“If the eyes are a window to the soul, then the mouth is the doorway to the body” – Dental care is considered important traditionally and for several centuries, plants have been used to enhance oral and dental health and this practice still exists in a number of communities all over the world. Miswak, a traditional substitute for the contemporary tooth brush is obtained from the twig of the Salvadora persica. In Arabic miswak means stick for cleaning teeth. It has been used since ancient times by the Arabs to whiten and clean their teeth. The use of miswak as a means of oral hygiene is still common in many parts of Africa, Asia and the Middle East. Although there are several sources of making miswak, Salvadora persica is the most commonly used one. Chewing miswak has been found to be effective in cleaning hard to reach areas of the tooth as well as the accessible areas. The effectiveness of Salvadora persica is mainly attributed to its mechanical cleansing action. Studies also suggest that miswak helps in slowing down the formation of plaque and in destroying oral bacteria. What is encouraging is that the World Health Organization (WHO) had given its recommendations for use of miswak as a cheap and effective tool for oral hygiene. It is known by different names like siwak or arak or kharijal.

Importance of miswak in oral health

Just like the modern tooth brush, miswak has also been found to be a very effective oral health tool. The effectiveness of this twig is due to both its biological and mechanical actions. Miswak is rich in several chemical compounds that functions like toothpaste. The miswak twig has mechanical actions similar to a tooth brush, which makes it a useful tool to reach every corner of your mouth and remove the food remains on your teeth.

Active ingredients in miswak (Salvadora persica)

According to studies, miswak contains about nineteen active ingredients that help in promoting dental hygiene and health. It contains calcium, chloride and fluoride, all of which are important elements used for dental care. Other than these three ingredients, miswak also contains good amounts of vitamin C, resins, tannins, silica, alkaloid, and aromatic oils. Fluoride in miswak sap helps in remineralization of tooth structure. Silica acts as abrasive material and helps remove strain. Tanins offer astringent effect and stimulates premolar saliva production. Resins form protective layer over enamel and thus prevent caries. Alkaloids – salvadorine and trimethylamine are active ingredient which offer antibacterial effects. Essential oils while offering mild taste, act against bacteria, stimulate saliva and have carminative effect.

Health benefits of Miswak or Salvadora persica

Maintaining proper oral health is very important in preventing dental diseases including gingivitis, cavities, periodontal disease and bad breath. Research indicates that miswak helps significantly in improving oral health as well as in preventing many oral diseases.

Antibacterial effects of miswak

Several studies have shown that miswak consists of powerful antibacterial compounds that fight against the different types of bacteria usually found inside your mouth. It has been found that there are over 500 different types of microbes in your mouth, some of which are potentially harmful and can cause oral infections. The active ingredients in miswak not only help in preventing the growth and reproduction of bacteria but also in destroying them without causing any side effects. Miswak contains gallic acid, sulphur, salvadorine and trimethylamine that has antibacterial and anti-microbial properties and hence helps in inhibiting the growth of bacteria. The antimicrobial properties of miswak can also be utilized in cleaning your tongue along with your teeth.

Miswak prevents the formation of plaque

Oral problems like periodontal diseases and dental caries are often caused by the accumulation of dental plaque in your teeth. According to studies, the extracts derived from miswak have the potential to inhibit the growth of various bacteria that is responsible for the formation of plaque. Various aerobic and anaerobic bacteria including S. mutans and L acidophilus causes dental caries. A clinical study suggested that meswak has antimicrobial effect on such cariogenic bacteria and is effective anti dental carries herb. A survey in South India found lower prevalence of dental caries in people using miswak. Another study found that miswak extract raised the plaque pH, thereby showing potential in prevention of dental caries.

Salvadora persica increases calcium and chloride in saliva

Studies reveal that the use of miswak in cleaning teeth stimulated the production of chloride and calcium in the saliva. At the same time, it helped in the reducing the amount of phosphorus as well as the pH value in the saliva. While increase in the amount of calcium in the saliva helps in preventing the demineralization and promoting the remineralization of enamel, high amounts of chloride is helpful in slowing down the formation of calculus. As a result your teeth become stronger, healthier and are at reduced risk of decay and damage.

Salvadora persica reduces gingivitis

According to several reports, Salvadora persica is very effective in reducing dental plaque and thus gingivitis.  Dental plaque is prime cause of gingivitis and periodontal disease. Studies suggest that Miswak has an overall effect on dental plaque and gingival inflammation scores. Toothpastes that contain miswak have been found to be much more effective in getting rid of dental plaque. Rinsing the mouth with slurry of toothpaste that contains miswak has been found to ease gingival inflammation and prevent bleeding while examining. Furthermore, the joint effect of mechanical cleansing action and the increased secretion of saliva, while using Salvadora persica were found to be more effective than the modern toothbrushes in eliminating dental plaque. In another study, results showed significant improvement in plaque score and gingival health while using meswak along with tooth brushing.

