The Importance of Supervising Toothbrush Usage for Young Children at Risk of Lead Toxicity.

Lead exposure in childhood causes lasting deleterious health effects through multi-system organ toxicity, including in brain, skeletal system, and oral cavity. We report a case that illustrates the imperative for providers to give specific anticipatory guidance on supervising toothbrush usage for young children. A healthy 18-month-old male presented for routine well-child care and had an unremarkable physical exam and developmental assessment. Two days after his routine visit, his blood lead test result was more than 180 mcg/dL (acceptable level is less than five mcg/dL). Upon review of his home environment, the mode of exposure was determined to be the child rubbing his toothbrush against the window well and putting the toothbrush in his mouth, thus causing exposure to lead dust. Health care and dental providers who advocate for toothbrushing have a responsibility to provide specific guidance on toothbrush usage for toddlers with hand-to-mouth behavior.