title: Is it safe to use a toothbrush?
abstract: OBJECTIVE
  To systemically collect and summarize the literature on case reports concerning adverse events associated with the oral use of a toothbrush.
  
  
  METHODS
  Two electronic databases were searched for articles published up to October 2013 to identify appropriate studies using focused search terms and 'case reports' as a filter. Results. A comprehensive search identified 419 unique titles and abstracts. Ninety-four studies met the eligibility criteria. In total, 118 subjects (age range = 1-60 years) presented adverse events related to the oral use of a toothbrush. Events could be summarized in five categories, of which ingestion was the most reported problem among the individuals (50 cases). This was followed by impaction of a toothbrush (27 cases). Reports more frequently involved females and children were more likely to have injuries compared to males and adults. Most of the cases that presented with adverse events of the oral use of a toothbrush were referred for treatment to a physician.
  
  
  CONCLUSIONS
  The combined evidence related to serious adverse events as presented in case reports showed that the oral use of a toothbrush can be associated with ingestion, impaction, instant trauma, gingival traumatic injury and seizures. Given the incidence of reporting, important recommendations are that a toothbrush should not be used to induce vomiting, nor should people walk or run with this device in their mouths, especially children.
authors.affiliation: Department of Periodontology, Academic Center for Dentistry Amsterdam, University of Amsterdam and VU University Amsterdam , The Netherlands.
authors.forename: Sara Cioccari
authors.initials: SC
authors.lastname: Oliveira
authors.forename: Dagmar Else
authors.initials: DE
authors.lastname: Slot
authors.forename: Fridus
authors.initials: F
authors.lastname: van der Weijden
mesh_terms: D003679:Deglutition; D005547:Foreign Bodies / Q000209:etiology; D041981:Gastrointestinal Tract; D005881:Gingiva / Q000293:injuries; D006801:Humans; D009055:Mouth / Q000293:injuries; D010614:Pharynx / Q000293:injuries; D014099:Toothbrushing / Q000009:adverse effects / Q000295:instrumentation*
keywords: adverse events; impaction; ingestion; toothbrushing; trauma