Over 1,000 years ago, during a time when oral hygiene was not a significant concern for many civilisations, the final prophet of Islam, Muhammad (may peace and blessings be upon him), left behind a great emphasis on maintaining oral health.
In many reports, he highlighted the huge religious reward behind using the miswak stick to clean the teeth daily before the five prayers. In fact, one of the last actions of the blessed prophet before his death was using the miswak. Remarkably so, in the 21st century, even the World Health Organization has approved the use of the miswak as an effective oral hygiene tool.
The month of Ramadan is when many Muslims will pick up the miswak again since there is no debate about it interfering with the fast, so this is the perfect time to shed light on the efficacy of the miswak as an effective oral hygiene adjunct.
The miswak, or siwak, is a pencil sized traditional brushing stick commonly from the Arak tree. It has a unique chemical composition and hence offers both mechanical and chemical plaque control. Many clinical studies have been completed, which have successfully proven the efficacy of the miswak as an oral hygiene adjunct.
Strengthens enamel tissue and whitens teeth
Ajmal and colleagues (1981) concluded that this benefit was derived partly from the chemical composition of the miswak: silica in miswak mechanically acts to remove plaque and surface stains which whitens the teeth.
Tannins exert an astringent effect on the mucous membrane and form a layer over the enamel, thus strengthening this protective barrier. Additionally, essential oils possess characteristic aroma to fight bad breath.
Stimulates salivary flow to prevent xerostomia and freshen breath
Studies have also found that the strong aroma of the essential oils in miswak, as well as the chewing action required to use the miswak, stimulates the flow of saliva which acts as a buffering agent, ultimately preventing xerostomia (dry mouth) which is a major contributor towards bad breath.
Enhances periodontal health
A study by Darout and colleagues (2000) assessed the periodontal status of Sudanese adults who used the miswak. Community periodontal index (CPI) was used to measure gingival bleeding, supra-gingival calculus, probing depth and loss of attachment.
It was suggested that the periodontal status of the Sudanese adults using the miswak was better than those using the toothbrush alone, proving the undeniable benefit the miswak has on preventing periodontal disease.
Anti-microbial and anti-cariogenic properties
A study by Jagtap and Karkera (2000) focused on the anti-microbial activity of the miswak. They found that it was targeting many gram-positive cariogenic bacteria such as streptococcus mutans and gram-negative periodontopathic bacteria such as porphyromonas gingivalis. They also found that miswak had anti-fungal activity against candida albicans, proving the miswak to be anti-fungal and anti-bacterial.
Dangers of incorrect technique
Above are a few points from studies to prove the efficacy of the miswak as an oral hygiene adjunct. However, it’s very important to note that most clinical studies focused on the miswak as an adjunct for oral hygiene, alongside routine toothbrushing with fluoridated toothpaste (which is still the best clinically proven method for an oral hygiene regimen).
Any oral hygiene aid that is inappropriately used will cause detrimental effects, which is not ascribable to the aid itself. Miswaks have been associated with high levels of gingival recession and abrasion due to incorrect techniques/extreme pressures used by patients. A light pressure must be combined with a downward sweeping motion towards the end of the tooth – the opposite motion will cause receding gums.
Dental clinicians will find many of their patients utilising a miswak, and thus it is crucial for them to be aware and educate their patients on the correct techniques for its proper usage so that they can reap all benefits stated above.
The potential of the miswak for affordable preventative dentistry is undeniable, and yet again the wisdom of this beautiful prophetic tradition has been evidenced.
To everybody who will be observing this month, Ramadan Mubarak.
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