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Efficacy of Miswak (Salvadora persica) in preventing dental caries


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Abstract Introduction: The rate of tooth decay and periodontal diseases today is still high, regardless of progress in oral and dental hygiene. The traditional toothbrush or chewing stick called "Miswak" has been used since ancient times. Many significant effects of Miswak such as antibacterial, anti-caries and antiperiopathic effects have been recognized today. Tooth care is a very important issue and both prevention and treatment of dental caries could be very helpful in maintaining good personal health. In this research, the efficacy of natural toothbrush or Miswak in prevention of dental caries was investigated and compared with the efficacy of ordinary toothbrush and toothpaste. Aim: Miswak was introduced for preventing dental caries by the Holy Prophet Mohammad (S.A.W) 1400 years ago and has been used since then in many Islamic countries. In this research, the efficacy of Miswak in prevention of dental caries was investigated and compared with the efficacy of ordinary toothbrush. Methods: This analytical and clinical trial was performed in a high school student population (girls and boys) in the city of Yazd, Iran in 2001-2002. Twelve high schools were randomly chosen. From these high schools, 380 second year students (190 cases and 190 controls) were enrolled and their teeth condition such as the number of decayed, missing and filled teeth (DMF) were recorded in a specific questionnaire. The degrees of decay in the decayed teeth were recorded as well. Then, Miswak sticks were distributed to the case group and required dental training was given to both groups. After one year, the examinations were repeated and findings recorded in the same questionnaires. For analyzing the data, one-way variance analysis, Chi square, Paired t-test and two variable analyses were used. Results: At the start of the study, there were no significant differences between the two groups (case and control) with regards to their dental condition and the frequency of brushing of their teeth (p-value=0.162). In addition, there were no significant differences in DMF between the two groups. The prevalence of dental caries was slightly less in the control group (0.89 times of this in the case group). The data collected at the end of the study showed a significant increase in DMF in the control group (P-value=0.000). There was a 55% increase in the rate of dental caries in the control group as compared to the case group (0.89 before the study and 1.38 after the study). The risk of dental caries for each tooth in the control group was 9.35 times more than the case group (9.14% and 0.98% respectively). Conclusion: Despite the same training and similar intention in brushing of teeth and the same dental situation in two groups at the start of the study, rate of dental caries which was primarily more in the case group in the beginning was lesser than the control group at the end of this study. This might be as a result of the antimicrobial effects of Miswac. A study with more cases and longer time period is needed to prove this suggestion. Our data shows the need to encourage the use of Miswac in the general population, especially in developing countries for its effectiveness in the prevention of progress of dental caries.
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Vol.2, No.5, 499-503 (2010)
pyright © 2010 SciRes. Openly accessible at
Efficacy of Miswak (salvadora persica) in preventing
dental caries
Fatemeh Ezoddini-Ardakani
Department of Oral and maxillofacial radiology, School of Dentistry, Shahid Sadoughi University of Medical Sciences, Yazd, Iran;
Received 1 November 2009; revised 5 December 2009; accepted 7 December 2009.
The rate of dental caries and periodontal dis-
eases in the world is still high, regardless of
progress in the oral and dental hygiene. The
natural toothbrush or chewing stick called “Mis-
wak” has been used since ancient history. In
this research the efficacy of Miswak in prevent-
ing dental caries was investigated and com-
pared with the efficacy of toothbrush and tooth-
paste. The analytical and clinical trial method
was applied for this research among high sch-
ool’s students in the city of Yazd, Iran, 2006.
Three hundred eighty second year’s students
(190 cases and 190 controls) were examined
dentally. Then the Miswak was distributed to the
case group and required trainings were given to
both groups. After one year, the examinations
were repeated. For analyzing the data one-way
variance analysis test, Kai square, Paired t-test
and two variable analyses were used. In the be-
ginning of this study, there were no significant
differences between two groups (cases and
controls) regarding their dental situation and
the frequency of brushing their teeth (p-value =
0.162). In addition, there were no significant
differences in DMFT between the two groups.
The data collected at the end of the study
showed a significant increase in DMFT in the
control group (p-value = 0.000). There was 55%
increase in the rate of dental caries in control
group compared to case group (0.89 before the
study and 1.38 after the study). The risk of den-
tal caries for each tooth in control group was
9.35 times more than case group (9.14% and
0.98% respectively). Dental caries rate was de-
tected slightly less in the case group at the end
of this study. This might be as a result of the
antimicrobial effects of Miswak. A longer study
with more cases is needed to prove this sug-
Miswak; Dental Caries;
Salvadora Persica; Toothbrush
Salvadora Persica (S.P.) is a plant that grows in the de-
serts of the area from west India to Africa. The roots and
sticks of S.P. are used widely for cleaning the teeth in
these areas. The other names for this plant are Arak tree,
Chewing stick, Natural toothbrush and Miswak [1].
