THE MISWAK (SALVADORA PERSICA) AS A MODERN ALTERNATIVE IN ORAL HYGIENE: A NARRATIVE REVIEW

Background: Effective plaque control remains the cornerstone of preventing dental caries and periodontal disease. While the fluoridated nylon-bristle toothbrush and paste is the conventional standard of care, the miswak (Salvadora persica) — a chewing stick with a documented history spanning millennia and continued daily use by hundreds of millions of people — has attracted renewed scientific interest as a natural, low-cost oral hygiene device. 
Objective: This narrative review synthesises the available evidence on the composition, mechanism of action, and clinical efficacy of miswak, and evaluates its standing as a modern alternative or adjunct to conventional oral hygiene. Methods: A non-systematic narrative review of peer-reviewed literature — including systematic reviews, meta-analyses, and randomised controlled trials indexed in PubMed, Scopus, and the Cochrane Library — was undertaken, focusing on chemical composition, antimicrobial and antiplaque activity, and comparative clinical trials of miswak versus toothbrushing and chlorhexidine. 
Results: Miswak contains a broad range of bioactive constituents — including fluoride, silica, tannins, alkaloids (salvadorine), and benzyl isothiocyanate — that confer mechanical cleansing and antimicrobial, astringent, and remineralising properties. Meta-analytic evidence indicates that miswak reduces plaque and gingivitis scores to a degree statistically comparable with manual toothbrushing, and that Salvadora persica mouthrinse significantly reduces plaque and cariogenic bacterial counts relative to placebo, although its antiplaque effect remains modestly inferior to chlorhexidine. Adjunctive use of miswak alongside toothbrushing appears to confer additional benefit. Reported disadvantages include a risk of gingival recession with vigorous or improper use and inconsistency in reporting of technique across trials. 
Conclusion: The evidence supports miswak as a safe, effective, and accessible oral hygiene tool, particularly suited to resource-limited and rural settings, and as a complementary adjunct to conventional oral hygiene practice. Larger, longer-term, well-standardised trials are required to establish optimal technique and frequency of use.