Content Dam Rdh En Articles Print Volume 38 Issue 3 Content Dam Fun In The School Cafeteria Leftcolumn Article Thumbnailimage File

Fun in the school cafeteria

March 1, 2018
Noel Kelsch, RDHAP, discussed sanitation processes in school cafeterias that promote oral health practices. 
Infection control practices, though, may be missing from the lunchroom

Noel Brandon Kelsch, RDH, RDHAP, MS

I walked into the school cafeteria. It looked like a plume of dust was rising. It wasn’t until I heard that familiar tune, “Well, you wake up in the morning. It’s a quarter to one and you wanna have a little fun. You brush your teeth…” that I realized what was happening. Over a 100 children who just finished lunch were brushing teeth all at once. Two boys were “dulling” toothbrush swords. Two girls declared they were trading toothbrushes; one wanted the Trolls toothbrush and the other one wanted the Minnie Mouse toothbrush.

The intention of this afternoon brushing program was noble; the action may be doing more harm than good.

I discussed the issue with the school nurse and soon found out that many times not even the school nurse is aware of the contagious nature of dental diseases. I gave the nurse the example of dental caries. I explained this is the simple most common chronic childhood disease. It is a contagious infectious disease. Family members, caregivers, and even playmates can transmit caries producing oral bacteria. This can happen by sharing a spoon, kissing, and even wiping off a pacifier that has fallen on the ground in the mouth.1,2,3 The nurse was shocked. She said she had no idea.

In the school setting, the Centers for Disease Control and Prevention takes a strong stand in this area on the need for both a protocol and a high level of supervision. They state that the likelihood of toothbrush cross-contamination in the school setting in toothbrushing activities is very high. Improper storage and children’s behavior can have a big impact. There is also a small chance exists that toothbrushes could become contaminated with blood during brushing (gingivitis, trauma, etc.).4

So what do we need to do? First evaluate the process, and then develop a protocol. We looked at the storage of toothbrushes, methods of applying toothpaste, toothbrushing task, and supervision level. The tooth brushing in group settings should always be supervised to ensure that toothbrushes are not shared and that they are handled properly. We found some areas of concern.

Issue: The toothpaste was being dispensed from one tube of toothpaste, going from child to child. Cross-contamination can be an issue with this method.

Solution: Dispense toothpaste in dappin dish, parchment paper, wax paper, or foil in individual serving.

Issue: The system for identifying tootbrushes was to use a tape system to mark them. These peeled off over time.

Solution: Use a permanent marker to apply the child’s name.

Issue: Children were sharing toothbrushes, trading, and using as swords.

Solution: Have direct supervision in well ventilated area for the brushing task. Set rules of no-touch for other students’ toothbrushes.

Issue: Storage was in the student’s desk in a zip lock bag. Many of the student’s toothbrushes were clearly “dirty.” Water was not included in the process. They spit the residual toothpaste in a cup.

Solution: Always have the students rinse the toothbrush with water. Store in an upright position in disposable cup in the sun, exposing it to air. Both are antimicrobial. Give a new cup each time they brush and dispose of it after brushing.

NOEL BRANDON KELSCH, RDH, RDHAP, MS, is a syndicated columnist, writer, speaker, and cartoonist. She serves on the editorial review committee for the Organization for Safety, Asepsis and Prevention newsletter and has received many national awards. Kelsch owns her dental hygiene practice that focuses on access to care for all and helps facilitate the Simi Valley Free Dental Clinic. She has devoted much of her 35 years in dentistry to educating people about the devastating effects of methamphetamines and drug use. She is a past president of the California Dental Hygienists’ Association.


1. accessed 12/2/17

2. Svanberg M. Contamination of toothpaste and toothbrush by Streptococcus mutans. Scand J Dent Res. 1978 Sep;86(5):412-4.

3. Glass RT, Lare MM. Toothbrush contamination: a potential health risk? Quintessence Int. 1986 Jan;17(1):39-42.

4. Accessed 12/2/17