Regardless of daily improving dental and oral health
in the world the dental caries and gingivitis is increasing
due to the widely use of sugar in food, fluoride and cal-
cium deficiency and finally ignoring health care [2].
There are nearly seven plants for this meaning but the
most commonly used one is Miswak which is derived
from S.P. plant mostly in Saudi Arabia and parts of the
Middle East [3]. The values of these sticks are due to
their components and cleaning mechanisms. Recently
these sticks were recommended as an effective tool for
oral health by the World Health Organization (WHO).
The sticks have usually 15 cm length and 1 cm di-
ameter (Figure 1). This is why these sticks are called
chewing sticks as well. Their pleasant hot taste made
them easily chewable. Sometimes a small part of the
stick is used as a tooth stick.
Primary analysis showed that S. Persica contains
Tri-Methyamin, Salvadrin, Chloride, Fluoride, Silica,
Sulfur, Mustard, Vitamin C and a small amount of Sapo-
nine Tanin. These components have antibacterial and
antifever effects in addition to be against gingival irrita-
tion [4]. There are many studies showing that Miswak
have strong anti caries effects due to large amounts of
fluoride in it. Many dental studies reported antimicrobial
activity in derivates from Miswak. In addition, the me-
chanical cleaning effects of Miswak were investigated
and it was reported that the value of chewing sticks is
due to their mechanical cleaning [5]. There are many
reports showing Miswak is effective in decreasing gin-
givitis and dental plaques. Elvin-Lewis et al. [6] showed
that the dental loss in adults is very low in the countries
F. Ezoddini-Ardakani / HEALTH 2 (2010) 499-503
Copyright © 2010 SciRes.
Openly accessible at
Figure 1. The shape of some chewing sticks.
that Miswak is used widely. Almas, [7] showed amazing
antibacterial effects of Miswak on Streptococcus Mutant
and Fecalis. Olsson [8] reported that chewing sticks are
more effective in decreasing dental caries than tooth-
brush. Al-lafi and Ababneh [9] investigated antibacterial
effects of Miswak in three ways and showed that deriva-
tives if these sticks have strong effects on the growth of
Streptococcus and staphylococcus aurous. Danielsen, et al.
[10] studied two groups of students in Kenya. One group
used chewing sticks plus toothpaste and the other group
used only chewing sticks. There were no extra effects in
removing dental plaques in the group that used tooth-
paste in addition to chewing sticks.
The aims of this study were to investigate the effects
of Miswak in preventing tooth caries comparing with
This study was a clinical trial with before and after de-
sign. It was done in 190 cases and 190 controls (95 girls
and 95 boys) in the second year students of Yazd high
schools. Cluster sampling was used to choose 6 boys and
6 girls high schools in Yazd. Then these high schools
were randomly divided into two groups of three high
schools each using as case and control groups.
The investigators were chosen among final year dental
students. Required training regarding filling question-
naires and dental examination were given to them. The
author supervised all the investigation’s steps. The mate-
rials used by the investigators were explorer, mirror,
light, gloves, upper and lower teeth models, Oral-B
toothbrush and Miswak. Dentists examined all of the
students teeth at the beginning of the study and the
number and degree of DMF teeth were recorded in the
questionnaires. The degrees of caries were measured by
explorer and persons complaints. Even small insertion of
the explorer in the teeth recorded as a caries. The de-
grees of the caries were divided to class I to class VI.
After recording the primary data Miswak were given to
the case group and the way to use it were trained to the
group and ask them to use it two to three times per day.
The Miswaks were controlled every three months and
the new Miswaks were given to them if it was neces-
sary. While, the toothbrushes were given to control
group, and the training was given to them to brush their
teeth two to three times per day exactly as it done for
the case group.
After one year, the teeth examinations were done the
same as the beginning of the study and the data were
recorded in the questionnaire. Our data showed the car-
ies rate in the beginning and at the end of the study and
because DMFT have no improvement so the differences
were considered to be as the results of disease develop-
ment in the study year.
The data were imported in the EPI 6 software and
were analyzed by SPSS 13 version software. For com-
paring the data one way variance analysis test, Chi-
Square, Paired t-test and two variable analyses were
used. For comparing the relative risk of disease devel-
opment in two groups the Relative risk index was used.