Miswak shows antifungal activity

Candida is responsible for multiple infections of mouth cavity. Miswak extract have been found effective in controlling such fungal infection. Studies show that miswak has antifungal properties and hence can be used to inhibit the growth of fungi such as Candida albicans.

Miswak whitens teeth

The silica in miswak functions as an abrasive substance and is helpful in removing stains from your teeth, thus improving their whiteness.

Miswak remove bad breath

Miswalk helps in removing bad breath and odor from the mouth and provides fresher breath.

Analgesic effect of miswak

Miswak decoction has been found to possess analgesic properties and hence is effective in releiving dental pain. Studies confirm analgesic properties of miswak.

Anticancer properties of Miswak

Various active ingredients in miswak are believed to have antioxidant properties which are helpful in preventing plethora of diseases including cancer. Benzyl isothiocynate is present in miswak which is chemotherapeutic agent and have anticancer properties.

Miswak reduces cholesterol

Animal studies suggest that stem decoction of Salvadora persica reduced cholesterol and LDL plasma levels in rat. This shows potential of the herb in reducing cholesterol. Further research is expected in this area to establish such claims.

Miswak reduces gastric ulcers

Animal studies show that Salvadora persica have protective effect over alcohol and stress induced gastric ulcers. This traditional chewing stick thus offers benefits beyond teeth.

Salvadora as anticonvulsant

Salvadora persica have been investigated for anticonvulsant potential. Stem extract helped in protecting drug induced convulsions in rats. Studies further show sedative and relaxing effect of miswak.

Medicinal uses of other parts of Salvadora persica

Leaves – Leaves are eaten as vegetables in eastern Africa. Though bitter, its astringent properties are believed to be helpful for liver and digestive system. It offers diuretic and analgesic properties and traditionally used in treatment of ozoena, nose disorders, piles, scabies, scurvy, leukoderma, skin inflammation and rheumatism. Decoction of leaves is used in relieving asthma and cough.

Fruits – Sweet fruits of salvadora are edible. It offers carminative and diuretic properties and used in treatment of liver and stomach problems.

Root bark – Root bark is used as a vesicant. Home made plaster made from paste of root bark is used on gonorrhea and vesical catarrh.

Stem bark – A decoction of the bark is used as a tonic and regularizing menstruation in women. It is also used in treatment of epilepsy, stomach ulcer, spleen problems and skin disorders. Latex from bark finds use in curing sores and some skin problems.

Seeds – Seeds of miswak are used as purgative, diuretic and tonic. Oil is used in treating skin inflammation and rheumatic joint pain. It is also used in treatment of digestive tract disorders. Salvadora persica oil is used in making candles and soap.

Essential oil of miswak obtained from leaves and stem have ability to repel insects. Significant tick repellent properties of miswak have been tested in lab.

Other uses of Salvadora persica

Chewing on miswak is considered to be effective in getting rid of bad habits like smoking. Some researchers claim that miswak is helpful in reducing fatigue, sharpening the brain, increasing appetite, and diluting mucus. The young shoots and leaves of Salvadora persica make good fodder for cattle, camels, and sheep as they have high water content. The leaves are also good for increasing lactation in cows.

Modern use of Miswak

Because of its benefits for teeth and oral hygiene, miswak finds its use in dental and oral care products. Some commercial known tooth paste with miswak extract are available in market – Sarkan toothpaste (UK), Quali-miswak toothpaste (Switzerland), Epident toothpaste (Egypt), Siwak-F toothpaste (Indonesia), Fluroswak miswak (Pakistan), Dentacare Miswak plus (Saudi Arabia). Dabur Miswak (India).  Though it has ability to reduce plaque, its action is still not significant compared to cholrohexidene. Use in miswak in mouthwash and endodontic irrigation solution is still only on paper and no commercial product is yet available.

Potential adverse effect of Miswak

This traditional herb has been used for ages. Latest animal studies have pointed out some adverse effect on reproductive system of rats. However this is one isolated study conducted in 2003 and more studies need to be conducted establishing such claims. Till such time one may rely on traditional wisdom.

How to use miswak

First trim or chew off the bark (about 1 centimeter) at one end of the twig. Then start chewing the center of the stick till it turns soft and forms bristles. Softening can be made faster by dipping the stick in water. Water softens its natural fibers and helps them separate. Once the bristles are formed, brush your teeth as usual but without using toothpaste. When brushy end is shred, it can simply be cut and further chewed to form fresh edge.

Where to find miswak sticks? If you are not in Asia region, you probably would like to order it online. Find some sellers of miswak sticks on amazon – Sewak Al-Falah: Miswak (Traditional Natural Toothbrush) (10 Pack)

Miswak is a natural oral cleaning tool and is considered to be one of the best methods in implementing good oral health. Apart from being healthy for your teeth, it offers improvement in your overall health as well. The very fact that miswak is simple to use, easily available and low in cost, have made it popular in modern.

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