Miswak as an alternative to the modern toothbrush in preventing oral diseases

2 Summary The history and use of miswak (tooth stick) as an oral tool as well as biological effects of Salvadora persica extracts are reviewed. An adult Sudanese population using miswak or a modern toothbrush regularly was examined by using clinical and microbial parameters. Use of Freeze-dried extract of miswak was analyzed for antimicrobial components. The results presented in this report showed lower caries experience in the miswak users than in subjects who used a modern toothbrush. There were no significant differences in the periodontal variables of the two groups except for less calculus in the posterior sextants of miswak users. The results also indicate that regular use of miswak has a significant inhibitory effet on the levels of some salivary and subgingival plaque bacteria. Miswak extracts contained antimicrobial components including Cl-, SO 4 2-, SCN-, NO 3-. These findings partially supported the hypothesis that adult Sudanese regular miswak users have better oral health and lower levels of oral pathogens than have adult Sudanese who use a modern toothbrush regularly. (Introduction) Miswak Miswak (siwak and several other synonyms are being used) is an Arabic word meaning tooth cleaning stick [1, 2]. In English, miswak has been mentioned as the " natural toothbrush ". The use of miswak can be traced back at least to pre-Islamic times [3]. Presently, many of the world populations including India, Pakistan, several African countries, the Arab countries and most of the Muslim world still use miswak [4]. In geographical regions in which the Arak (Araak) shrub or tree (botanical name Salvadora persica L) grows, miswak is interpreted as tooth sticks prepared from this plant. Where S. persica is not growing, miswak is prepared from other suitable plants. Miswak is a pencil-sized stick 15-20 cm long and with diameter 1-1.5 cm that is prepared from the root, stem, twigs or bark. The stick is chewed or tapered at one end until it becomes frayed into a brush. 3 Cleansing efficacy of miswak Various explanations for the cleansing efficacy of miswak have been offered including: (i) the mechanical effects of its fibers, (ii) its release of beneficial chemicals or (iii) a combination of (i) and (ii) [5]. Also, when the mouth cleaning procedure that includes brushing of teeth, gums and tongue is completed, miswak is removed from or may be left in the mouth for some additional time. Left in the mouth, it will stimulate salivation and …