In this research, from the initial 380 students that started
this study, 330 students continued it until the end. In case
group there were 174 students which used Miswak for one
year and 156 students were in the control group which
used toothbrush for one year. The trainings and number of
brushing teeth per day were the same for two groups. At
the beginning of the study the numbers of case and control
students were the same (190). This means that 16 students
in the case group (8.4%) but 34 students in the control
group (17.9%) did not continue the experiments until the
end. The difference is significant (p-value = 0.006). This
means that the cases which used Miswak have more in-
terest in brushing their teeth than the controls. The odds
ratio to discontinue brushing was 2.37 times in control
group than this ratio in case group with the confidence
interval of 1.21 to 3.72 which is different from number
one significantly (p-value < 0.05).
F. Ezoddini-Ardakani / HEALTH 2 (2010) 499-503
Copyright © 2010 SciRes. accessible at
The same numbers of male and female were chosen at
the beginning of this study, but after one year 159 male
and 171 female continue the study. This means that the
number of cases which abandon the study was more in
the male group but this difference is not significant
(p-value = 0.068) and the sex ratio in two groups is
nearly the same. In addition, the age of all the cases and
controls were nearly the same with maximum 6 months
difference from the median.
The number of brushing the teeth in two group were
the same at the beginning of the study (p-value = 0.162)
(Table 1). There were no significant differences regard-
ing DMFT rate between two groups of cases and con-
trols at the beginning of the study (Table 2).
In this study DMFT was used as a dependent vari-
able to investigate the effectiveness of Miswak. The
mean DMFT in two groups at the beginning of the
study was 3.691 ± 2.797 (mean ± S.D.) with the confid-
ence interval of 95% from 3.39 to 3.99. These data
shows the efficacy of Miswak in preventing tooth de-
cay (Table 3 ).
Table 4 shows that the rate of increased DMF in the
case group was nearly 10 times this rate in the control
Our data showed that at the beginning of the study the
incidence of DMF in the case group was more than this
in the control group, but after one year (at the end of the
study) this incidence in the case group became less than
this in the control group (Ta ble 5 ). The prevalence ratio
of decayed teeth in control group compare with case
group was 0.89 before the study, but this was 1.38 after
the study. These data shows a 55% increase in the rate of
decay in control group compare with the case group. In
addition, the relative risk of decay incidence in the con-
trol group was 9.35 times this in the case group.
The importance of chewing sticks or Miswak was inves-
tigated in several studies (11, 12, 13 and 14). Almas, [7]
showed that Miswak has antimicrobial effects against
Streptococcus Mutants and Fecalis. In addition, Al-Lafi
and Ababnch [9] and Almas, et al. [15] studies showed
that Streptococcus Fecalis is the most sensitive microor-
ganism affected by Miswak. Our results showed that the
rate of carries decreases after using Miswak and this can
be due to these antimicrobial effects. Almas and Al-Zeid
[16] in a study investigated the antimicrobial effects of
Miswak and it’s extract specially on Streptococus Mutan
and Lacto Basilus. These effects were compares with the
effects of toothbrush and normal saline. Their results
showed that in Miswak users there was a significant de-
creases in streptococcus (p = 0.013) but not in Lacto
Basilus (p = 0.147).
Table 1. The number of brushing per day in the two groups at
the beginning of the study.
Cases Controls Total
No % No % No %
3 times 2 1.1 2 1.3 4 1.2
2 times 12 6.9 18 11.5 30 9.1
1 time 84 48.3 71 45.5 155 47
Rarely 62 35.6 43 27.6 105 31.8
Never 14 8 22 14.1 36 10.9
Total 174 100 156 100 330 100
P-value = 0.162.
Tab le 2. The teeth situation in the students at the beginning of
the study.
Cases (No = 174) Controls (No = 156)
Mean S.D. Mean S.D.
Filled teeth
One side 0.79 1.81 0.54 1.47 0.176
Two sides 0.1 0.52 0.08 0.32 0.767
Three sides 0.06 0.375 0 0 0.036
Decay teeth
Class I 2.36 2.18 2.41 2.14 0.366
Class II 0.16 0.47 0.16 0.461 0.99
Class III 0.02 0.13 0.05 0.3 0.17
Class IV 0 0 0.02 0.18 0.156
Class V 0.01 0.08 0.02 0.18 0.364
Class VI 0.01 0.11 0 0 0.18
Missing teeth 0.13 0.44 0.17 0.41 0.39
Tab le 3. Comparison of the differences between DMF in two
groups before and after the study.
Case No = 174 Control No = 156
X S.D. Min Max X S.D. Min Max p-value
Before 3.9 2.89 0 14 3.46 2.68 0 13 0.147
After 4.14 3.05 0 17 5.7 3 0 16 0.000
p-value 0.000 0.000
Tab le 4. The difference between DMF in each group.
Group No
Mean of increase
during 1 year
S.D. p-value
Case 174 0.2356 0.523 0.000
Control 156 2.2436 1.188 0.000
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Tab le 5. Prevalence and incidence of decay in two groups.
