Effectiveness of Disinfection Methods for Toothbrushes: A Systematic Review and Meta-Analysis

OBJECTIVES: To systematically evaluate and compare the effectiveness of various toothbrush disinfection methods. METHODS: Four databases were searched for studies published between January 1, 2000, and December 31, 2024. Following risk of bias assessment, meta- and subgroup analyses were performed to estimate the pooled effectiveness of chemical disinfection, home remedies and physical disinfection. RESULTS: Forty-one studies comprising 8 randomized controlled trials (RCTs) and 33 non-RCTs were included. The 3 strategies significantly reduced bacterial load compared to controls (P < .001), with home remedies showing the greatest overall effect with a standardized mean difference (SMD) of -2.97 (95% CI: -4.33 to -1.61). Subgroup analyses revealed that 0.2% chlorhexidine (CHX) demonstrated an extremely large effect (SMD = -3.17, 95% CI: -5.32 to -1.02; P < .001), while 50% white vinegar treatment also demonstrated extremely large effects (SMD = -2.52, 95% CI: -4.50 to -0.55; P < .001). Ultraviolet (UV)-based disinfection exhibited statistically significant effects (SMD = -1.79, 95% CI: -3.52 to -0.07; P < .001). Despite overall effectiveness, substantial heterogeneity (I >75%) and 95% prediction intervals (PIs) that included zero were observed across studies. Overall, the certainty of evidence was deemed very low. CONCLUSIONS: The 3 strategies effectively reduce toothbrush contamination. CHX remains the reference standard, while home remedies and physical disinfection show promise as accessible alternatives. However, due to high heterogeneity and risk of bias across studies, these finding should be interpreted with caution. Future research requires high-quality, standardized RCTs to confirm clinical efficacy and optimize protocols.