Miswak (Salvadora persica chewing stick): the natural toothbrush revisited

The review encompasses the historical background, chemical composition of miswak (Salvadora persica) and the effects it has on oral health. Miswak is an Arabic word meaning "tooth cleaning stick" and is a natural toothbrush made from the twigs of Salvadora persica (S. persica). Not only is S. persica miswak used in several countries throughout the world, but in some cases, it has proved to be more beneficial as compared to its counterparts-a toothbrush and toothpaste. Additionally, how to prepare the miswak, proper use of it, and the techniques to use will be discussed. An overview of the antimicrobial, anticariogenic, antiplaque, and antigingivitis effects of miswak on oral health will be given in the context of in vitro experiments and clinical trials. Lastly, various oral hygiene studies will be discussed, in order to identify a common denominator between modern-day and the age-old practice of miswak. Recent scientific evidence regarding its probiotic role, cell viability and comparative cytotoxicity and future research trends would be highlighted. Miswak, a cultural and history-based oral hygiene tool is now being evaluated on scientific evidence. Through comparing the naturally-occurring and scientific evolution of S. persica's usage, we will be able to better understand the uniqueness of miswak, relative to that of other oral hygiene tools as being a solo oral hygiene tool of a significant part of the World population. It's hope that the review would help health care professionals to have better knowledge and awareness about miswak, to improve the quality of life of their culturally diverse patients population who are uninitiated for regular oral hygiene measures due to various constraints. The use of miswak can be added to the notion of primary health care approach (PHCA) and oral health promotion.