Teeth No in Case group Teeth No in Control group
Total Decayed % Total Decayed %
Before 4872 679 13.94 4368 539 12.34 0.059
After 4872 720 14.78 4368 889 20.35 0.00
One year
4193 41 0.98 3829 350 9.14 0.00
Wolinsky et al. [17] showed that S.P. decreases the
ability of some Streptococcus to colonize on teeth sur-
faces. Bearing in mind that the cause of tooth decay is
acid secretion by microorganisms, the decreases in the
rate of caries in this study and also low rate of DMF in
the countries which use Miswak can be due to this abil-
ity of S.P.
Elvin-lewis et al. [6] and Almas [7] suggested that the
antibiotic effects detected in S.P. may have interaction
with bacteria and prevent their attachment. The other
component of Miswak with possible interaction with
bacterial glycolytic enzyme and their acids or intracellu-
lar polysaccharides products is Fluoride. Furthermore,
Benzylisothiocyanate (BIT) that is naturally a compo-
nent of S.P. acts as inhibitor of bacterial growth and their
acidic products [18]. Chawla [19] showed that some
kinds of chewing sticks such as Neem, S.P. and Acaccia
Arabica have reasonable amounts of fluoride. They
showed that Miswak sticks from S.P. tree have signifi-
cant antimicrobial effects on streptococcus mutants,
streptococcus mitis and staphylococcus. Darout et al. [20]
studied the caries and periodontal situation of adults
Sudanese using either habitual Miswak or Toothbrush.
They suggested using Miswak in developing world be-
cause of its availability and cheap price. In our study as
well the effects of Miswak were significant and every
three months that we were going to the schools to deliver
new Miswak sticks to the students their excitement in
requesting Miswak was interesting.
At the end of our study, the Miswak has been used
more frequently in the Miswak users than toothbrush in
the other group. This difference cannot be due to the
training, because both groups have the same trainings. In
addition our study showed that the rate of DMF which
was the same in both groups increased significantly in
the toothbrush users compared with Miswak users. This
difference can be because of two reasons; 1/Miswak
users used Miswak more frequently and 2/Miswak has
antimicrobial effects plus fluoride and calcium.
Faiez [21] reviewed the effects of Miswak. Many re-
searchers believed that the efficacy of S.P. is because of
its mechanical action while the others believe that Mis-
wak is a natural source for topical fluoride.
About half of the people in Saudi Arabia use Miswak.
Magbool [22] showed that only 12.5% of students are
Caries free in Saudi Arabia and the rate of tooth decay is
48% in 6 and 7 years old age group but this rate de-
creases and is only 1.03% in 16 and 17 years old age
group. We showed that the prevalence of caries in case
group is less than this rate in control group and this can
be as a result of using Miswak.
Norton and Addy [23] did a pilot and cross sectional
study among adults in Ghana. They showed that the rate
of plaque and carries in Miswak users was less than this
rate among non users.
In the other studies among Ethiopian and Nigerian
students and Saudi Arabian dental students, using Mis-
wak and toothbrush was compared. These comparisons
showed that Miswak was more effective than toothbrush
in removing plaque [6,23,24]. These differences can be
related to the frequency and duration of brushing, ex-
periences in using Miswak, motivation and supervision.
One of the specifications of Miswak is its straight
shape that is a disadvantage because it cannot clean lin-
guinal sides of the teeth.
Miswak contains nearly 1.02 μg/g total fluoride.
Chawla showed that the chewing sticks of S.P., Neem-
kikar, Walnut and Pekujebu have 2.8, 1.0, 0.5 and 0.2
μg/ml fluorides respectively [19]. Miswak releases a
significant amount of calcium and phosphor in water and
these elements are necessary for remineralization. Crys-
tallographic studies with fluorescence and x-ray micro-
analysis showed that S.P. sticks have more calcium and
phosphor [24].
Recently S.P. extract was used in some toothpastes
like Ouali Meswak, Pharba, Sarakan, Backenham UK,
Basaraj and Epident [25]. Miswak extract and 0.8 %
monoflourophosphate sodium) compared with Oral-B
toothpaste (containing only 0.8 % monoflourophosphate
sodium) in dental students. Their results showed that the
toothpaste containing Miswak extract significantly was
more effective in removing dental plaques compare with
Oral-B toothpaste. It was also showed that Miswak has
antidecay effects because of its fluoride contents. In ad-
dition, the hot taste of Miswak plus the chewing effects
of the stick can increase the salvia secretion in the mouth
and therefore increase its buffering capacity [21]. In our
study these factors can be effective as well.
Sofrata reported that the chewing stick (Miswak) is
used for oral hygiene in many parts of the world. In ad-
dition to the mechanical removal of plaque, an antibac-
terial effect has been postulated. Miswak embedded in
or suspended above the agar plate had strong anti-
bacterial effects against all bacteria tested. The antibac-
terial effect of suspended Miswak pieces suggests the
presence of volatile active antibacterial compounds [26].
