Efficacy of Miswak in Oral Hygiene Maintenance
Condition: Dental Plaque
MeSH terms: Dental Plaque
Study type: Interventional
Phase: Phase 4

Summary: 
      Miswak has been recommended by world health organization for oral hygiene because of its
      availability, beneficial effect and affordability. The popularity of Miswak in Arab countries
      has meant that there have been several studies that have confirmed the ability of miswak to
      provide effective mechanical and chemical cleansing when used as an adjunct to other oral
      hygiene aids.

      Fluoridated tooth paste and manual tooth brushes have been the standard of clinical
      preventive dental care for over 50 years.However, the objection to the use of fluorides by
      some parents has meant that these pastes are not universally accepted.

      There are several non-fluoridated pastes available in the market that include the extract of
      miswak. There are few studies that have compared these pastes to fluoridated pastes and to
      miswak as a stand alone agents.

      Miswak has been recommended by world health organization in 1987 for oral hygiene because of
      its availability, beneficial effect and affordability.

      It has been stated that "Several clinical studies have confirmed that the mechanical and
      chemical cleansing efficiency of miswak chewing sticks are equal and at times greater than
      that of the toothbrush" this was mentioned and reviewed that it is in fact right but only
      when used in a regular constant matter with a proper and effective way of plaque removal.
      This study aims to use a cross over model to study the effectiveness of miswak as a stand
      alone agent in maintaining oral hygiene in young adults and compare it miswak containing
      toothpastes and fluoridated toothpastes when used with a manual tooth brush.
    

Detailed description: 
      Oral hygiene is the key of maintaining human's mouth at a state of equilibrium and free of
      diseases (e.g. cavities, dental decay, gingivitis, halitosis). Poor oral hygiene can
      significantly affect the quality of life and has a considerable influence on diet, sleeping,
      social communication, psychological status, and by being less productive at work.

      Therefore, oral hygiene is essential for general health and well-being. Oral hygiene measures
      include toothbrush which is the most commonly used method for plaque control. However, miswak
      is a commonly used method in many developing countries.

      Miswak has a widespread among religious, rural and developing countries for its spiritual
      impact since the use of miswak was advised by prophet mohammed (peace be upon him) centuries
      ago as he said "had I not thought it difficult for my ummah, I would have commanded them to
      use miswak before every prayer".

      Miswak has been recommended by world health organization for oral hygiene because of its
      availability, beneficial effect and affordability. Previous chemical examinations changed our
      idea in Miswak which showed us that miswak sticks contain natural ingredients which benefits
      our oral health. Miswak extracts appear to have different beneficial biological properties
      like anti-bacterial and anti-fungal effects which will play a high role in oral hygiene
      measures.

      Multiple researches suggested that miswak has anti-cariogenic effects. several studies
      concluded that Chewing sticks (miswak) has revealed parallel and at times greater mechanical
      and chemical cleansing of oral tissues as compared to a toothbrush.

      The popularity of Miswak in Arab countries has meant that there have been several studies
      that have confirmed the ability of miswak to provide effective mechanical and chemical
      cleansing when used as an adjunct to other oral hygiene aids. In a previous study found that
      the periodontal health of miswak users was better than the periodontal health of manual
      toothbrush users, also it was concluded that miswak is more effective than tooth brushing for
      reducing plaque and gingivitis when preceded by professional instruction regarding its
      correct application.

      Another research reported the opposite thing, Punit Patel and S. Shruthi studied the clinical
      effects of miswak as an adjunct to tooth brushing on gingivitis clearly and they find that
      the indication of miswak cannot replace the toothbrush, but can be used an adjunct to
      toothbrush, utilizing the mechanical efficacy of toothbrush and chemical effects of miswak.

      However, it was concluded that "The use of S. persica miswak alone or in combination with
      conventional toothbrushes, when performed judiciously, will result in superior oral health
      and hygiene." Fluoridated tooth paste and manual tooth brushes have been the standard of
      clinical preventive dental care for over 50 years. However, the objection to the use of
      fluorides by some parents has meant that these pastes are not universally accepted.

      There is a lot of controversy whether the miswak alone can be used for effective plaque
      removal and good gingival health or should it be only used as an adjunct to tooth brushing.

      In this study we will determine whether the miswak can be used as the chief tool in oral
      health rather than an adjunct to tooth brushing. We will also determine whether toothpaste
      using the miswak extract can be as effective as the normal fluoridated toothpaste.
    

Intervention name(s): Fluoride toothpaste; Toothpaste Product; Toothbrush; Miswak Stick
Intervention type(s): Drug; Drug; Device; Device
Intervention description(s): Fluoridated paste containing 1450ppm NaF; Non Fluoridated toothpaste with extract of miswak ( Dabur, miswak tooth paste); Colgate classic clean Soft bristled toothbrushes, 19.05 x 1.27 x 1.91 cm; A miswak stick of 15 cm length
Intervention MeSH terms: Fluorides
Allocation: Randomized
Intervention model: Crossover Assignment
Masking: None (Open Label)
Primary purpose: Prevention
Keywords: miswak; siwak; S. persica; chew stick