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Guidance for Safe Use, Handling, Cleaning, and Storage of Toothbrushes in Child Care Settings and Elementary Schools


toothbrush guidanceGuidance for Safe Use, Handling, Cleaning, and Storage of Toothbrushes in Child Care Settings and Elementary Schools provides information related to toothbrushing in educational settings. It discusses safe use and handling of toothbrushes, for example, disinfecting the classroom table, washing hands, and wearing gloves. It also discusses safe cleaning and storage of toothbrushes, for example, not covering toothbrushes and how to store toothbrushes in a toothbrush holder. The handout was produced by the National Maternal and Child Oral Health Resource Center.

Guidance for Safe Use, Handling, Cleaning, and Storage of Toothbrushes in Child Care Settings and Elementary Schools

Toothbrushing with fluoride toothpaste in child care settings (e.g., child care centers, Head Start programs) and elementary schools is a great group learning activity. It allows for teachable moments when staff can model, coach, and promote good toothbrushing habits. Brushing with fluoride toothpaste strengthens tooth enamel and helps prevent tooth decay.

Supervising toothbrushing is critical in child care settings and elementary schools. Program staff should ensure that toothbrushes are used, handled, cleaned, and stored properly to avoid spreading bacteria. Brushing can be done with children seated at the table or on the floor or standing at the sink.

Safe Use and Handling of Toothbrushes

  • Ensuring that each child has a toothbrush. Make sure that each child has their own child-sized, soft-bristle toothbrush. Write the child’s name on the toothbrush with a permanent marker. Teach children not to share their toothbrushes.
  • Cleaning and disinfecting the program table. If children brush at the program table, clean and disinfect the table before and after toothbrushing.
  • Washing hands and wearing gloves. Wash hands with soap and water before and after helping children brush their teeth. Wear gloves when handling toothbrushes, and change to a new pair of gloves when helping each child brush.
  • Dispensing toothpaste. Place the appropriate amount of fluoride toothpaste on the rim of a cup or on a piece of wax paper for each child, and have children scoop the toothpaste from their cup or wax paper onto their toothbrush. The amount of toothpaste for children under age 6 is shown below:
    • For children under age 3: no more than a smear or rice-sized amount
    • For children ages 3 to 6: a pea-sized amount
    a smear or rice-sized amount a pea-sized amount
  • Toothbrushing coaching. Coach children to gently brush their teeth, making small circles with the toothbrush, for about 2 minutes. Encourage them to brush all tooth surfaces: the outside, the inside, and chewing areas of the top and bottom teeth.
  • After toothbrushing. Have the children spit the remaining toothpaste into a disposable cup. No rinsing is needed because of the small amount of fluoride toothpaste remaining in the mouth. Make sure children wash their hands with soap and water for at least 20 seconds.
  • Using toothbrushes for brushing only. Do not allow children to walk, run, or play with toothbrushes.
  • Replacing toothbrushes. Replace each child’s toothbrush every 3 to 4 months, when the bristles become worn or frayed, or after an illness. Also replace a child’s toothbrush if it has come in contact with another child’s toothbrush or has been used by another child.

Safe Cleaning and Storage of Toothbrushes

  • Cleaning toothbrushes. Have each child rinse their toothbrush with water. Do not soak toothbrushes in water with bleach or other disinfecting solutions. Do not clean toothbrushes in a dishwasher or microwave; doing so may damage the toothbrushes. It is not necessary to use ultraviolet light to disinfect toothbrushes.
  • Not covering toothbrushes. Do not cover toothbrush bristles because bacteria can grow on the bristles if they are kept in a closed, dark space.
  • Storing toothbrushes. Place toothbrushes in an upright position to air dry. If toothbrushes are stored in a toothbrush holder, make sure there are at least 2 inches between them, so they don’t touch. Label each slot in the toothbrush holder with each child’s name.
  • Storing the toothbrush holder. Store the toothbrush holder on an open shelf or mounted on the wall where children cannot reach it. Do not store the toothbrush holder in toileting and diapering areas to reduce exposure to bacteria. Clean and sanitize the toothbrush holder with soap and warm water or in a dishwasher, if the holder is dishwasher-safe, at least once a week.
  • Cleaning and disinfecting the sink. After all toothbrushes are rinsed and properly stored, clean and disinfect the sink.

Resources

Administration for Children and Families. 2025. Helping Children Brush Their Teeth [webpage].

California Department of Public Health, Office of Oral Health. 2022. Toothbrushing in Early Education and Childcare (EECC) Programs: Brush in a Box Toolkit. Sacramento, CA: California Department of Public Health, Office of Oral Health.

Indian Health Service, Head Start Program. 2009. Classroom Circle Brushing: Quick Reference Guide. Albuquerque, NM: Indian Health Service, Head Start Program.

National Center on Health, Behavioral Health, and Safety. 2018. Steps for Toothbrushing at the Table: Growing Healthy Smiles in Early Care and Education Programs. Washington, DC: National Center on Health, Behavioral Health, and Safety.

Cite as

Holt K, Linden J. 2025. Guidance for Safe Use, Handling, Cleaning, and Storage of Toothbrushes in Child Care Settings and Elementary Schools. Washington, DC: National Maternal and Child Oral Health Resource Center.

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Guidance for Safe Use, Handling, Cleaning, and Storage of Toothbrushes in Child Care Settings and Elementary Schools © 2025 by National Maternal and Child Oral Health Resource Center, Georgetown University.

This publication was supported by the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services (HHS) as part of an annual award totaling $1,700,000 with no funding from nongovernmental sources. The contents are those of the author(s) and do not necessarily represent the official views of, or endorsement by, HRSA, HHS, or the U.S. government. For more information, please visit www.HRSA.gov.

Permission is given to save and print this publication and to forward it, in its entirety, to others. Requests for permission to use all or part of the information contained in this publication in other ways should be sent to the e-mail address below.

National Maternal and Child Oral Health Resource Center
Georgetown University
E-mail: [email protected]