Almas concluded that toothbrushes and Miswak (che-
wing sticks) are widely used for the mechanical removal
of plaque [27].
F. Ezoddini-Ardakani / HEALTH 2 (2010) 499-503
Copyright © 2010 SciRes.
Sofrata reported that the difference in plaque pH be-
tween Miswak extract and water rinse was statistically
significant at 30 min (p < 0.001) [28]. Rinsing with
Miswak extract stimulated parotid gland secretion (p <
0.01). Miswak extract raised the plaque pH, suggesting a
potential role in caries prevention
Openly accessible at
Our study showed that Miswak effectively prevented
dental caries in high school students. Conducting some
studies on antimicrobial and silicate effects of Miswak
are suggested.
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... 9 Although the improvement of daily dental and oral health has been seen nowadays in the world, the incidence of the dental caries and periodontal diseases is still increasing, as there is wide use of sugar in food and also due to fluoride and calcium deficiency. 10,11 The maintenance of oral health is also an important factor for the prevention of the dental caries and periodontal diseases. The habit of oral self-care with the help of cleaning agents, such as toothpaste and toothbrush or various chewing sticks varies from country to country, culture to culture, and urban to rural areas. ...
... These sticks were also recommended as efficient tool for maintenance of oral health by the World Health Organization (WHO). 11 The chewing sticks are effective in evacuating the dental plaque as there is joint effect of antimicrobial activity, mechanical cleaning, and upgraded salivation. 2,14 In the present study, it was found that the caries incidence was higher in the non-Miswak group as compared to Miswak using group. ...
... This shows that Miswak has some anticariogenic properties that inhibit the plaque formation, and ultimately caries formation. 11 Miswak is made up of a pencil-sized stick of 15 to 20 cm long with a diameter of 1 to 1.5 cm from the Arak tree or also called as toothbrush tree. But in some areas it is also made from the lime (Citrus aurantifolia), orange (Citrus sinensis), or neem (Azadirachta indica). ...
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Introduction: Various types of oral hygiene measures have been practiced by different populations around the world, as there is difference in the oral hygiene products including toothpicks and toothpowders. Miswak or tooth cleaning stick, for mechanical tooth cleaning, can be traced back at least to pre-Islamic times. Currently, many of the world populations still use chewing sticks as the single method for tooth brushing. The present study was done to study the incidence and prevalence of caries among Miswak and non-Miswak users. Materials and methods: The study was done consisting of 120 cases and 120 control group (60 boys and 60 girls in each group) from the secondary school. The materials used were light, explorer, mirror, gloves, upper and lower teeth models, Miswak, and common toothbrush. After the recording of the primary data, Miswak was given to case group and the students were trained to use it on the teeth models. After 2 years, the examination of the teeth was done using the same method as before start of the study and by the same investigators. All the data were recorded, tabulated, and analyzed with the help of Statistical Package for the Social Sciences (SPSS) statistics version 17 using Student's t-test.Results: From the 240 participants, only 211 had continued the study for the total period of time. Out of these, 111 were from the study group and 100 from the control group. On comparison of the decayed-missing-filled (DMF) index scores of the study and control groups, before and after completion of the study, had also shown that the caries index was increased and the difference was found to be statistically significant. Conclusion: From the study, it can be concluded that the study group using Miswak had less number of caries incidence than the control group of non-Miswak. Clinical significance: Miswak can be used as teeth cleaning aid in day-to-day life as it can reduce the caries incidence.Keywords: Caries prevalence; Miswak; Non-Miswak Tooth-brushing..
... As for antimicrobial actions of chewing stick is concerned, the risk of dental caries was 9.35 times higher in toothbrush users in comparison to those who used chewing sticks 24 . Neem and Arak miswak sticks have also been reported to have lower incidence of dental caries 25 . This trial excluded dental caries from consideration. ...
