Relationship between Toothpaste Dilution Ratio and Droplets Generated during Tooth-Brushing

Guidelines for using toothpaste during tooth-brushing in public places during the coronavirus epidemic are lacking. In addition, the advantages and disadvantages of using toothpaste in terms of droplet generation during brushing, the number of droplets generated, and their scatter range are unknown; therefore, we investigated the relationships between diluted toothpaste viscosity, the number of droplets generated, and the droplets' flight distance. We developed a system to quantitate droplet generation during tooth-brushing. Brushing with water generated 5965 +/- 266 droplets; 10.0x diluted toothpaste generated 538 +/- 56, 4.00x diluted toothpaste generated 349 +/- 15, and 2.00x diluted toothpaste generated 69 +/- 27 droplets. Undiluted toothpaste generated no droplets. Droplet number tended to increase with increased toothpaste dilution ratio and decreased viscosity (r = -0.993). The maximum flight distances were 429 +/- 11, 445 +/- 65, 316 +/- 38, and 231 +/- 21 mm for water, 10.0x, 4.00x, and 2.00x diluted toothpaste, respectively. The maximum flight distance and toothpaste viscosity correlated negatively (r = -0.999). Thus, the less diluted the toothpaste, the fewer the droplets generated during brushing, and the shorter their flight distance. The use of an appropriate amount of toothpaste is recommended to prevent droplet infection during tooth-brushing.