongue surfaces (Beneduce et al., 2010).

Not only the proper choice but the care and maintenance of the toothbrush are important for good oral hygiene because although the toothbrush is an ideal environment for organisms’ growth, it is capable of supporting growth of microbes (Downes et al., 2008). A new toothbrush is not a favourable habitat for bacteria but in some cases it is already slightly contaminated because of the absence of regulations that ensures its sterility when packaged for sale (Glass and Lare, 1986). Since the mouth is a hospitable niche for all kinds of microbes, the toothbrush will always be contaminated through brushing (Quirynen et al., 2001).

Bacteria are the most obvious inhabitants of the oral cavity (Mbakwem-Aniebo, 2012). Many bacteria are found in in toothbrushes after brushing. These microorganisms can remain viable for a day to a week after brushing (Efstratiouet al., 2006). The human oral cavity is colonised by a larger variety of bacteria flora than any other anatomic area. More than 700 species of bacteria have already been identified, 400 of which were found in the periodontal pocket adjacent to teeth (Abraham et al., 1990).

Neisseria and Streptococcus specimen are early colonizers of the tooth surface. The growth and metabolism of these pioneer specimens alter the environmental conditions such that more fastidious microbes are able to further colonize, forming dental plaque (Vinogrador et al., 2004). Prolonged use of toothbrush facilitates contamination by various microorganisms such as Streptococcus, Staphylococcus and Lactobacilli (Fernandez and Cesar, 2006). These bacteria are implicated as causative agents of disease that affects both oral and general health (Boylan et al., 2008).

Contaminated toothbrushes may play an important role in many oral and systemic diseases including septicaemia and gastro intestinal, cardiovascular, respiratory and renal problems (Nascimento et al., 2010). Poor oral hygiene is not only associated with oral diseases such as dental caries and periodontal diseases, but it is also associated with systemic inflammatory and infectious diseases such as pneumonia and respiratory tract infections (Sjogren et al., 2008), rheumatic arthritis (Pischon et al., 2008), endocarditis (Lockhart et al., 2009), acute myocardial infection (Marfil-alvarez et al., 2014) and cancers of oral cavity and other parts of the body (Abnet et al., 2008; Muerman, 2010).

Toothbrushes can become contaminated from the oral cavity, environment, hands, aerosol contamination and storage containers (Frazelle and Munro, 2012). They are frequently stored in the bathroom or close to the toilet sink. As a result, they may be exposed to enteric bacteria dispersed by aerosols (Taji and Rogers, 1998). Even small droplets from the toilets lead to the release of millions of bacteria in the atmosphere (Ankola et al., 2009).

Patients with oral disease experienced a decrease of symptoms when they changed their toothbrushes during the disease (Glass and Jensen, 1988). The American Dental Association (2009) recommends change of toothbrush once in every 3-4 months. Previous studies suggested that patients with systemic disease or undergoing organ transplantation or chemotherapy should change their toothbrush more frequently (Glass and Jensen, 1988; Bhat et al., 2003; ADA, 2005). The American Dental Association (2009) suggests soaking used toothbrushes in antimicrobial mouth rinses for patient s in high risk groups.

The Centre for Disease Control (2008) contains guidelines giving information about the use and handling of toothbrushes. These guidelines suggest that people who are immune supressed may need to seek alternative means of oral hygiene because toothbrushes can remain contaminated with potentially pathogenic microorganisms even after thorough rinsing with tap water.

In the hospital setting, toothbrushes are commonly used for oral care by nurses. There is a need for standardized nursing guidelines to prevent toothbrush contamination which may increase the risk of infection from potentially pathogenic microorganisms and it is clinically relevant for assessing the risk and benefits of oral care and informing nursing practise (Bezirtzogloua et al., 2008).