Background: Anti-bacterial effect of Miswak on microorganism has already been proven in previous researches. The Dandasa is used by most women in Saudi Arabia, India and Pakistan as a toothbrush for cleaning the teeth. Aim: This study was done for the comparison between the effect of Miswak and Dandasa in improving gingival health, as both has anti-plaque action and absence of plaque is directly proportional to gingival health. Methods: A prospective cohort study was carried out at the Department of Periodontology, Dr.Ishrat-ul-Ebad Khan Institute of Oral Health Sciences, Karachi for a period of 6 months. Total 90 patients fulfilling the inclusion criteria were included into two Groups. In group-A habitual user of miswak were taken and in group-B habitual user of dandasa were taken. The Plaque score and gingival index were made zero before the start of observation by conducting ultrasonic scaling. Results: In Group A 57.8% participants were using miswak once a day and 42.2% twice a day. In group B 44.4% participants were using Dandasa once a day 44.2% and 55.6% twice a day. Mean post-gingival index score was 1.95±0.52 in group A and 1.08±0.28 in group B. Mean post plaque index score in Group A was 1.97±0.69 and Group B was 1.15±0.36. The results portrayed significant discrepancy in pre and post gingival index. The conclusion also depicted prominent variability in pre-post-plaque index. Both indices showed that the dandasa was better at plaque control as compare to Miswak Conclusion: Mean Gingival Index (GI) and Plaque Index (PI) scores in dandasa group was prominently less as compared to Miswak group. Keywords: Gingival Index, Plaque index, Dandasa, Miswak
... The list also comprises drugs that reduce the buccal pH like inhaled powders and drugs that cause demineralization such as tetracyclines [14]. The current fast-changing lifestyles with more consumption of sugar, inadequate hygiene, and lack of both fluoride and calcium negatively impact oral hygiene all over the world [15]. ...
... The DMFT score of Ezoddini-Ardakani study was less as compared to the present study because of the dissimilarity in age group and monitoring system. [25] Elvin-Lewis et al. found that Miswak showed antibiotic effects by preventing carries formation as it contain intracellular polysaccharide product, fluoride which showed interaction with bacteria and prevented their attachment with tooth surface. [26] In developing countries where the use of toothbrush and toothpaste is still considered expensive, Miswak is an inexpensive and natural alternative oral hygiene tool. ...
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Introduction: Resources for oral health care remain limited in in rural and backward areas where an inherent need to exists to explore inexpensive cleaning aids at ease. Aim: To assess the efficiency of Miswak stick as an oral hygiene aid among madrasa-going 12–14 years old children, by comparing it with toothbrush and toothpaste in Nuh district of Haryana, India. Materials and Methods: The study population comprised of 540 madrasa-going children. 400 cases were Miswak users, whereas 140 toothbrush and toothpaste users were in the control group. Their oral hygiene status was assessed using the Gingival Index (GI), Oral hygiene index- simplified (OHI-S) and Plaque Index (PI). Decayed, Missing, Filled Teeth (DMFT) index was used to measure the dental caries incidence. The data were recorded, tabulated, and statistically analyzed. Results and Discussion: The results showed that Miswak users had significantly less mean GI score and OHI-S index scores (P = 0.001) but no statistically significant difference in PI score as compared to toothbrush and toothpaste users. Second, DMFT score was more in toothbrush and toothpaste users as compared to Miswak users. Conclusion: This study concluded that the oral hygiene status of Miswak users in the madrasa-going children of Nuh district was better than that of toothbrush and toothpaste users.
... Dental caries rate was detected slightly less in the case group at the end of this study. This might be as a result of the antimicrobial effects of miswak (6) . ...
... The diffusion of the use of Miswak in some countries has been directly influenced by Islamic religion practice, where dental hygiene is a part of religious practice. Principally, the roots, twigs, and stems of S. Persica have been recommended to clean teeth or used as toothpicks [16,19]. ...
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To evaluate, for the first time, the effect of the Moroccan Miswak (Salvadora persica) extract on the corrosion behavior of Ni–Cr dental alloy in artificial saliva, the electrochemical techniques, such as Inductively Coupled Plasma Atomic Emission Spectrometry (ICP-AES), surface analysis, and metal release were investigated. Data extracted from the obtained electrochemical corrosion tests demonstrated that the resistance to corrosion of Ni–Cr alloy was improved in presence of Miswak extract at various concentrations, due to the protective action created by the adsorption of Miswak extract on the Ni–Cr alloy surface; the concentration of 1000 ppm presents a corrosion inhibition efficiency of 87%. In presence of the Miswak extract, the SEM–EDS and XRD studies confirm the formation of a film on Ni–Cr dental alloy surface and revealed a reduction in the relative dominance of Ni and Cr on the alloy surface. Also the release of Ni, Cr, and Mo ions has been obviously decreased.
... Among these, aside from antiplaque effects, herbal oral hygiene tools were anti-inflammatory and anticariogenic. Different sections of Miswak (drawn from a plant species of Salvadora persica belonging to the Salvadoraceae family) such as twigs, stem, and roots were used to extract plaque from the oral cavity [3], including interdental areas [4]. Miswak (S. persica) has a broad geographical range, and its beneficial properties are considered to be exercised by the fibres' abrasive effects and by the presence of therapeutic chemicals. ...
