Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Summary Review
  • Published:

Does the use of miswak reduce plaque and gingivitis among adults?

Abstract

Data sources Searches were performed using broad search terms and suitable Boolean operators and Medical Subject Headings terms on the electronic databases PubMed (US National Library archive), EBSCOHost (Dentistry and Oral Sciences) (US Corporate Research Database), Scopus (Elsevier Archive) and the Cochrane Database for Systematic Reviews with no relevant time limit.

Study selection Randomised control trials were included where adults were participants and using miswak sticks to brush was the independent variable. The primary outcome reviewed was the effect on periodontal health, with secondary outcomes including oral health practices. Exclusion criteria were applied to studies including patients with orthodontic appliances.

Data extraction and synthesis Data extraction was led by a single author, with further authors (where necessary) assessing accuracy and appropriateness. Data extracted included first author, publication year, study design and setting, sample size, description of the participant, the intervention and comparison, clinical measurements, assessment interval and wash-out period. An I2 test with confidence intervals was performed, showing the included studies to display heterogeneity in methodology and outcome measures. As such, a random effects model was used for the meta-analysis of effect size. Further subgroup analysis of the included papers was completed and presented in a forest plot format. The Cochrane risk of bias tool was employed.

Results In total, 150 abstracts were screened, with ten RCTs included and nine utilised in a descriptive meta-analysis. The findings claimed that miswak offered similar outcomes to toothbrushing when considering mean plaque score (p = 0.08; SMD: 0.39 and 95% CI: 0.05-0.83) and mean gingivitis score (p = 0.37; SMD: 0.13, and 95% CI: 0.16-0.43). A further significant secondary outcome was noted, showing reduced mean plaque scores (p = 0.01; SMD: 0.68, and 95% CI: 0.14-1.22) and reduced gingivitis score (p = 0.04; SMD: 0.66, and 95% CI: 0.03-1.29) when miswak was used in addition to toothbrushing.

Conclusions Miswak sticks may offer similar plaque reduction to brushing and may reduce plaque-induced gingivitis when used as an adjunct to toothbrushing. However, more evidence is required in this area.

This is a preview of subscription content, access via your institution

Access options

Buy this article

Prices may be subject to local taxes which are calculated during checkout

Similar content being viewed by others

References

  1. Sanz M, Herrera D, Kebschull M et al. Treatment of stage I-III periodontitis - The EFP S3 level clinical practice guideline. J Clin Periodontol 2020; DOI: 10.1111/jcpe.13290.

  2. Almas K, al-Lafi T R. The natural toothbrush. World Health Forum 1995; 16: 206-210.

  3. Karia R, Kelleher M G. Bizarre tooth surface loss and the Miswak stick. Dent Update 2014; 41: 355-364.

  4. Walsh T, Worthington H V, Glenny A-M, Marinho V C, Jeroncic A. Fluoride toothpastes of different concentrations for preventing dental caries. Cochrane Database Syst Rev 2019; DOI: 10.1002/14651858.CD007868.pub3.

Download references

Author information

Authors and Affiliations

Authors

Ethics declarations

The authors declare no conflicts of interest.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Scott, J., Marshman, Z. Does the use of miswak reduce plaque and gingivitis among adults?. Evid Based Dent 23, 152–153 (2022). https://doi.org/10.1038/s41432-022-0833-y

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/s41432-022-0833-y

Search

Quick links