This is because, currently, there are no nursing guidelines related to toothbrush frequency of use, storage and decontamination. Surfaces in close contact with the patient such as bed frames, countertops, sinks, bedside tables, linen and mattresses may serve as fomites. Toothbrushes may come into contact with these surfaces prior to or after use thus increasing risk (Fernandez and Cesar, 2006). Although some interventions such as chlorhexidine, toothpaste, mouthwash and ultraviolet sanitizers reduce bacterial survival, oral hygiene practices in the hospital setting by nurses vary (Downes et al., 2006).

1.2       Justification of the Study

Multiple factors have been attributed to the microbial contamination of toothbrushes including the type of toothbrush head (soft, medium, or hard), the place of storage (Karibasappa et al., 2011) and the handle design (Rosenberg et al., 2017). Studies have suggested various disinfection methods for toothbrushes that most people cannot or do not use (Tomar et al., 2014; Basman et al., 2016). Even the recommendation on changing the toothbrushes once every three months is only effective in its cleansing power not the microbial contamination that has been reported to occur.

Microorganisms from storage environments can also be introduced; these include enteric bacteria dispersed via aerosols from toilet flushing or from contaminated fingers and skin commensals and Pseudomonas emanating from the bathroom and other wet areas (Scott et al., 1982).

The conditions by which toothbrushes are kept are of big importance for the bacterial survival; toothbrushes which are kept in airy conditions have fewer bacteria than those which are kept close and the bacterial growth is 70% higher in wet and protected environment (Mehta et al., 2007).

It has been estimated that 51 million school hours per year are lost due to dental related diseases alone (Folaranmi et al., 2014). Therefore, actualizing the problem of toothbrush contamination, the choice of proper tools and the patients’ education are important issues which should be brought to the fore because of the need of prevention of the potential influence to the oral and systemic health.

1.3   Aims and Objectives

The aims and objectives of the study are:

• To evaluate bacterial contaminants in toothbrushes used daily by individuals
• To assess level of oral hygiene practices among individuals regarding their toothbrushes
• To determine the antibiotic susceptibility profiles of the bacteria in the used toothbrushes of apparently healthy individuals.

1.4       Research Questions

In order to ascertain the above stated objectives, the study came up with the following research questions:

1. What are the bacterial contaminants in toothbrushes used daily by individuals?
2. What level if oral hygiene is practiced among individuals regarding their toothbrushes?
3. What are the antibiotic susceptibility profiles of the bacteria in the used toothbrushes of apparently healthy individuals?

1.5    Significance of Study

As a result of increasing rate of dental problems such as Gum disease, Tooth decay, Mouth sores, Bad breath, Oral cancer, etc, and also due to the fact that previous researches point out that these dental problems are mostly caused by one bacterium or the other, this study therefore seeks to evaluate the oral hygiene practice in respect to toothbrushes which serve as a reservoir for bacteria, which attack the teeth and the mouth as a whole. The study also seeks to monitors the susceptibility pattern of these contaminants to know the changes in the trend, if any, and to what degree.

1.6    Scope of Study

This study will cover facts regarding antibiotic susceptibility pattern of bacterial contaminants associated with toothbrushes (used toothbrushes), and the preventive measures to take in limiting or preventing contamination.

1.7     Limitations of Study

Financial Constraint- Insufficient fund tends to impede the efficiency of the researcher in processing some of the relevant materials needed in the study.

Time Constraint- Due to academic work, the time devoted for the research work was cut down.

1.8 Operational Definition of Terms

1. Antibiotic: This is a chemical substance derivable from a mold or bacterium that kills microorganisms and cures infections.
2. Susceptibility: A state or quality of being susceptible; easily affected.
3. Pattern: This is something made after a model.
4. Bacteria: These are single-celled or non-cellular spherical or spiral or rod shape organisms lacking chlorophyll that reproduce by fission.
5. Contaminants: These are substances with the ability to contaminate.
6. Toothbrush: This is a small brush with a long handle, scientifically designed for cleaning the teeth.
7. Contamination: This is the act or process of contaminating with contaminants.
8. Decontamination: This is the removal of contaminants.