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Purpose: To compare the periodontal status of exclusive users of Miswak (Salvadora persica) with that of exclusive toothbrush users among adult smokers of cigarettes in Saudi Arabia.Methods: This educational-institutional study included one hundred and fifty adult patients (age and socioeconomic status matched, SES) between the ages of 18 and 75, and were listed as the group I, II, and III, with 50 participants each (participants with no oral hygiene, toothbrush users and miswak users respectively). Oral hygiene habits, the number of cigarettes smoked, and time since the habit began. Periodontal and radiographic parameters were reported.Results: All parameters related to periodontium (plaque index (PI), gingival index (GI), bleeding on probing (BOP), probing pocket depth (PPD), gingival recession (Rec), clinical attachment level (CAL) and bone loss (BL)) showed that the analysed groups exhibited differences (p < 0.001). Least amount of BL (anterior and posterior) was found in toothbrush users and Miswak users, while least amount of attachment loss (both anterior and posterior) was recorded among Miswak users (p > 0.05). Positive association was found for GI (r = 0.753) and recession (r = 0.436, p < 0.001) in terms of the number of cigarettes smoked in group I, and anterior PPD (r = 0.388, p < 0.001) in group III for the duration of smoking. A negative correlation was found for BOP in group III (r = - 0.339, p < 0.05) in terms of frequency of tooth cleaning and GI (r = - 0.381) (p < 0.001) in group II, in terms of time taken attain oral hygiene.Conclusion: This study indicates less severe periodontal damage among adult current cigarette smokers in miswak users than in toothbrush users. Thus, there some potentials for miswak use for promotion of oral hygiene. Keywords: Periodontal status, Adult cigarette smokers, Miswak, Oral hygiene
... . Traditional and medicinal usage: Salvadora plants are narrated in Quran and Sunnah as the oral hygiene tool being used as root and shoot sticks for many years (Khafagi et al., 2006;Anonymous, 2009). The Prophet Muhammad (PBUH) used Miswak and its gums to clean the teeth and declared Aarak (Salvadora Persica L.) as excellent tooth cleaning stick (Wu et al., 2001;Ezoddini-Ardakani, 2010). This custom was adopted and Islamized by Prophet Muhammad (PBUH) around 543 AD, used by the Arabs, Babylonians in 7000 years ago (Wu et al., 2001;Raed, 1999;Wu et al., 2001) reported that modern toothbrush may be drew from chewing sticks by Babylonians in early 3500 BC as discussed in Greek and Roman literatures. ...
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... A clinical trial found that the dental carries decreases after using Miswak and this might be because of antimicrobial property [110]. Miswak decoction possesses very good antiulcer and anti-inflammatory properties as found in vivo studies [111,112]. ...
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Background: Unani system of medicine originated in ancient Greece, with the teachings of Buqrat (Hippocrates, 460-377 BC); and was introduced in India by the Mughal emperors. In Unani medicine, diseases and drugs are classified on the basis of mizaj (temperament) which is one of the fundamental Fortune J Health Sci 2020; 3 (1): 30-54 concepts of Unani medicine. Oral health is given special emphasis in Unani medicine due to the understanding that diseases of the mouth affect eating and nutrition which may affect all systems of the body. Oro-dental diseases are described extensively in Unani literature in a systematic manner and many drugs such as Aqar Qarha (Anacyclus pyrethrum DC.), Kaat safed (Acacia catechu Willd.) etc are described which have shown promising results in recent scientific studies. Methodology: First, a review of Unani classical books was completed and the drugs to be further researched were selected. Then, a search was made on major scientific search engines regarding scientific evidence of their efficacy and safety. Conclusion: The Unani drugs mentioned in classical literature have shown promising results as anti-inflammatory, antipyretic, antiseptic, anti-bacterial, anti-fungal and anti-ulcerative agents in many oral disorders. Also, most of the drugs have a multi-dimensional action which is both curative and preventive.
... In terms of oral health, Salvadora persica has been reported to be antibacterial (Al-Ayed et al., 2016, Al-Bayaty et al. 2010a, antifungal (Pribadi, Rihansyah and Darusman, 2014), anticariogenic (Ezoddini-Ardakani, 2010), and antiplaque (Varma et al., 2018). Other reported pharmacological properties of Salvadora persica include hypolipidemic (El Rabey et al., 2017), antiulcer (Lebda et al., 2018), anticonvulsant (Monforte et al., 2002), antifertility (Darmani et al., 2003), and antioxidant (Mammad et al., 2018). ...
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Poor oral health has been associated with several chronic and systemic disease. Currently, the most common method of teeth cleaning is the use of a toothbrush together with dentifrices. However, natural chewing stick such as S. persica miswak is still used in many developing countries due to their low cost and availability. The present review aims to summarize the evidences on effectiveness of miswak in promoting oral health. The search was performed using Medline via Ebscohost, Scopus and Google Scholar database to obtain relevant articles published between 2010 to May 2020 using the following set of keywords 1) Miswak OR Salvadora OR persica AND 2) dental OR caries OR plaque OR oral OR orthodontics. Isolated microbial inhibition studies were excluded from the review due to its well-established wealth of literature. Miswak was administered as ten different forms, namely mouthwash, toothpaste, chewing stick, essential oil, aqueous extract, ethanol extract, probiotic spray, dental varnish, dental cement or chewing gum. All studies reported a positive effect of miswak as an anti-plaque, anti-gingivitis, anti-cariogenic, promotion of gingival wound healing, whitening properties, orthodontic chain preservation, and biocompatibility with oral cells. Miswak in its different forms demonstrated positive effect towards oral health maintenance and management.
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The chewing stick (miswak) is used for oral hygiene in many parts of the world. In addition to the mechanical removal of plaque, an antibacterial effect has been postulated; however, tests of miswak extract from Salvadora persica (Arak) disclosed only low to moderate antibacterial effects. This may be attributable to the extraction process. Our aim was to test in vitro the antibacterial effect of miswak pieces, without extraction, on bacteria implicated in the etiology of periodontitis and caries. Miswak pieces were standardized by size and weight (0.07 and 0.14 g) and tested against Streptococcus mutans, Lactobacillus acidophilus, Aggregatibacter actinomycetemcomitans (previously Actinobacillus actinomycetemcomitans), Porphyromonas gingivalis, and, as a reference, Haemophilus influenzae. The miswak pieces were tested in two ways: embedded in the agar plate or suspended above the agar plate. The inhibitory effect was most pronounced on P. gingivalis, A. actinomycetemcomitans, and H. influenzae, less on S. mutans, and least on L. acidophilus. Suspended miswak had comparable or stronger effects than miswak embedded in agar. The 0.14-g suspended miswak exhibited significantly greater inhibition on A. actinomycetemcomitans and H. influenzae than the 0.14-g miswak embedded in agar (P<0.01 and P<0.001, respectively). Miswak embedded in agar or suspended above the agar plate had strong antibacterial effects against all bacteria tested. The antibacterial effect of suspended miswak pieces suggests the presence of volatile active antibacterial compounds.
Miswak (Salvadora persica) is commonly used in Saudi Arabia and other middle Eastern countries as an oral hygiene tool. The purpose of this study was to evaluate the effect of freshness on the antibacterial action of 1, 5, 10 and 50% concentrations of miswak extract which were tested against six different microbes, using the blood agar ditch plate method. After 48 h of incubation there was no difference in antibacterial effect of freshly cut and 1-month-old miswak. At 50% concentration the extract was effective in inhibiting Streptococcus mutans, Streptococcus sanguis and Streptococcus faecalis, producing an inhibition zone of 2-7 mm. At 5 and 10% concentrations, the extract was effective only against Streptococcus faecalis. It is concluded that miswak (Salvadora persica) has an antibacterial effect at higher concentrations and there is no difference in the antibacterial effects of fresh and 1-month-old miswak.
abstract The effect of oral hygiene programs was studied in 248 children from five school classes in Asella, Ethiopia. All children received professional toothcleaning after an initial clinical examination, and were again examined after a trial period of 3 months. The classes were assigned to the following procedures: one class received information and instruction in the use of the toothbrush, and a second class in the use of the mefaka, a wooden chewing stick traditionally used for oral cleaning. The children were advised to clean their teeth daily. Two other classes received similar information and instruction with regard to the toothbrush and the mefaka. Oral cleaning was then performed daily under direction and supervision, in one class with the toothbrush and in the other class with the mefaka. The fifth class was used as control. Instruction only was found to have no effect on the amount of oral deposits. Supervised oral cleaning, on the other hand, improved the oral hygiene of the schoolchildren significantly. The mefaka was found to be as effective as the toothbrush in removing oral deposits. It was concluded that the mefaka should be recommended for use in preventive dental programs in Ethiopia since it is effective, inexpensive, and familiar to the population.
The antibacterial activity of aqueous, isobutanol, and benzene extracts of five popular African chewing sticks was studied by the agar ditch plate method. The isobutanol extract produced the greatest antimicrobial activity, and the benzene extract the least. Streptococci were the most sensitive to the extracts, while Escherichia coli was the most resistant. It would appear that the active principles of the various chewing-stick extracts are not the same and that the extract from a given chewing stick is chemically heterogeneous. It is suggested that the regular use of the African chewing stick, acting as an antiseptic, may control the formation and activity of dental plaque and therefore reduce the incidence of gingivitis and possibly dental caries.
The author collected base-line data on the prevalence of dental caries in Al-Khobar. He submits that examination of children's teeth should be part of clinical examinations by pediatricians.